SAD Children and Teens

by on December 12, 2013

in Monthly

Are your kids SAD? Seasonal Affective Disorder difficult to treat in children


Seasonal Affective Disorder can also strike children when our daylight hours shrink — but what works for adults to treat the depressive ailment, may not work for kids.

In the early 1980s Dr. Norman Rosenthal, formerly from sunny South Africa, became a pioneer in the field of chronobiology. Rosenthal, then affiliated with the National Institutes of Health, noticed that during the winter months he became depressed and sluggish. At that time the term Seasonal Affective Disorder (SAD) was not familiar to many.

Rosenthal’s book, Winter Blues, published in 1993, remains a popular resource for those who suffer from SAD.

The recently updated DSM V manual refers to SAD as a mood disorder marked by seasonal depression — predominantly during winter months. (It may also be seen in some individuals during spring and summer)

The incidence in children and adolescents is not well-defined. In adults we know that SAD occurs in close to two per cent of people in Florida. It is up to seven times more common among people living further north.
SAD is common in Nordic countries but surprisingly uncommon in Iceland.

Most articles on SAD talk about abnormalities in serotonin levels and melatonin disturbances as major factors. Yet there is no consensus on the exact causes.

In Iceland it is thought that genetic adaptation to longer nights and shorter days may be a factor and that a higher intake of fish, providing omega 3’s and vitamin D, may alleviate tendencies toward having SAD.

In a Lancet publication, Timo Partonen, affiliated with the University of Helsinki, speculates that a genetic defect in how serotonin is transported may account for a higher prevalence of SAD in some individuals.

Typically, patients who suffer from SAD experience cyclical patterns where for at least two years in a row, every winter, and their “batteries run low.” How low varies from patient to patient, but in children where the knowledge on SAD remains astonishingly thin, these symptoms may surface: lack of motivation; poor concentration; irritability; anxiety; a drop in grades; poor self-esteem; excess sleep; cravings for comfort foods, especially those high in simple carbohydrates; an inability to enjoy life and extreme mood swings.

It may bother a parent when a formerly fine-functioning teen develops the above symptoms as the days shrink, the sun rises long after 8 a.m.; only to be gone again before the teen arrives home from school.

Teachers may call a home to point out their own concerns. The lines between true depression and SAD can become blurred — especially when SAD in children and adolescents is not well described or recognized.

There are three main ways to deal with SAD: light therapy, exercise and possibly an antidepressant as a last resort.

According to the Canadian Mental Health Association, all three of these modalities may work in adults, but once again, there is little research on the effects of bright lights in children.

Light therapy involves sitting by a bright light in the mornings for at least one hour. The best times may be between 6 a.m. and 9 a.m. Few kids will be prepared to get up that early and school starts before 9 a.m. In addition, the majority of patients exposed to light therapy find it cumbersome after a few months. Side-effects may include eye strain and headaches.

There seems to be consensus that tanning beds should not be used as a form of light therapy.

Physical activity outside, especially at noon when the atmosphere may be the brightest, may be helpful. In a popular book titled Spark, Harvard Psychiatrist Dr. John Ratey elaborates on why exercise works so well.

Antidepressants (SSRIs) can be used as a last resort, but they take some time to have an effect and the off-label use of these medications in children continues to fuel endless debates.

Because of the latter, and with families trending toward more natural and holistic lifestyles, yoga and massage therapy are attractive alternatives. Few studies exist to tell us if alternative therapies consistently provide relief.

When alternative medications are used — such as St. Johns wort — inform a doctor of the use of all alternative medications, because some products do interact with prescribed pharmaceutical products.

It is important to stick to a set sleep routine for patients prone to SAD. Be very firm and consistent in this regard — especially with teens who seem to think they know more than their parents.

The role of Vitamin D supplements and omega 3’s remain uncertain, but studies out of Israel showed that for mild depression, increased DHA intakes had a positive impact. Two servings of fish per week is a very natural way to consume DHA.

The good news is that SAD symptoms disappear when families take winter breaks, going south. The bad news is that the mood disturbances resurface upon the return to the frigid, dark north.

In the end it appears that simple daily outdoor activity may be the most logical and natural way of dealing with SAD. Not only will it be a mood-lifter, but the comfort food cravings and subsequent weight gain may be better managed by increasing blood flow to the brain.
© Copyright (c) The Calgary Herald

Comments on this entry are closed.

Previous post:

Next post: