Leah is not alone in making the connection between her daughter’s depression and the changing seasons. Seasonal affective disorder is a subtype of major depressive disorder that displays a seasonal pattern. For most individuals living with SAD, this means that their major depressive symptoms arrive in late fall and tend to taper off in the spring when the weather begins to warm up and daylight starts to last longer.
While it is well recognized in adults, many parents and practitioners struggle to identify SAD’s distinct characteristics in children and adolescents. Correctly diagnosing seasonal affective disorder can take years, as recognizing a seasonal pattern in symptoms naturally requires time, so children, who are often newly experiencing symptoms, may not receive a complete diagnosis.
In older children and adolescents, signs of depression — seasonal or otherwise — can include losing interest in things they liked before, a change in appetite or weight, changes in sleep patterns, low energy, feelings of hopelessness or worthlessness, and difficulty concentrating. With younger kids, who are less able to communicate their feelings verbally, symptoms of depression are often characterized by behavioral changes.
“Behavior is a communication tool for kids,” says Kamilah Jackson, a physician and a medical director at AmeriHealth Caritas, a national managed care organization for underserved populations. “Depression in younger kids often appears as irritability or snappiness rather than sadness, although some kids may seem sad or express loneliness.”
While an official diagnosis of seasonal affective disorder can take years to obtain, parents and practitioners can be on the lookout for specific symptoms that point to the fact that a child’s depression may be seasonal. In addition to noticing that symptoms arrive in late fall, Mylien Duong, a clinical child psychologist and social-emotional learning researcher at Committee for Children, says that there are some specific characteristics that parents can look out for that indicate the issue could be seasonal. While depression often causes changes in sleep and appetite, SAD is characterized specifically by an increase in sleep and an increase in appetite.
“Cravings for comfort food, carbs, weight gain and a loss of energy can all be specific symptoms of SAD,” Duong says.
Experts also say that the social climate of 2020 might make it particularly challenging to accurately diagnose seasonal affective disorder or even major depression in children and adolescents. Because widespread school shutdowns are causing strife for a lot of children, it’s likely that some who are struggling with underlying depression may have their symptoms misdiagnosed as issues with virtual learning, isolation or loneliness related to the pandemic.
If parents are noticing a behavioral shift in their children, or their kids are telling them that something is wrong, it’s important to listen.
“Older kids and adolescents can often communicate their feelings verbally,” says Jackson, though parents may have to be intentional about raising the subject of mental health. Jackson suggests parents share a neutral observation, such as, “I’ve noticed you spending time in your room more often and that you’re having trouble sleeping.” Then ask the child what that might mean: “I’m wondering if you’re feeling sadder than usual?” It can also be helpful for parents to take notes or keep a journal of their observations. Jotting down simple information about when symptoms occur can help parents provide accurate information to a mental health care provider and, hopefully, get an accurate diagnosis — and effective treatment — sooner.
While a child who is diagnosed with major depression is likely to be referred for treatment that will improve their symptoms, if the seasonal aspect of their depression is not recognized, they may miss out on therapies that could provide particular benefit. Talk therapy is typically considered the first line of treatment for kids with depression, and many families decide to explore medication next. In addition to these options, seasonal affective disorder tends to respond well to other targeted treatments, such as daylight exposure, artificial light therapy and vitamin supplements.
“A lot of the science points to the impact that shorter daylight hours can have on hormones, which can lead to increases in melatonin and decreases in serotonin,” Duong says. This shift in the hormones that regulate sleep and mood can increase depressive symptoms. Another option is artificial light therapy, an at-home practice in which individuals spend time sitting near a special light box that gives off sunlight-mimicking bright light. And vitamin D supplements can also provide some relief. While these options can be very effective and are often affordable and accessible, experts recommend that parents consult with their child’s pediatrician or mental health team before exploring a new therapy.
As we head into a pandemic winter that will likely include ongoing school closures and social isolation along with increasing cases of the coronavirus, parents need to keep tabs on their children’s mental state.
And remember: just because a child is feeling down or is voicing frustration about missing their normal winter activities does not mean they are experiencing major depression. “Winter blues are common and generally represent subclinical symptoms of depression,” Duong says.
If your child is experiencing symptoms that get in the way of their relationships, or are making it difficult for them to complete the things they need to do each day, experts recommend reaching out to your pediatrician for additional guidance, while also reflecting on whether, and when, these symptoms have occurred in the past. Because wait lists for appointments with mental health practitioners can be long, Duong also recommends making the call sooner rather than later: “Call before you think you need it. You can always cancel if things get better naturally.”
Whether a child is currently experiencing diagnosable mental health challenges or not, there are some important steps parents can take to boost the whole family’s mental health. “Getting into and staying in a regular routine, spending time outdoors, exercising, eating a well balanced diet and helping kids maintain connections with family, friends and things they find pleasurable can all be helpful in preventing or lessening the symptoms of depression,” Duong says.
With many parents also facing stress because of the coronavirus, it’s important for them to self-reflect and be intentional about their own mental health as well. “We know that when parents are doing better, their children do better,” says Jackson. “You truly can’t pour from an empty cup.”
Leah, in Charlotte, has taken several steps to help her daughter since becoming aware that her depressive symptoms are seasonal, including purchasing a light box for her desk and making sure to open curtains and let sunlight in. They’re also focusing on helping her stay active and connected with others. They have her take walks or participate in exercise programs daily, and they’ve worked to connect her with peers through church and support groups.
“She’s told me she is happy with the changes we’ve made,” says Leah. “She’s still a teen who likes being in her room, but she’s coming out more now and seems to be applying herself more in school and having more fun with our family.”
Julia Pelly is a freelance writer in Charlotte.