By: Didi Dunin, CEI Intern
More than just the winter blues and the stress of report cards and exams, seasonal affective disorder (SAD) is a subtype of clinical depression that occurs during the winter months. Fortunately, there are ways to treat SAD and we should consider treatment options as early as possible so that youth can stay on the path towards a healthy positive life. The Center for Educational Improvement, with our colleagues at the New England Mental Health Technology Transfer Center, created a toolkit to help educators prevent, recognize, and treat SAD in their school buildings. We’ll share some tips from that toolkit below.
Symptoms and Diagnosis
While many youth and adults tend to feel a little bluer during the cold, dark winter months, to be diagnosed with SAD, individuals must meet full criteria for major depression coinciding with specific seasons (typically appearing in the winter months) for at least 2 years (NIMH, 2016). SAD is more serious than mere “winter blues” and educators should take this mental health issue seriously since severe cases can lead to suicide ideation, and in some cases, suicide completion.
Youth with SAD may experience some or all of the following symptoms (NIMH, 2016):
Increased cravings for sugary foods and carbohydrates
Weight gain
Fatigue
Hypersomnia (sleeping excessively, especially during the day)
Difficulty concentrating
Irritability and anxiety
Increased sensitivity to rejection
Avoidance of social situations
Loss of interest in previously enjoyable activities
Feelings of guilt or hopelessness
Causes
To date, there is no consensus on the underlying cause of SAD. However, there is indirect evidence that supports the idea that reduced sunlight exposure is a major factor. For example, there is higher prevalence of SAD in the northern states like Alaska (9%) where daylight hours are shorter, compared to southern states such as sunny Florida (1%) (Horowitz, 2008).
This lack of sun exposure during the winter months can lead to disruptions in wake-sleep cycles, which can be a reason for fatigue. Specifically, darker lighting triggers the brain to make more melatonin, a hormone that makes people feel sleepy. Decreased sun exposure has also been associated with a drop in serotonin, which is a neurotransmitter associated with boosting mood and helping people feel calm and focused. Since the sun is out for less time and the cold temperatures motivate people to stay inside, there is also a reduction in Vitamin D, an important vitamin that helps regulate the immune and neuromuscular system.
These chemical imbalances exaggerate the stress response to everyday stressors, compounding the negative effects. For example, darker mornings not only make it harder for children to wake up, but can cause conflict with parents who are trying to get them to school on time having had less sleep themselves. With lower levels of “feel good” chemicals, parents’ reactions to children’s behavior can be less calm and effective than it might be if they had the serotonin, melatonin, and Vitamin D levels they’re used to the rest of the year.
Treatment Options
Light Therapy As you might have guessed, if lack of sunlight causes or contributes to SAD, then getting more light might be the solution. Indeed, bright light at the right duration and time of day has been shown to reverse seasonal symptoms (Virk, Reeves, Rosenthal, Sher, & Postolache, 2009). While getting outside to enjoy natural sunlight is the best method for beating the SAD blues, it’s not always possible for students or teachers to spend 30 minutes outdoors during the coldest months. An alternative, light therapy entails sitting close to a special “light box”, which shines brighter than the average indoor light, for 30 minutes each day.
It is important to keep in mind that light therapy does not always work and is not always appropriate for everyone. Some children might need more or brighter light; and it might even be harmful to some children. For example, light boxes can trigger hypomania or mania in those with bipolar disorder (Miller, 2015). Thus, patients should always check with a doctor before trying light therapy.
Cognitive-Behavioral Therapy (CBT) Although light therapy has traditionally been used in treating SAD, CBT may be even more effective, especially in preventing relapse (Rohan, Lindsey, Roecklein, & Lacy, 2004).
With CBT, children can learn life-long skills for coping with stress and negative thought patterns. Specifically, cognitive reframing is a skill that can help students focus on the brighter side of the winter months. Seeing the snow as an opportunity to make a snow man or go sledding, instead of seeing the snow as cold slush that makes getting to school more difficult, is just one example of how students can reframe their situation. Through this process, children become more in tune with their thoughts and feelings and realize they can change them.
Medication If light therapy or CBT does not sufficiently ameliorate symptoms, prescription antidepressants might be another option. However, antidepressants must be used with caution and be monitored closely to make sure there are no serious side effects.
That said, the benefits of antidepressants, especially when combined with psychotherapy, tend to outweigh the risks when monitored by a physician (Holmes, 2019). An antidepressant may be needed to help children with SAD live the best, and most fulfilling lives that they can. However, we caution against the use of antidepressants for younger children and urge mental health professionals to try alternative remedies before turning to medication.
Prevention and Alternatives
Considering the importance of early detection, teaching students mind-body awareness can help youth realize their symptoms before they become debilitating, which can encourage them to find appropriate treatment as soon as possible. Accordingly, have mental health supports available, especially cognitive behavior therapy (CBT).
What else can parents and educators do to help combat SAD?
Keep blinds open to let in sunlight.
Have recess outside; focus on playing winter games.
Stabilize or reduce workload over winter months.
Have self-care and stress-relieving supports available (e.g. free massage day, support dogs, dance breaks, etc.).
Provide and/or encourage healthy carbohydrates.
Use of aroma therapy, music, or videos to elevate mood.
While there will always be a summer light at the end of the tunnel, there is also a light box to shine along the way.
References
Holmes, L. (2019, September 14). Benefits of Children Taking Antidepressants Can Outweigh the Risks.
Horowitz, S. (2008). Shedding Light on Seasonal Affective Disorder. Alternative and Complementary Therapies,14(6), 282–287.
Miller, M. C. (2015, October 30). Seasonal affective disorder: bring on the light.
Rohan, K. J., Lindsey, K. T., Roecklein, K. A., & Lacy, T. J. (2004). Cognitive-behavioral therapy, light therapy, and their combination in treating seasonal affective disorder. Journal of Affective Disorders, 80(2-3), 273–283.
The National Institute of Mental Health (2016, March). Seasonal Affective Disorder.
Virk, G., Reeves, G., Rosenthal, N. E., Sher, L., & Postolache, T. T. (2009). Short exposure to light treatment improves depression scores in patients with seasonal affective disorder: A brief report. International Journal on Disa