SAD in Teens: Understanding Seasonal Affective Disorder

People sometimes joke about the “winter doldrums” that accompany the let-down after the holiday season and the arrival of cold, dark winter days, but Seasonal Affective Disorder – SAD – is a real mental health diagnosis that affects about 5% of adults in the United States. SAD is a type of depression that typically begins in late fall or early winter and lasts for approximately 4-5 months. Some individuals with this disorder experience a spike in depressive symptoms during the spring and summer months, but summer-pattern SAD is much less common than winter-pattern SAD.

SAD is not the same as other forms of depression and it can be distinguished from the “holiday blues” that are triggered by stressors including unrealistic expectations, interpersonal conflict, family dynamics, the experience of loss and loneliness, financial worries, and sensory overload. Above all, SAD is characterized by a mood shift that is brought on by the change of seasons, most notably by the reduction of light, and by its tendency to resolve as the seasons change and days become longer. Just because SAD can resolve on its own as the seasons change, however, does not mean that there are not effective treatments to help individuals maintain a more balanced mood and avoid severe symptoms that interfere with healthy functioning.

The Signs of SAD and What We Know About What Causes It

SAD is a type of major depression and as described by NIMH (National Institute of Mental Health) the typical signs of depression include the following:

  • Persistent sad, anxious, or “empty” mood most of the day, nearly every day, for at least 2 weeks
  • Feelings of hopelessness or pessimism
  • Feelings of irritability, frustration, or restlessness
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities (and a tendency with winter-pattern SAD to “hibernate” and withdraw socially)
  • Decreased energy, fatigue, or feeling slowed down
  • Difficulty concentrating, remembering, or making decisions
  • Changes in sleep or appetite or unplanned weight changes (for winter-pattern SAD this often involves excessive sleeping and overeating, with a particular craving for carbohydrates)
  • Physical aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause and do not go away with treatment
  • Thoughts of death or suicide and/or suicide attempts

NIMH has also noted that for summer-pattern SAD symptoms can include trouble sleeping, poor appetite and possible weight loss, restlessness and agitation, heightened anxiety, and violent or aggressive behavior.

It is well known in the scientific community that reduced levels of the neurotransmitter serotonin are associated with depression and many antidepressant medications work by directly impacting the availability of serotonin in the brain. Research indicates that individuals with SAD have reduced amounts of serotonin and that both sunlight and vitamin D levels may be associated with the amount of serotonin in the brain. Other studies have found that altered levels of melatonin – a hormone that helps regulate circadian rhythms and sleep-wake cycles – may contribute to SAD, with too much being produced in winter (leading to sleepiness and oversleeping) and too little in the summer (contributing to insomnia and other sleep disruptions). More research is needed to determine the exact relationship among these various factors, but since the amount of light as well as hormone and vitamin levels are known to impact sleep-wake cycles it seems reasonable to hypothesize that disrupted bodily rhythms are associated with the development of SAD.

While SAD affects people of all ages the prevalence does vary based on geography, age, and sex. SAD is more common in people living at higher latitudes, that is, people living far from the equator where there are fewer daylight hours in the winter. SAD may begin at any age, but it typically starts when a person is between ages 18 and 30 and research has shown that younger people and women tend to be at higher risk.

Several risk factors are associated with the development of SAD, including:

  • Family history. Individuals who have blood relatives with SAD or with other diagnosed or undiagnosed forms of depression are more vulnerable.
  • The presence of a major depression or bipolar disorder diagnosis. Symptoms of depression may worsen seasonally in individuals with a diagnosed mood disorder.
  • As mentioned above, living far north or south of the equator increases vulnerability as there is significantly less sunlight during the winter months and exceptionally long days during the summer.
  • Low levels of vitamin D. Some vitamin D is produced in the skin when exposed to sunlight and Vitamin D has been shown to boost serotonin activity. Less exposure to sunlight combined with a diet that is low in vitamin D may result in low levels of vitamin D in the body and an increased risk of SAD.

SAD in Teens

While SAD affects people of all ages, teens and young adults may be particularly vulnerable to its negative effects given the specific tasks that must be accomplished during that developmental period. Adolescence is a time to focus on the academic knowledge and skills that lay the groundwork for the additional education and training needed for one’s future occupation. It is a time when critical interpersonal skills are honed, including the ability to communicate, manage conflict, cultivate empathy, and set appropriate boundaries. And it is a critical period for the development of the “self”, a time to more clearly articulate the “me” and “not me” aspects of one’s identity.

SAD and other forms of depression can negatively impact all three of these developmental areas. Depressive symptoms affect energy, motivation, memory, and focus – all necessary for academic achievement. They can lead to “hibernating” and other forms of social withdrawal that affect both the quality of friendships and participation in activities that develop teamwork and the ability to navigate relationships with different types of people. And, perhaps most damaging of all, depression impacts one’s sense of self. Self-defeating beliefs about being worthless, powerless, unattractive, boring, unlovable, etc. – if not tempered with self-accepting and self-affirming beliefs – can set up a life-long vicious cycle of depressive thinking habits. A further complication is that persistent feelings of depression and anxiety can trigger the inappropriate use of alcohol and drugs, a behavior that can create a host of other negative outcomes.

Available Treatments for SAD

As a depressive disorder, SAD can be treated with a combination of the evidence-based interventions available to treat other forms of depression and mood disorders. These include medications to impact serotonin levels in the brain (most typically SSRIs – serotonin reuptake inhibitors – such as Prozac or Zoloft) or to stabilize mood (e.g., Lithium, Lamictal, Abilify, Latuda, etc.).

Cognitive Behavior Therapy (CBT) continues to be the go-to psychotherapy approach, along with Dialectical Behavior Therapy (DBT) that blends CBT techniques with mindfulness and validation and includes a specific emphasis on self-regulation. The technique known as behavioral activation is especially noteworthy as it involves the deliberate and planful inclusion of mood-enhancing behaviors into one’s daily schedule, including physical activity. The sharpening of interpersonal skills is also an important intervention for those suffering from depression as a lack of assertion and problems with effective communication can contribute to depression.

One common treatment for SAD not typically used with other forms of depression is light therapy. It involves a certain amount of sun exposure per day and/or the use of specifically manufactured light boxes for about 30’ per day. Light boxes deliver a therapeutic dose of bright light that mimics outdoor light. SAD sufferers, and especially those who have a co-occurring bipolar disorder, should consult with treating providers to determine the type of lamp and appropriate “dosage” of light therapy to maximize its therapeutic effect and to minimize adverse effects such as a possible increase of manic symptoms in bipolar patients.

Supporting Teens with SAD

There a number of strategies that parents and educators should be mindful of in their efforts to support young people who are struggling with SAD symptoms:

  • As with other mental health disorders, it is important to provide young people with age-appropriate information about SAD, its causes, signs, and treatment.
  • It is not just younger children who need structure and routines – teens and young adults may need help in defining and sticking to routines that will help maximize their physical and mental health. Consistent sleep schedules, meals, self-care, homework, social, and activity times can help stabilize their internal clocks and circadian rhythms.
  • Encourage outdoor activities to maximize sunlight exposure and to increase endorphin-boosting physical activity.
  • Encourage healthy eating habits and consistent meal/snack times to prevent plunges in sugar and energy levels.
  • Facilitate social activities. Inquire about friendships and school activities and look for ways to facilitate socialization (e.g., provide transportation) so young people can visit each other and share recreational activities such as going to parties, seeing movies, etc.

Resources

Seasonal Affective Disorder – National Institute of Mental Health (NIMH)

Psychiatry.org – Seasonal Affective Disorder (SAD)

Seasonal affective disorder (SAD) – Symptoms & causes – Mayo Clinic

Seasonal Affective Disorder in Teens and Young Adults: Signs and Support

What Is Seasonal Affective Disorder? – Child Mind Institute

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