Winter Brings an Increase in Seasonal Affective Disorder

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The days are short in winter, and weather patterns often come with cloud covers that can reduce sunlight for long periods. In these conditions, seasonal affective disorder (SAD) becomes a problem for many adults, adolescents, and children.

First described as a medical condition in the 1980s, most people are probably familiar with SAD and its characteristics. What may be less well known is that SAD is not a stand-alone diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association; rather, it is a specifier for recurrent major depressive disorder.

The requirements for major depressive disorder must first be met, and then the specifier, with seasonal pattern, must be added. Major depressive disorder requires that someone exhibit at least five of a list of nine symptoms that must have been present during the same two-week period and be a change from the previous status. At least one of the five symptoms must be either depressed mood or loss of interest or pleasure in daily life experiences.

For children and adolescents, the DSM states that irritable mood may also satisfy the depressed mood criterion.

Other symptoms are:

1. Weight changes, including loss or gain and decreased or increased appetite. In children and adolescents, it can manifest as failure to make expected weight gain appropriate for age and stage of development;
2. Insomnia or hypersomnia nearly every day;
3. Psychomotor agitation or slowing nearly every day;
4. Fatigue or loss of energy nearly every day;
5. Feelings of worthlessness or excessive, inappropriate guilt nearly every day;
6. Diminished ability to think, concentrate, or indecisiveness nearly every day;
7. Recurrent thoughts of death, recurrent thoughts of suicide, or a suicide plan or attempt.

Again, a majority, but not all, of these symptoms must be present to warrant a formal diagnosis. Further, the symptoms must cause the individual significant distress or impairment in social, occupational, or other important areas of daily functioning. The clinician must determine that the symptoms are not due to normal responses to significant losses such as bereavement, serious medical problems, or other life circumstances.

For children and adolescents, such events could be distress about a relationship breakup, worries about school grades or distressing experiences at school, worries about problems at home, and many others.

Only after these criteria are met can the specifier with seasonal pattern be added, and the further criteria are:

1. There must be a clear incidence during a particular time of year (usually fall or winter);
2. The depression must diminish or resolve at a different time of year (typically spring);
3. The episodes must have taken place over the past two years, with no nonseasonal depressive episodes during that period;
4. Over the person’s lifetime, seasonal episodes must substantially outnumber nonseasonal episodes.

While these extensive criteria must be met for a clinical diagnosis, many individuals may sometimes show some of the symptoms at a subclinical level. For children and adolescents, determining the presence of symptoms at either the clinical or subclinical level may be difficult since they sometimes do not express their feelings verbally or behaviorally.

However, most parents are likely attuned to their children’s moods and may recognize some symptoms of SAD. In my opinion, if a parent observes as many as two or three symptoms that persist for two or more weeks, taking some action should be considered.

Some Steps to Take When SAD Is Suspected

1. Make sure that exposure to sunlight is maximized. Winter has many cloudy days, but when days are sunny, outside activities should be provided and encouraged.
2. When indoors, encourage spending as much time as possible near windows. Even on cloudy days, enough ambient light is available to be of benefit.
3. In addition to natural sunlight, many devices may help, including light therapy lamps, boxes, and eyeglasses.
4. Ensure that good sleep hygiene is practiced, including bedtime routines, cessation of electronic device use before bedtimes, ensuring the sleeping area has temperature and humidity conducive to good sleep, and maintaining a consistent bedtime and waketime throughout the week.
5. Provide opportunities and encouragement for exercise. Winter weather and shorter days often interfere with opportunities, so extra effort to find activities may be required.
6. Ensure healthy nutrition. While doing so is important year-round, it is especially important when SAD is suspected.
7. If symptoms persist for more than two or three weeks, consider visiting a healthcare professional.