A form of depression that follows a seasonal pattern, SEASONAL AFFECTIVE DISORDER (SAD) appears and disappears at the same times each year. Aspergers children with SEASONAL AFFECTIVE DISORDER usually have symptoms of depression as winter approaches and daylight hours become shorter. When spring returns and the days become longer again, they experience relief from the symptoms and a return to a fairly normal mood and energy level.
Signs and Symptoms—
Like other forms of depression, the symptoms of SEASONAL AFFECTIVE DISORDER can be mild, severe, or anywhere in between. Milder symptoms minimally interfere with the child’s ability to participate in everyday activities, while more severe symptoms can interfere much more.
The symptoms of SEASONAL AFFECTIVE DISORDER are the same as those of depression, but occur during a specific time of year. It's the seasonal pattern of SEASONAL AFFECTIVE DISORDER — the fact that symptoms occur only for a few months each winter (for at least 2 years in a row) but not during other seasons — that distinguishes it from other forms of depression.
Symptoms of SEASONAL AFFECTIVE DISORDER may include:
- Changes in eating: craving simple carbohydrates (e.g., comfort foods and sugary foods); tendency to overeat (which could result in weight gain during the winter months)
- Changes in mood: irritability and/or feelings of hopelessness or worthlessness most of the time for at least 2 weeks; tendency to be more self-critical and more sensitive than usual to criticism; crying or getting upset more often or more easily
- Changes in sleep: sleeping much more than usual (which can make it difficult for children to get up and get ready for school in the morning)
- Difficulty concentrating: more trouble than usual completing assignments on time; lack of usual motivation (which can affect school performance and grades)
- Lack of enjoyment: loss of interest in things that are normally enjoyable; feeling like tasks can't be accomplished as well as before; feelings of dissatisfaction or guilt
- Less time socializing: spending less time with friends in social or extracurricular activities
- Low energy: unusual tiredness or unexplained fatigue
The problems caused by SEASONAL AFFECTIVE DISORDER — such as lower-than-usual grades or less energy for socializing with friends — can affect self-esteem and leave the Aspergers child feeling disappointed, isolated, and lonely, especially if he doesn’t realize what's causing the changes in energy, mood, and motivation.
Fall and Winter SEASONAL AFFECTIVE DISORDER—
Winter-onset seasonal affective disorder symptoms include:
- Appetite changes, especially a craving for foods high in carbohydrates
- Difficulty concentrating
- Heavy, "leaden" feeling in the arms or legs
- Loss of energy
- Loss of interest in activities you once enjoyed
- Social withdrawal
- Weight gain
Spring and Summer SEASONAL AFFECTIVE DISORDER—
Summer-onset seasonal affective disorder symptoms include:
- Poor appetite
- Trouble sleeping (insomnia)
- Weight loss
Causes of SEASONAL AFFECTIVE DISORDER—
It's believed that with SEASONAL AFFECTIVE DISORDER, depression is somehow triggered by the brain's response to decreased daylight exposure. How and why this happens isn't yet fully understood. Current theories focus on the role of sunlight in the brain's production of certain key hormones that help regulate sleep-wake cycles, energy, and mood.
Two chemicals that occur naturally in the body are thought to be involved in SEASONAL AFFECTIVE DISORDER:
- Melatonin, which is linked to sleep, is produced in greater quantities when it's dark or when days are shorter. Increased production of melatonin can cause sleepiness and lethargy.
- Serotonin production increases with exposure to sunlight. Low levels of serotonin are associated with depression, so increasing the availability of serotonin helps to combat depression.
Shorter days and longer hours of darkness in fall and winter can increase melatonin levels and decrease serotonin levels, which may create the biological conditions for depression.
In addition, the child’s biological clock (circadian rhythm) is altered. The reduced level of sunlight in fall and winter may disrupt the body's internal clock, which lets you know when you should sleep or be awake. This disruption of your circadian rhythm may lead to feelings of depression.
Factors that may increase your risk of seasonal affective disorder include:
- Being female. Seasonal affective disorder is diagnosed more often in females than in males, but males may have symptoms that are more severe.
- Family history. As with other types of depression, those with seasonal affective disorder may be more likely to have blood relatives with the condition.
- Having clinical depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions.
- Living far from the equator. Seasonal affective disorder appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter, and longer days during the summer months.
Take signs and symptoms of seasonal affective disorder seriously. As with other types of depression, seasonal affective disorder can get worse and lead to problems if it's not treated. These can include:
- School or work problems
- Social withdrawal
- Substance abuse
- Suicidal thoughts or behavior
Seeing the Doctor—
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- Is your child taking any medications, supplements or herbal remedies?
- Do any blood relatives have seasonal affective disorder or another mental health condition?
- Does your child have any other physical or mental health conditions?
- Have his symptoms been continuous or occasional?
- How severe are the symptoms?
- What are the symptoms?
- What, if anything, appears to worsen the symptoms?
- What, if anything, seems to improve the symptoms?
- When did your child first begin having symptoms?
Your doctor may also ask other questions depending on your individual situation.
Tests and Diagnosis—
To help diagnose seasonal affective disorder, your doctor or mental health provider will do a thorough evaluation, which generally includes:
• Physical exam. Your doctor or mental health provider may do a physical examination to check for any underlying physical issues that could be linked to your child’s depression.
• Medical tests. There's no medical test for seasonal affective disorder, but if your doctor suspects a physical condition may be causing or worsening the depression, your child may need blood tests or other tests to rule out an underlying problem.
• Detailed questions. Your doctor or mental health provider will ask about your child’s mood and seasonal changes in thoughts and behavior. The doc may also ask questions about your child’s sleeping and eating patterns, relationships, school, or other questions about his life. You may be asked to answer questions on a psychological questionnaire.
Seasonal affective disorder is considered a subtype of depression. Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health provider to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms.
To be diagnosed with seasonal affective disorder, your child must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.
The following criteria must be met for a diagnosis of seasonal affective disorder:
- The periods of depression have been followed by periods without depression.
- There are no other explanations for the changes in your mood or behavior.
- The child has experienced depression and other symptoms for at least two consecutive years, during the same season every year.
There's no known way to prevent the development of seasonal affective disorder. However, if you take steps early on to manage your child’s symptoms, you may be able to prevent them from getting worse over time. Some parents find it helpful to begin treating their child before symptoms would normally start in the fall or winter, and then continue treatment past the time symptoms would normally go away. If you can get control of your child’s symptoms before they get worse, you may be able to head off serious changes in mood, appetite and energy levels.
Treatment for SEASONAL AFFECTIVE DISORDER, which varies depending on the severity of the symptoms, includes:
1. Talk therapy (psychotherapy). Helping to ease the sense of isolation or loneliness, talk therapy focuses on revising the negative thoughts and feelings associated with depression. It also can help children understand their condition and learn ways to prevent or minimize future bouts.
2. Medication (pharmacotherapy). Medications, which might be used in combination with talk therapy and light therapy, may be prescribed for a youngster or adolescent with SEASONAL AFFECTIVE DISORDER and should be monitored by a doctor. Antidepressant medications help to regulate the balance of serotonin and other neurotransmitters in the brain that affect mood and energy. Tell your doctor about any other medications your youngster takes, including over-the-counter or herbal medicines, which could interfere with prescription medications.
3. Light therapy (phototherapy). More troublesome symptoms may be treated with a stronger light that simulates daylight. A special light-box or panel is placed on a tabletop or desk, and the person sits in front of it briefly every day (45 minutes or so, usually in the morning) with eyes open, glancing — not staring — occasionally at the light (to work, the light has to be absorbed through the retinas). Symptoms tend to improve within a few days or weeks. Generally, light therapy is used until enough sunlight is available outdoors. Mild side effects of phototherapy might include headache or eyestrain. Lights used for SEASONAL AFFECTIVE DISORDER phototherapy must filter out harmful UV rays. Tanning beds or booths should not be used to relieve symptoms of SEASONAL AFFECTIVE DISORDER. Their ultraviolet rays can damage skin and cause wrinkles and age spots, and even lead to skin cancer such as melanoma. Phototherapy should be used with caution if someone has another type of depressive disorder, skin that's sensitive to light, or medical conditions that may make the eyes vulnerable to light damage. Like any treatment, phototherapy should be used under a doctor's supervision.
4. Increased light exposure. Because the symptoms of SEASONAL AFFECTIVE DISORDER are triggered by lack of exposure to light and tend to go away on their own when available light increases, treatment for SEASONAL AFFECTIVE DISORDER often involves increased exposure to light during winter months. For someone with mild symptoms, it may be enough to spend more time outside during the daylight hours, perhaps by exercising outdoors or taking a daily walk. Full-spectrum (daylight) light bulbs that fit in regular lamps can help bring a bit more daylight into winter months and might help with mild symptoms.
Lifestyle and Home Remedies—
If the symptoms are severe, your child may need medications, light therapy or other treatments to manage seasonal affective disorder. However, there are some measures your child can take on his own that may help. Try the following:
• Exercise regularly. Physical exercise helps relieve stress and anxiety, both of which can increase seasonal affective disorder symptoms. Being more fit can make your child feel better about himself, too, which can lift his mood.
• Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if your child spends some time outside within two hours of getting up in the morning.
• Make the environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or school.
Several herbal remedies, supplements and mind-body techniques are commonly used to relieve depression symptoms. It's not clear how effective these treatments are for seasonal affective disorder, but there are several that may help. Keep in mind, alternative treatments alone may not be enough to relieve symptoms. Some alternative treatments may not be safe if your child has other health conditions or takes certain medications.
Supplements used to treat depression include:
- Melatonin. This natural hormone helps regulate mood. A change in the season may change the level of melatonin in the body.
- Omega-3 fatty acids. Omega-3 fatty acid supplements may help relieve depression symptoms and have other health benefits. Sources of omega-3s include fish such as salmon, mackerel and herring. Omega-3s are also found in certain nuts and grains and in other vegetarian sources, but it isn't clear whether they have the same effect as fish oil.
- SAMe. This is a synthetic form of a chemical that occurs naturally in the body. SAMe hasn't been approved by the Food and Drug Administration to treat depression in the United States. However, it's used in Europe as a prescription drug to treat depression.
- St. John's wort. This herb has traditionally been used to treat a variety of problems, including depression. It may be helpful if your child has mild or moderate depression.
Mind-body therapies that may help relieve depression symptoms include:
- Guided imagery
- Massage therapy
What Parents Can Do—
Talk to your doctor if you suspect your youngster has SEASONAL AFFECTIVE DISORDER. Doctors and mental health professionals make a diagnosis of SEASONAL AFFECTIVE DISORDER after a careful evaluation and a checkup to ensure that symptoms aren't due to a medical condition that needs treatment. Tiredness, fatigue, changes in appetite and sleep, and low energy can be signs of other medical problems, such as hypothyroidism, hypoglycemia, or mononucleosis.
When symptoms of SEASONAL AFFECTIVE DISORDER first develop, moms and dads might attribute low motivation, energy, and interest to an intentional poor attitude. Learning about SEASONAL AFFECTIVE DISORDER can help them understand another possible reason for the changes, easing feelings of blame or impatience with their youngster or adolescent.
Moms and dads sometimes are unsure about how to discuss their concerns and observations. The best approach is usually one that's supportive and nonjudgmental. Try opening the discussion with something like, "You haven't seemed yourself lately — you've been so sad and grouchy and tired, and you don't seem to be having much fun or getting enough sleep. So, I've made an appointment for you to get a checkup. I want to help you to feel better and get back to doing your best and enjoying yourself again."
Here are a few things you can do if your Aspergers youngster or adolescent has been diagnosed with SEASONAL AFFECTIVE DISORDER:
1. Be patient. Don't expect symptoms to go away immediately. Remember that low motivation, low energy, and low mood are part of SEASONAL AFFECTIVE DISORDER — it's unlikely that your youngster will respond cheerfully to your efforts to help.
2. Encourage your youngster to get plenty of exercise and to spend time outdoors. Take a daily walk together.
3. Establish a sleep routine. Encourage your youngster to stick to a regular bedtime every day to reap the mental health benefits of daytime light.
4. Find quality time. Spend a little extra time with your youngster — nothing special, just something low-key that doesn't require much energy. Bring home a movie you might enjoy or share a snack together. Your company and caring are important and provide personal contact and a sense of connection.
5. Help with homework. You may have to temporarily provide hands-on assistance to help your youngster organize assignments or complete work. Explain that concentration problems are part of SEASONAL AFFECTIVE DISORDER and that things will get better again. Children and adolescents with SEASONAL AFFECTIVE DISORDER may not realize this and worry that they're incapable of doing the schoolwork. You may also want to talk to the teachers and ask for extensions on assignments until things get better with treatment.
6. Help your youngster to eat right. Encourage your youngster to avoid loading up on simple carbohydrates and sugary snacks. Provide plenty of whole grains, vegetables, and fruits.
7. Help your youngster understand SEASONAL AFFECTIVE DISORDER. Learn about the disorder and provide simple explanations. Remember, concentration might be difficult, so it's unlikely your youngster will want to read or study much about SEASONAL AFFECTIVE DISORDER — if so, just recap the main points.
8. Participate in your youngster's treatment. Ask the doctor how you can best help your youngster.
9. Take it seriously. Don't put off evaluation if you suspect your youngster has SEASONAL AFFECTIVE DISORDER. If diagnosed, your youngster should learn about the seasonal pattern of the depression. Talk often about what's happening, and offer reassurance that things will get better, even though that may seem impossible right now.
Coping and Support—
Following these steps can help your child manage seasonal affective disorder:
- Practice stress management. Learn techniques to manage stress better. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors
- Socialize. When your child is feeling down, it can be hard to be social. Help him make an effort to connect with friends he enjoys being around. They can offer support, a shoulder to cry on, or a joke to give your Aspie a little boost.
- Stick to the treatment plan. Take medications as directed and attend therapy appointments as scheduled.
- Take a trip. If possible, take winter vacations in sunny, warm locations if your child has winter seasonal affective disorder – or to cooler locations if he has summer seasonal affective disorder.
- Help your Aspie to take care of himself. Get enough rest and take time to relax. Participate in a regular exercise program. Eat regular, healthy meals.
The Aspergers Comprehensive Handbook