Winter is Coming: End of Year Mood Changes


October 15, 2021

There hasn’t been much change in weather or temperature here in Texas, but the fading daylight reminds us we’re heading into the last months of 2021. While typically associated with holiday celebrations and winter vacation, this time of year can be accompanied by a decline in mental health. Even without a pandemic hovering over everything, it’s not unusual to see patients suffering from changes in mood and functioning.

For children and adolescents, heavier workloads and impending semester exams adds extra pressure. Not only are more assignments due simultaneously, but students are expected to juggle time off during breaks and studying for major tests. Many will forgo proper sleep and other healthy habits, despite the risk of aggravating the situation. In addition, the holidays are fraught with potential emotional triggers. Children without stable homes must contend with a constant barrage of happy families, while others face the knowledge their parents cannot afford the gifts or celebrations their peers will receive. There’s also the increased risk of emotional or physical abuse that could occur due to parents or authority figures struggling with their own stressors. Beyond that, risk of catching the flu or respiratory infections is higher during this time of year.

All of these can lead to a dip in mood, increased anxiety, irritability, sleep disturbances, low energy, and appetite changes. Some children and adolescents may even develop a noticeable drop in functioning or increased acting out behavior. In patients with no prior mental health issues, these changes are often temporary and will resolve with conservative measures and monitoring. Encouraging the patient (with parental assistance) to continue with a good sleep schedule, eating regular meals, and coming up with a good plan to manage school deadlines are all ways to reduce stress.

If the child or adolescent has a diagnosed mental health issue, particularly a mood disorder like depression, anxiety, or bipolar disorder, the approach should include review of their current treatment. Should the patient be struggling with stress management, worry or rumination over grades, or dealing with conflicted feelings about the holidays, increased sessions with their therapist might be indicated. If the mood changes or psychomotor symptoms are significant, adjustment of their medications may be needed. This could include anything from short-term use of melatonin or other OTC sleep aides to assist with insomnia to temporary increases in antidepressants or mood stabilizers. If changes are made, more frequent check-ins via phone or clinic visits will be beneficial and indicated. If the patient should decline to the point of suicidal thinking or preoccupation with death, they should be monitored very closely. Safety planning and emergency resources need to be discussed with the patient and family along with medical treatment.

In some cases, patients could also benefit from the addition of light therapy if their moods tend to worsen during winter. This could apply to patients who do not exhibit any issues during the rest of the year, or ones whose depression increases in a seasonal pattern. While light therapy has not been shown to be effective for everyone with this pattern, use of a “sun lamp” that mimics natural daylight can be a safe supplement to other interventions.

With some proactive effort, we can help our patients navigate any challenges that the end of the year will bring.

Written by: Jennifer Yen, MD