Written by: Jennifer Yen, MD
While Texas winters are more chilly days than regular snowstorms, our days grow short along with the rest of the country. Along with the loss of daylight and difficulty adjusting to a new sleep schedule, many people will notice a drop in their mood. Though these shifts may be temporary and manageable–commonly described as the “winter blues”—some individuals may find their mental health deteriorating to the point of dysfunction. Additionally, those with pre-existing mental illness could struggle with increased or more intense symptoms. When this occurs, particularly in a seasonal pattern, these negative changes may point to a diagnosis of Seasonal Affective Disorder.
For children and adolescents, the many schedule changes around winter and holiday times often disrupt their normal routine, causing added pressure and stress. Many students will forgo proper sleep and other healthy habits despite knowing it could make things worse. In addition, holiday times and their immediate aftermath are often fraught with potential emotional triggers for families and children without stable homes. There’s also the increased risk of emotional or physical abuse due to parents or authority figures struggling with their stressors.
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 a 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 significant mood changes or psychomotor symptoms are present, 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 ongoing 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, the use of a “sun lamp” that mimics natural daylight can be a safe supplement to other interventions.
The upcoming days may fade into darkness, but with a proactive approach, we can shed light on our patients’ seasonal mood changes and guide them through any challenges they face.