Mental Health Roundup: Seasonal Affective Disorder

In the first of an occasional series, I'm providing a roundup of blog posts on a specific mental health topic. I'm starting off with Seasonal Affective Disorder (SAD) since this is the time of year that most people who suffer from SAD start to experience symptoms. As you'll read below, some people experience reverse SAD in the spring and summer.

Dr. Deb covers the basics in her post Seasonal Affective Disorder including symptoms and treatments.
The psychiatrist and researcher who first described SAD, Norman Rosenthal, includes a self-assessment checklist in How Seasonal Are You? | Psychology Today.

Phillip Dawdy at Furious Seasons discusses whether SAD is a separate disorder rather than a variant of Major Depressive Disorder in Should Seasonal Affective Disorder Be A Separate Disorder?. He quotes an editorial by Norman Rosenthal in the American Journal of Psychiatry from which the following table is taken.


Douglas Cootey at A Splintered Mind: Overcoming AD/HD & Depression With Lots Of Humor And Attitude writes about his inexpensive solution to SAD--full-spectrum CFL's in Putting a Spotlight on Seasonal Affective Disorder - Haunting My Family With My Spectral Personality.

John Briffa reviews two research studies in ‘Blue’ light found to be most effective in combating seasonal affective disorder | Dr Briffa's Blog and mentions his own experience using a blue-light box.

For those of you interested in neuroscience, read Seasonal Affective Disorder - The Basics | A Blog Around The Clock written by chronobiologist Bora Zivkovic at Science Blogs. He discusses the relationship between circadian rhythms, melatonin, and SAD.

That's it for this Mental Health Roundup. Tell me what you think. Do you have other resources or experiences to share, especially, on SAD in children or adolescents? If not, what about your own success in coping with SAD?

Please note that I allow anonymous comments. I also moderate comments to exclude commercial or otherwise inappropriate comments.

E-mail me with your suggestions for future roundups with links to your own or other people's non-commercial posts for consideration.

You Asked: Depression - Thyroid or Hormonal Changes?

A reader wants to know if depression could be caused by undetected thyroid or hormonal changes. The short answer is yes. Hypothyroidism (an underactive thyroid gland), hyperthyroidism (an overactive thyroid gland), and adrenal insufficiency (a dysfunctional adrenal gland) are hormone disorders that can cause symptoms of depression. These illnesses can be detected by simple tests performed by your child's pediatrician.

Other medical conditions that may be associated with depressive symptoms include metabolic illness, anemia, seizure disorder, acquired immunodeficiency syndrome, Addison's disease, post-concussion, tuberculosis, diabetes, brain tumor, and chronic fatigue syndrome. Medications that can cause depression include antihypertensives, barbituates, corticosteroids, oral contraceptives, and albuterol. Green-Hernandez, C., Singleton, J. K., & Aronzon, D.Z. (2001). Primary care pediatrics. Philadephia: Lippincott, Williams & Wilkins, pg 314.

Hormonal changes at puberty have been linked to an increase in depression in adolescents as compared to children. There is little difference in the rates of depression between boys and girls prior to puberty, but among teenagers, twice as many girls as boys become depressed. It is unclear why there is such a significant gender difference. Many research studies show inconsistent results for hormone levels, early or late onset of puberty, psychosocial differences, and body image issues as possible causes. One explanation could be that hormonal changes only affect girls with a genetic predisposition for depression. Gotlib, I. H. & Hammen, C. L. (Eds.),2008. Handbook of depression (2nd ed.). New York: Guilford Press, pgs 388-389.

Many Depressed Teens Go Untreated

According to a recent report from the 2007 SAMHSA National Survey on Drug Use and Health, during the past year, 8% of teenagers ages 12-17 experienced at least one episode of major depression defined as:

...a period of 2 weeks or longer in which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image.

Even though 70% of the depressed teens reported severe impairment in daily functioning (chores at home, school or work, close relationships with family, or social life), only 39% received any mental health treatment!

Why did less than half of the depressed teens get help? The study points to at least one cause--lack of health insurance. Only 17% of uninsured, depressed teenagers obtained treatment. However, this does not explain why nearly 60% of teens covered by health insurance weren't treated.

The primary reason depressed teens don't get help is that neither they nor their parents recognize the source of their problems. It's easy to ascribe moodiness, irritability, lack of energy, and poor concentration to the stress and sleep deprivation experienced by today's over-scheduled teens.

In addition, the stigma of mental illness affects teenager's willingness to ask for help. Many suffer in silence and hide their pain from parents and friends. In an excerpt from Day for Night: Recognizing Teenage Depression, teens who have dealt with major depression describe the symptoms they had:

It's important for both teens and parents to become better informed about the symptoms and treatments for depression. The following publications from the National Institute on Mental Health are a good place to start. Because they are not currently available from NIMH, I've linked to pdf's on my website's Resources page:

Let's Talk About Depression

What to Do When A Friend is Depressed

Howie Mandel on Stigma and Children's Mental Health

According to Mental Health America, 1 in 5 children and adolescents have a diagnosible mental health condition, yet only 1/3 of them get help. One reason is the stigma associated with having a mental illness.

Howie Mandel, host of "Deal or No Deal," often talks about his own mental illnesses of obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). As ambassador for National Children's Mental Health Awareness Day (May 7, 2009), he speaks on the stigma of seeking help:

Because children and adolescents often don't tell anyone about troubling thoughts and feelings, it is up to adults to notice symptoms of possible mental illness. The U.S. Dept. of Health & Human Services' on-line publication Child and Adolescent Mental Health lists the following warnings signs:

A child or adolescent is troubled by feeling:

• Sad and hopeless for no reason, and these feelings do not go away.
• Very angry most of the time and crying a lot or overreacting to things.
• Worthless or guilty often.
• Anxious or worried often.
• Unable to get over a loss or death of someone important.
• Extremely fearful or having unexplained fears.
• Constantly concerned about physical problems or physical appearance.
• Frightened that his or her mind either is controlled or is out of control.

A child or adolescent experiences big changes, such as:

• Showing declining performance in school.
• Losing interest in things once enjoyed.
• Experiencing unexplained changes in sleeping or eating patterns.
• Avoiding friends or family and wanting to be alone all the time.
• Daydreaming too much and not completing tasks.
• Feeling life is too hard to handle.
• Hearing voices that cannot be explained.
• Experiencing suicidal thoughts.

A child or adolescent experiences:

• Poor concentration and is unable to think straight or make up his or her mind.
• An inability to sit still or focus attention.
• Worry about being harmed, hurting others, or doing something "bad".
• A need to wash, clean things, or perform certain routines hundreds of times a day, in order to avoid an unsubstantiated danger.
• Racing thoughts that are almost too fast to follow.
• Persistent nightmares.

A child or adolescent behaves in ways that cause problems, such as:

• Using alcohol or other drugs.
• Eating large amounts of food and then purging, or abusing laxatives, to avoid weight gain.
• Dieting and/or exercising obsessively.
• Violating the rights of others or constantly breaking the law without regard for other people.
• Setting fires.
• Doing things that can be life threatening.
• Killing animals.
  

The presence of one or more of the above symptoms indicates a need for further evaluation. Pediatricians and family physicians can refer families to psychiatrists or psychologists in their area who specialize in treating children and adolescents. For other resources, see Mental Health America's factsheet How Do I Find Treatment?