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Sarah Hanly, Ph.D.

The holidays are a time of excitement and wonder for most kids, but children experiencing depression may have a difficult time finding holiday cheer.

Depression is one of the most common mental health problems in the United States. Each year, it affects 17 million people of all age groups, races and economic backgrounds. Children are not immune to this common problem: As many as 1 of every 33 children may have depression; in teens that number may be as high as 1 in 8.

Experts say the onset of winter is an important time to monitor kids closely.

Children who are susceptible to depression can exhibit symptoms as the days become shorter – “seasonal affective disorder” or SAD.

Sarah Hanly, Ph.D., a clinical psychologist at SSM Cardinal Glennon Children’s Medical Center in St. Louis, explains that children who are at risk for depression may be particularly susceptible to a low mood trigged by reduced hours of daylight.

Because kids experience ongoing changes in their lives – such as a new school year or making new friends – a pattern of recurring depression in winter may not be obvious.

But Dr. Hanly suggests that parents learn all they can about symptoms so they can stay aware of potential problems. One key to spotting depression in kids, she continues, is to understand how it differs from adult depression.

Dr. Hanly explains that adults who are depressed often are sad, and children can be melancholy as well. But more often, she says, watch for irritability. “The kids who are depressed do withdraw socially, and experience a loss of interest in things they previously enjoyed.

“But one of the hallmarks of adolescents in particular is a heightened sense of irritability,” Dr. Hanly says. “They can be hard to be around.”

SAD doesn’t strike all kids who are at risk, and the symptoms are somewhat controversial, Dr. Hanly continues. She notes that one study in Norway in a community where no winter sunlight was present found little evidence the condition exists, but many more studies have found increasing rates of depression in winter as one moves north in latitude.

The holiday period also is a key time to evaluate how kids are doing. Dr. Hanly notes that a key diagnostic question for depression is to ask, “When was the last time you had a good time?”

 If a child no longer looks forward to holidays and the break from school as in past years, it can indicate a potential problem, she continues.

Serious depression differs from an occasional bout with sadness. In a seriously depressed child or adult, the down state or mood lingers for weeks or months and limits the person’s ability to function normally.

Dr. Hanly notes that depression in children and teens can impede their academic performance and, untreated, tends to linger into adulthood, degrading quality of life.

The most serious consequence of depression is suicide, which Dr. Hanly adds is a “very real” risk factor for depressed children, adolescents and teens.

Some studies find that depression is more prevalent in adolescent and teen girls than boys this age; among younger children, Dr. Hanly says the disorder more clearly affects girls and boys equally.

In addition to sadness and irritability, Dr. Hanly lists a number of symptoms that should be red flags for parents: social withdrawal; failure to find enjoyment in activities such as the holidays that previously were enjoyable; changes in appetite or not sleeping; being highly self-critical; expressing thoughts about death or wanting to be dead; feelings of hopelessness and “feeling everything is your fault.”

Dr. Hanly urges parents to “keep communicating” with their children, monitoring their moods and seeking treatment when a depressed state does not pass relatively quickly.

 “Sometimes depression can be triggered with events in their lives, but getting kids the help they need to deal with those difficult times and helping them to develop coping skills to move forward in their lives is very important.”

For mild depression, the therapy can be as simple as getting more exercise -- especially out of doors in the morning light if the low mood is thought to be related to SAD.  Dr. Hanly explains the most effective treatment for SAD is exposure to light – either outdoors (even cloudy days outside help) or inside or with a light box.

She continues that therapy for mild depression in any season often consists of “engaging in behaviors that are inconsistent with depression in order to lift mood.” Dr. Hanly describes this as a “fake it until you can make it” approach.

Treatment for serious depression also includes medicine, or a combination of therapy and medicine. Dr. Hanly notes that cognitive behavior therapy has been shown to be effective in helping kids to learn to control anxious or negative thinking.

Dr. Hanly urges parents who have concerns about a child to talk with their family doctor and to consider referral to a child psychologist or psychiatrist.

“There is a life-long risk of repeated episodes of depression if a child doesn’t get the help they need.”

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