Summer Seasonal Affective Disorder | Symptoms & Treatment
Of natures, some are well- or ill-adapted for summer, and some for winter.
—Hippocrates
What is Summer SAD?
While Seasonal Affective Disorder (SAD) is commonly associated with the fall and winter months, some individuals experience a similar pattern of depressive symptoms during the summertime. This condition is known as reverse seasonal affective disorder, summertime seasonal affective disorder, or summer-onset SAD.
How My Colleagues and I Discovered Summer SAD
We have known about summer seasonal affective disorder (Summer SAD) for almost as long as its more common winter counterpart.
After my colleagues and I at the National Institute of Mental Health (NIMH) first encountered a few people who reported having regular winter depressions (separated by non-depressed periods in spring and summer), I approached a journalist Sandy Rovner at the Washington Post, who was intrigued by the idea of seasonal depression. Her resulting article, aptly titled, “Seasons of the Psyche” was deemed so novel that it was syndicated all over the country. Thousands of readers responded, the majority endorsing the regular winter pattern of depression featured in the article. But a significant minority complained that they felt worst in the spring and summer, year after year. So we realized, there was indeed a summer version of seasonal affective disorder, which we called “Summer SAD” or “Reverse SAD” because its timing was the opposite of winter SAD.
My colleague Thomas Wehr and I were eager to explore the features of what we called Summer SAD.
We compared 30 people with recurrent summer depression (summer SAD) to 30 sex-matched people with recurrent winter depression (winter SAD).
Here’s what we found.
Similarities and Differences Between People with Summer and Winter SAD
Seasonal depression symptoms in people with summertime seasonal affective disorder
Although people with both types of SAD reported feeling worst in their seasons of risk, those with the reverse seasonal affective disorder were more likely to report the following:
- Sleeping less
- Feeling overactivated and agitated
- Having decreased appetite
- Having more suicidal ideas
- Being bothered by heat and/or light
Seasonal depression symptoms in people with winter seasonal affective disorder
Those with winter seasonal affective disorder were more likely to report the following:
- Sleeping more
- Feeling slowed down
- Feeling lethargic
- Having increased appetite and carbohydrate craving
- Gaining weight
- Having fewer suicidal ideas
- Being bothered by darkness
Not sure if you have SAD? Take the seasonal affective disorder quiz
People with winter SAD seemed more like one another than those with summer SAD, whose symptoms differed to a greater extent from person to person.
Both groups in our study were predominantly women (90%), having a greater preponderance than we usually find in people with winter SAD in whom the female to male ratio was closer to about 3 or 4 to 1.
As you might expect, those with Summer-SAD were more likely to attribute their symptoms to heat or light, whereas those with winter SAD typically blamed the short dark days.
Since the world is getting warmer and more people, at least in the US, are moving south, summer SAD may become increasingly common and important from a public health perspective.
Treatment of Summer Depression
1. Keep cool
We had learned from Winter SAD the value of reversing the seasonal changes that seemed instrumental in causing symptoms: Hence the development of light therapy. By analogy, some sort of “cold therapy” seemed logical for people with Summer SAD.
Of course, with regard to light therapy, we were at an advantage as a result of basic studies, which suggested that bright light would be especially helpful. Specifically, Alfred J. Lewy and colleagues in our group had shown that exposing people to bright light was capable of suppressing the nighttime secretion of melatonin – a hormone known to be responsible for orchestrating seasonal rhythms in animals.
Even though we had no analogous biological finding to guide us in the treatment of summer depression, we followed a basic principle in medicine: Replace what is missing – in the case of summer SAD, cool temperatures. Although there have been no systematic studies of this treatment. Several patients endorse the value of staying cool.
Here is an example.
Elaine: Bathing in cool waters
Elaine was a woman in her mid-fifties, who had suffered from regular summer depressions for several years – until she and her family went on a visit to the Finger Lakes in northern New York State during the summer. There she developed the habit of bathing in the cold lake waters every day, which had a profoundly positive effect on her mood. She believed that it broke the worst part of her summer depression, shortening it and making it less severe.
Over time, Elaine began to seek out cool spaces, much as people with winter SAD gravitate to the light.
Just as traveling south during winter may help people with winter SAD, so traveling north during the summer may be helpful for people with summer SAD.
Other ways to stay cool during the hot summer days
Although we haven’t yet developed an effective “cold therapy” for people with summer-SAD, analogous to the treatment of winter SAD, here are some things you can do to stay cool during the summer, which may greatly help people with summer SAD.
- Take regular cold showers or baths
- Turn down the thermostat on your air conditioning
- Keep curtains drawn (If you also have winter-SAD, make sure that doesn’t cause another set of problems by reducing your ambient light levels too much.)
As yet untested both for effectiveness and safety are the relatively new cryotherapy chambers, in which a person climbs into a chamber filled with very cold air for brief periods. It would certainly be something worth testing in people with summer-SAD under proper experimental circumstances.
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2. Consider starting or altering your dose of antidepressant medications
Of course, when it comes to receiving antidepressant medications, an appropriate medical professional needs to be involved.
One special consideration in treating summer SAD with medications is to anticipate the coming depression based on past history. For example, if you happen to get depressed even in July (not an uncommon pattern of summer SAD), it might be helpful to start antidepressants (or increase the dosage of current antidepressants) a few months earlier — for example in April or May. That way the higher dose of medicine will be in place when it is needed most.
Since summer depressions often have mixed features – overactivity and agitation combined with low mood – it may be useful to combine antidepressants with mood stabilizers, such as lithium carbonate, Lamictal (lamotrigine) and neuroleptics, such as Abilify (aripiperazole). As you can imagine, it is important to find someone with appropriate expertise to help you manage the shifting mood fluctuations of this tricky form of SAD.
3. Light manipulations
Even though heat is usually an important component of the problem of summer SAD, light may also play a role.
Too much light may agitate people, creating an uncomfortable mix of depression and irritability. For some people, decreasing environmental light may settle down the irritable component of the problem, which can help calm people down. People can decrease their ambient light by staying in darkened rooms or wearing blue-blocking goggles, which can be less inconvenient. Such goggles can readily be obtained online.
Paradoxically, some people may benefit from extra light, strategically administered at certain times of the day. One colleague of mine with summer SAD, for example, found that being exposed to a short burst of sunlight early in the morning did wonders for reversing the symptoms of her summer SAD.
Conclusion:
Summer SAD certainly exists and can be both severe and dangerous since the mix of depression and agitation may go along with suicidal ideas and behavior. The pattern of agitation, loss of appetite, insomnia, and negative responses to heat and/or light is opposite to that usually found in people with winter SAD. Although people with summer SAD often do not respond as well as those with winter SAD, there are still several ways to alleviate symptoms, as outlined above.
Related reading:
- What college students should know about Seasonal Affective Disorder
- 11 Tips for Greater Happiness
- Seasonal Affective Disorder—Beating the Winter Blues
- 4 Articles: Seasonal Affective Disorder & Winter Blues
