SAD (seasonal affective disorder) makes us think of wintertime depressions, but some people with bipolar disorder experience seasonal depression in the spring and summer months.
Individuals with bipolar disorder know all too well that life can be unpredictable. Seemingly out of nowhere, a depressive episode lands like a bag of wet grass. It can feel like insult on top of injury when it happens in late spring or summer, just when it seems things should be looking up.
It’s common to associate seasonal affective disorder (SAD) with a drop in mood during the fall and winter months. For a small but significant number of people, however, it is spring and summer that bring depressions.
SAD simply denotes a pattern of mood symptoms — at either end of the spectrum — that have a tendency to occur around the same time every year.
RELATED: Why Does My Bipolar Worsen as the Seasons Change?
For some people with bipolar, depressions in fall and winter pair with hypomania or mania in the spring. Sometimes the pattern occurs in reverse: depressions in the summer, with elevated moods emerging in the darker winter months.
Sometimes, manic or hypomanic episodes in the spring lead to summer depressions. In a fraction of cases, it’s just the summer depressions.
When a pattern occurs two years running, we can clinically apply the descriptor “seasonal affective disorder” to the episodes.
Is There a Biological Cause?
Perhaps. However, there’s limited data to either refute or confirm this. Some findings indicate that those living in areas closer to the equator — where there is less distinction in weather and sunlight between seasons — are somewhat more likely to experience depression in summer versus winter.
Research done in the 1990s suggested there may be characteristic differences between summer and winter depressions. It appeared that summer depressions were more likely to involve loss of appetite and sleeping difficulties, while winter depressions went the other way: oversleeping and increased appetite.
That has not borne out, however. Current thinking focuses on identifying usual depressive and hypomanic or manic symptoms for each individual and tailoring a treatment plan specific to those challenges.
So What Should I Watch For?
It’s important to know what emotional underpinnings tend to prompt a depressive slide.
The factors driving summer depressions vary from person to person.
My first encounter with summer depression was a patient who informed me that she became depressed immediately after the summer solstice in late June every year. Knowing that days were going to get shorter, even by just a minute or two at first, triggered a depressive mindset for this woman.
For other people, emotional preoccupation and depressive rumination might be prompted by summer anniversaries (weddings, graduations, loss of loved ones). A failed “summer fling,” or memories of one, can bring regret and longing.
Feeling a lack of social contacts with whom to enjoy summertime activities can result in pervasive loneliness. Wearing less clothing, especially at the beach or a pool, may bring forth body image issues that gnaw at the core of self-esteem.
Chronic lack of sleep, potentially related to the increased amount of daylight, can lead to ongoing fatigue — a common precursor to low and irritable moods. Schedules disrupted by vacations or the long school break also can be destabilizing.
What Should I Do?
1. Keep a Mood Diary
The key to identifying SAD is to watch for patterns over time. Your diary doesn’t have to be detailed. In general, when do mood symptoms of any kind become a significant problem? Soliciting input from friends and family member will help, too.
2. Review Your Medications
Talk with your prescribing practitioner about what options are available to you. Have you tried an effective mood stabilizer over an extended period of time (at least one year)? Are there adjustments in dosage or choice of medication that can deter seasonal mood shifts?
3. Maintain Daily Routines
Sleep hygiene matters enormously in limiting mood imbalances. Stick to your regular bedtime despite longer evening light. Keep up your usual levels of activity, watching for any inclination to do less — or impulse to do more. Again, your care providers can discuss strategies to help you keep on course.
UPDATED: Printed as “Ask the Doctor: When Warm & Sunny Means SAD,” Spring 2022
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