Why seasonal depression can happen in the summer too

Summer seasonal affective disorder (SAD) has been on doctors’ radars for decades. But many are unaware of the condition, and it can be harder to shake than the winter blues.

Published 27 Aug 2020, 07:47 BST, Updated 5 Nov 2020, 04:57 GMT
Photograph by Li Hui

Last summer, Cristina Flores planned to spend two weeks on a road trip through the U.S. Midwest, weaving her car along Ohio’s shoreline into the plains of Iowa and beyond. Each state she’d visit would bring her ever closer to the goal of seeing all 50 in the country. But the day before she was set to embark, Flores abruptly cancelled the trip, losing the deposits for all her booked Airbnbs. She was too depressed to leave the house.

This wasn’t new, but rather the latest—and worst that she recalls—in a seasonal pattern of depression that hangs around but is manageable throughout the year, then rears up in the summer. Flores, now 43 and a high school teacher, says that by high school she had started noticing seasonal changes in her mood, although she wasn’t formally diagnosed with depression until the summer of 2010. Thinking back, she can trace these summer blues all the way to childhood.

“My parents always thought it was because I was bored or wasn't kept busy,” she says. “I realised now as an adult that a lot of my childhood problems were clearly mental health issues.”

Unbeknownst to her, what Flores has been living with is summer seasonal affective disorder (SAD)—the underdiagnosed, rarer, and harder-to-treat sibling to winter seasonal affective disorder. Those with winter SAD experience sluggishness, increased sleep, increased appetite, and subsequent weight gain, but can pretty effectively treat their symptoms with palliative light therapy: exposure to a lamp with a frequency that simulates natural light. If done for at least 30 minutes a day, this treatment has been shown to keep winter SAD at bay.

By contrast, people with summer SAD feel more agitated and experience insomnia, loss of appetite, and weight loss. They are also more likely to be suicidal than those with the winter version.

And while winter SAD is uniformly set off by steady seasonal darkness, the summer version is sparked by multiple environmental factors such as high temperatures, humidity, and even high pollen counts. These fluctuating triggers make a manageable treatment for summer SAD elusive. Some people resort to staying inside as much as possible during the summer months, but that can be difficult when social pressure to have fun in the sun is so incredibly high.

Though summer SAD has been on doctors’ radars for nearly 40 years, it remains less clearly understood. Of the few studies about summer SAD, most are confined to the 1990s and early 2000s, and they haven’t been updated or explored since.

Photograph by Li Hui

“Whereas the winter SAD area has really taken off in research, there are not many people carrying the torch out there, studying the [summer] variant of this,” says Kelly Rohan, director of clinical training at the University of Vermont and a psychologist who has been studying seasonal affective disorder since 1993.

This disorder is quite rare and often underdiagnosed. Taking that into account along with the inadequate body of research means most people with summer SAD have likely never heard of it. Before being interviewed for this story, Flores says she counted herself as one of those people; she’d even kid with her therapist “about the irony of what seems to be reverse SAD.”

“People think it's odd or they think I'm joking. Nobody can understand why you would hate the summer,” Flores says. “Because I like the cold and the dark so much, we joke around like I’m a cave-dwelling creature that likes to be in my lair. But people just really don't have an understanding of it.”

The sad days of summer

Although winter SAD is very much part of the zeitgeist, summer SAD remains less understood partly because, as far as we know, it’s pretty rare. Still, its prevalence does appear to wax and wane slightly along latitudes, like winter SAD, though less dramatically so.

A 1990 U.S. study showed that 9.7 percent of people in Nashua, New Hampshire, experienced winter SAD, while only 0.5 percent reported summer SAD symptoms. But zoom down to Sarasota, Florida, and you’ll find that the winter SAD population drops to 1.4 percent, while the summer SAD population goes up to 1.2 percent—a small proportion overall but noticeably higher than the northernmost city in the study.

Because of the rarity of the disorder and the complexity of its environmental triggers, early studies of summer SAD struggled to pinpoint a precise target for care, a shortcoming that’s been magnified by decades of underdiagnosing the disorder.

“A condition will become better known if there’s something clear that you can do about it. That’s the case with winter SAD,” says Norman Rosenthal, the psychologist who first identified seasonal affective disorder in 1984. “With the summer version, I can give you some recommendations, but they’re not the same kind of easy, widely effective, and widely implementable thing as light therapy.”

Photograph by Li Hui

For women, who are more likely to be afflicted by seasonal affective disorders in general, having a rare psychological affliction can be especially difficult. With fewer studies comes less institutional knowledge, so women who bring their symptoms to doctors are often incorrectly written off as suffering from low self-esteem and body image issues triggered by the summer uniform of shorts and bathing suits.

“[Summer SAD is] a difficult thing to get your hands around, but don't think that it isn't real. It is real,” says Rosenthal.

Evaporating the summer blues

Public awareness eases the burden of coping with mental afflictions, including seasonal affective disorders, because social norms place subtle taxes on our well-being. Even if most of the general population doesn’t experience full fledged depressive episodes during the winter, many can relate to feeling glum or not wanting to engage with others during the darkest months of the year.

The opposite scenario applies in the summer. Many people prefer warm weather to cold weather, which can be alienating and isolating for those who struggle during everyone else’s favourite season.

Laura Price Steele, a 33-year-old based in North Carolina, who lives with summer depression, says she feels interminably out of sync with everyone all year. “I feel more aligned with the world when it’s darker and colder and everyone else is tired and a little miserable,” Steele says.

But this disharmony can also come with moments of peace. Winter’s sharp air, quiet solace, and protection of darkness bring with it a sense of vitality, she says. While everyone around her is hunkering down and burrowing in, Steele’s productivity, focus, energy, and enjoyment of the world all peak. The same applies for Flores, who may have cancelled her road trip last summer, but confidently plowed ahead with a November trip to Iceland with her husband.

People with summer SAD manage their depression in some expected ways, such as talk therapy, medication, and pulling back from difficult activities like travel. One less clinical remedy is seeking air conditioning more frequently than the average person coping with summer heat does.

In 1987, a case study of 12 patients with seasonal affective disorder showed that a rather extreme method could push back summer depression. One woman with the condition stayed completely shut inside an air-conditioned space for five days and took cold, 15-minute showers multiple times a day. It worked, but in addition to being totally unsustainable in everyday life, the woman reported that soon after stepping outside this sealed environment, her symptoms returned.

The development of more practical treatments will become more important in light of global warming. Climate change is already having a negative impact on mental health, and both Rosenthal and Rohan think this anthropogenic phenomenon will elevate rates of summer SAD. Think of the heatwaves in Siberia or the growing pollen clouds across the Northern Hemisphere: Populations that have never had to tolerate triggers of summer SAD are increasingly exposed to them. Additionally, people prone to winter SAD who live in places that are already hot and humid, but who typically enjoy the summer, might lose their tolerance for the season as it becomes more extreme.

“If they don't have air conditioning to insulate them against the onslaught of increasing heat and humidity with global warming, [they] could develop a [biannual] pattern,” Rohan says.

But in a darkly humorous twist, during this pandemic-laden summer, when rates of depression and anxiety are spiking for everyone else, both Flores and Steele are having a fairly easy go of it for the first summer in a while. Steele and her wife even welcomed a new baby in June, but the pressures of being a new parent during a pandemic still seem manageable to her as long as there’s a reason to stay cool indoors.

There are no pool parties, beach meetups, or garden BBQs. Even invitations to get together outside, masked and distanced, can be avoided with a socially acceptable excuse that doesn’t involve disclosing a misunderstood mood disorder. Summer is effectively cancelled this year, and some folks frankly couldn't be happier about it.

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