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Norman E. Rosenthal, M.D. Headshot

Summertime: And the Living Aint Easy

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I have on my bookshelf a small volume, published in 1879, called The Summer and its Diseases by James C. Wilson, M.D., then of the Medical College in Philadelphia. The good doctor notes wisely in the foreword that:

"Man, born to sorrow as the sparks fly upwards, finds some pain in every pleasure, some sadness in all joy, some fear in every hope. The changing seasons remind him that the seed is not quickened except to die, and each one brings to him, as it comes with its many blessings, some new suffering and sickness."

As a physician who has studied the effects of the seasons on human beings for years, I agree with Dr. Wilson. But as a psychiatrist, I see different types of afflictions that those listed his book, which include sunstroke, dysentery, cholera, fevers, allergies and skin problems. Instead, I see summer depression, mania, anger problems and, of all things, winter-SAD in summer. Here is a quick round-up of these maladies.

Summer Depression (Summer-SAD)

Shortly after we identified Winter-SAD, my colleagues and I identified a summer version of the condition, in which people become depressed as the days get longer and hotter and feel better in the winter. We still don't know why the summer triggers depressions regularly in some people -- perhaps it's the intense heat or maybe too much light. People with this type of depression often have symptoms that are different from those with Winter-SAD. They often lose appetite, sleep and weight and are agitated rather than lethargic -- all opposite to the typical symptoms of Winter-SAD. In some ways the summer-SAD is more dangerous than the winter version because those who suffer this malady are more likely to feel suicidal (which may go along with their feelings of agitation). Although it may be helpful to avoid heat (for example, by staying in air-conditioned rooms) and too much light (for example, wearing wrap-around dark glasses), the mainstay of treatment is starting antidepressant medications early and staying ahead of the curve as the summer progresses, thereby preventing the depression from deepening. Needless to say, this necessarily involves getting a qualified professional on board.

Mania and Hypomania

People with bipolar disorder tend to have problems with being over-activated, irritable and angry in the summer. Although many people think of mania as a state of excessive elation and exuberance -- which may occur -- that is often not the case. The agitation, restlessness and sleep loss that occur with hypomania (a less severe form of mania) often come along with a short fuse and a bad temper -- or suppressed anger in those able to restrain themselves.

Again, avoiding intense light is a key form of treatment (short of medication, which may also be necessary). Once again, this can be accomplished by dark glasses, along with avoiding light in the early morning and late evening. Blackout curtains may be helpful to prevent the rays of dawn from waking people too early; and dimming indoor lights (no more than one 60-watt bedside lamp and no bright computer screens) after 9 p.m. may also be helpful.

Winter-SAD in Summertime

This summer has introduced me to a form of summer distress that I had not previously considered: Winter SAD in summer. An apparent paradox, which I first encountered when Miranda, a long-standing patient of mine, stopped by for a routine office visit.

Miranda is a professional in her mid-50s who has suffered for many years from typical seasonal affective disorder (SAD) between October and March. Since it is now high summer, I expected her to be doing well, but I was wrong. She complained of all the typical symptoms of her winter depressions: glum mood, low energy, a desire to curl up on her couch in front of the TV, and a serious case of the munchies -- "everything that isn't nailed down," as she put it. To make matters worse, she said, although she expects to feel this way in the winter and has a whole regimen in place for dealing with her winter SAD symptoms, she was utterly unprepared for them at this time of year when she typically feels at her best.

"What could be going on?" we both wondered.

Now, I have certainly seen winter-SAD occur in summer or at any time of year when the weather is unseasonably foul. That's how many people with SAD must be feeling in London, where they have been having one of the rainiest summers in living memory. That and all the unpleasantness of having the Olympic Games in one's backyard is causing many Britons to complain much more than usual, according to a recent article in the New York Times.

Here in the United States, however, we are having one of the hottest summers on record with blazing cloudless skies. So, why should anyone be developing SAD? As I thought about the matter and discussed it with Miranda, the reason became clear. Miranda could not tolerate the hot days, so she was spending her time mainly indoors out of the sunlight. To make matters worse, she was keeping the blinds drawn so as not to put too much strain on the air conditioning system. In other words, she was creating winter lighting conditions in mid-summer. To test this theory, I suggested that Miranda use light therapy each morning as she does in the winter, though not for as long (10-15 minutes instead of 30-45 minutes). It worked, and within a few days, Miranda felt her happy summer self again. She plans to keep using the lights until outdoor temperatures settle down and she is able to get outdoors again.

Bottom line for those of you with winter-SAD: It is not simply a winter condition -- it is a light-deficiency condition. Any time the light levels fall too low -- even in midsummer -- you are at risk for symptoms.

Wishing you Light and Transcendence,

Norman Rosenthal

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

2012-08-06-WinterBlues.jpg To pre-order the newly-revised fourth edition of Winter Blues, Everything You Need to Know to Beat Seasonal Affective Disorder -- Click Here.

For more by Norman E. Rosenthal, M.D., click here.

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