By Dr. David Woo - July 24, 2023

Depression can affect anyone, at any time, but for some of us, a low mood with depressive symptoms tends to coincide with specific times of the year. This is related to what is known as seasonal affective disorder (SAD), a condition that affects, on average, 5% of the US population during any given year (1).

Although the popular imagination associates depression with the darker, colder winter months, seasonal depression can also impact our mental health in the summer.  In order to understand what is seasonal depression, we need to know a little about how the environment affects our brains.

Is Seasonal Depression Real?

Absolutely. Not only is SAD clinically classified in the Diagnostic Manual of Mental Disorders (DSM-5) as a type of depression, but the National Institute of Mental Health also notes specific symptoms for summer-pattern seasonal affective disorder, a.k.a. summer seasonal depression, which people experience near the end of spring or in early summer (2,3).

The symptoms of SAD have been linked to a biochemical imbalance in the brain that can be triggered by our circadian rhythm (the body’s internal clock) being disrupted by changing daylight hours or temperatures. Research suggests that sunlight helps our body regulate the production of important chemicals such as serotonin (which stabilizes our mood) and melatonin (which affects our sleep). In the case of winter SAD, a lack of vitamin D, which helps produce melatonin, can also be a contributing factor.

People with summer depression may experience disrupted thermoregulation (the body’s control of heat) which in turn affects their mood. The heightened levels of heat and humidity during the summer can disrupt one’s levels of norepinephrine, dopamine, and serotonin—all brain chemicals related to thermoregulation as well as mood regulation (4,5). Seasonal allergies may also play a role, as several studies have found a link between pollen and depression (6,7).

What Are The Symptoms Of Seasonal Depression?

SAD symptoms will regularly manifest during certain times of the year for around three to four months. Since SAD is a type of depression, the signs and symptoms associated with this disorder are similar to those of major depression and include:

• Persistent feelings of sadness or hopelessness
• Irritability 
• A loss of interest in normally enjoyable activities
• Difficulty concentrating

Depending on whether you are experiencing summer-pattern or winter-pattern SAD, certain symptoms may vary. Typical symptoms of summer-pattern SAD include:

• Symptoms of anxiety with depression, called anxious depression 
• Insomnia
• Poor appetite
• Weight loss
• Episodes of increased agitation or even violent outbursts

Whereas winter-pattern SAD is typically characterized by:

• Oversleeping
• Overeating, possibly leading to weight gain
• Withdrawal from social situations

TMS For Seasonal Depression 

Whether you are experiencing the winter or summer form of seasonal depression, it is crucial to seek help as soon as possible. Even if your symptoms may recede with the changing of the seasons, it is important to take care of your mental health in the long term. SAD is treated the same way as regular depression, i.e., with talk therapy or pharmaceutical antidepressants.

If antidepressants do not achieve satisfactory results, then transcranial magnetic stimulation (TMS) may be a good option for you. TMS is a non-invasive, FDA-approved treatment for depression that has been shown to relieve the symptoms of SAD in patients who have proven resistant to medications. In TMS, patients are treated with a head-mounted device called a coil that uses tiny electric pulses to target the areas of the brain associated with depression symptoms, stimulating nerve cells that regulate your emotions and overcome depression.

If you experience depressive symptoms at any time of the year, TMS may help you find relief. Madison Avenue TMS & Psychiatry provides talk therapy and TMS for treating depression and other mental health conditions. To make an appointment for consultation or treatment, contact us online or call (212) 731-2033.

Sources:

1. Seasonal Affective Disorder (SAD). American Psychiatric Association. 2020. Link. Accessed June 17, 2023.
2. Cotterell, D. Pathogenesis and management of seasonal affective disorder. Progress in Neurology and Psychiatry. 2010;14(5), 18-25. Link. Accessed June 15, 2023.
3. Seasonal Affective Disorder. National Institute Of Mental Health. Seasonal Affective Disorder. Publication Date Unknown. Link. Accessed June 15, 2023.
4. Chauhan NR, Kapoor M, Prabha Singh L, et al. Heat stress-induced neuroinflammation and aberration in monoamine levels in hypothalamus are associated with temperature dysregulation. Neuroscience. 2017;358:79-92. Link.  Accessed June 17, 2023.
5. Lõhmus M. Possible biological mechanisms linking mental health and heat—a contemplative review. Int J Environ Res Public Health. 2018;15(7):1515. Link. Accessed June 17, 2023.
6. Postolache TT, Lapidus M, Sander ER, et al. Changes in allergy symptoms and depression scores are positively correlated in patients with recurrent mood disorders exposed to seasonal peaks in aeroallergens. ScientificWorldJournal. 2007;7:1968-1977. Link. Accessed June 17, 2023.
7. Manalai P, Hamilton RG, Langenberg P, et al. Pollen-specific immunoglobulin E positivity is associated with worsening of depression scores in bipolar disorder patients during high pollen season. Bipolar Disord. 2012;14(1):90-98. Link. Accessed June 17, 2023.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.