When most people think about seasonal affective disorder (SAD) or seasonal depression, they think about the winter. Many folks dread the increasingly cold, long, dark days of fall and winter and look forward to better mental health in the spring and summer.
However, for some people, the opposite rings true. Enter: Reverse SAD.
Reverse SAD, or summer-onset SAD, is just as valid a disorder as traditional winter-onset SAD, although it’s less widely known and understood.
People who suffer from reverse SAD have a case of summertime sadness and feel depressed even though the days are long and the sun is shining.
SAD has a massive impact on mental health, and it can severely decrease someone’s quality of life, especially if they don’t seek treatment.
What is Seasonal Affective Disorder?
“Seasonal affective disorder is a type of major depression characterized by its recurrent seasonal pattern, most often fall or winter,” says Michelle Coleman, a licensed professional counselor specializing in depression with Grow Therapy.
There are two distinct types of SAD: winter-onset SAD, which is most common, and summer-onset SAD, also known as reverse SAD, which is rare.
“Typically, with [winter-onset SAD], symptoms start in the fall and continue into the winter months. These symptoms often resolve during the spring and summer months,” Coleman says.
Symptoms of seasonal affective disorder, regardless of the season of onset, include:
- A depressed or sad mood most of the time
- A loss of pleasure or interest in doing things you used to enjoy doing
- Trouble with concentration
- Feelings of guilt, worthlessness, or hopelessness
- Suicidal thoughts
Winter-onset SAD has some specific unique symptoms, too. Coleman says some other signs of winter depression include:
- Sleeping too much and tiredness
- Overeating, especially linked to cravings for carbs
- Gaining weight
- Feeling the desire to withdraw from others
Seasonal depression is not a one-time occurrence. It is recurrent.
In order to receive a formal diagnosis of SAD, per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), you must have experienced at least two years of depression following a seasonal pattern. The symptoms should have a distinct beginning and end. For example, someone with SAD may have symptoms throughout fall and winter and then feel significantly better during the spring and summer two years in a row. This clearly shows a pattern indicative of SAD.
People usually develop SAD during adulthood, and it affects 5% of adults in the United States every year. Those who live further from the equator and experience even fewer hours of daylight in the winter are at an even higher risk of having winter-onset SAD.
What is Reverse SAD?
Reverse seasonal affective disorder, also known as summer-onset SAD, is essentially the opposite of traditional winter-onset SAD. It accounts for only 10% of instances of this disorder.
While people with winter SAD fall into a depression when the days are shorter, colder, and darker, it seems that people with reverse SAD enter their deepest depression in the spring and summertime when there are high temperatures and longer days.
In the case of reverse SAD, Coleman says people’s symptoms will appear in spring or early summer and resolve during the fall or winter. The condition may start out mild and become more severe as the summer goes on.
To be diagnosed with summer SAD, someone must have had at least two consecutive years of depression with a seasonal pattern. People with this pattern will experience symptoms in the spring and summer and then feel significantly better in the fall and winter.
Symptoms of Reverse SAD
For the most part, the overarching symptoms of SAD, such as a depressed mood and lack of interest in activities, are the same regardless of the season of onset. However, just as there are some unique identifying symptoms for winter-onset SAD, there are also some different signs for those who have reverse SAD.
Symptoms unique to summer-onset SAD are:
- Anxiety
- Agitation
- Restlessness
- Insomnia
- Low appetite
- Weight loss
- Violent behavior
What Causes Reverse SAD?
Researchers do not know of an exact or definitive cause of seasonal affective disorder, including reverse SAD. However, there are some theories surrounding potential causes for winter-onset SAD, including:
- Serotonin activity abnormalities: Serotonin is a neurotransmitter (a type of chemical messenger in the brain) that is linked to mood. People with SAD may have lower serotonin activity during seasonal changes when there is less daylight.
- Too much melatonin: Melatonin is a hormone that plays a big part in regulating circadian rhythms, or sleep-wake cycles. People who have SAD might produce too much melatonin, contributing to sleepiness and fatigue characteristic of winter-onset SAD.
- Vitamin D deficiency: In the colder and darker months, people don’t get as much sun exposure, and therefore, they get less vitamin D. Vitamin D deficiency can lead to feelings of depression.
While these theories make sense for winter SAD, they don’t exactly explain the cause of reverse SAD.
More studies must be conducted specifically surrounding summer-onset SAD to further understand the mechanisms behind this unique pattern.
Preliminary research has pointed to a link between high pollen counts and mood. Researchers found that some people reported worsening moods when pollen counts rose, suggesting a seasonal pattern to the mood and predicting summertime SAD.
Additionally, certain risk factors could increase the chances of you developing SAD, including:
- Genetics: If you have a family history of SAD, another type of depression, or any other mental health condition, you are more likely to have SAD.
- Gender: Women are more likely to develop SAD than men.
- Co-occurring mental health conditions: Having a history of another mood disorder or mental health condition may make you more likely to have SAD. Examples are:
- Major depressive disorder
- Bipolar disorder
- Eating disorders
- Anxiety disorders
How to Treat Reverse SAD
Ultimately, we need further research to better understand reverse SAD and how to treat it. There is a larger body of research surrounding winter-onset SAD and its treatments, such as daily light therapy in the morning and vitamin D supplements. However, since lack of light exposure isn’t a contributing factor for reverse SAD, these treatments do not help in this case.
Hopefully, in the future, there will be a more specialized treatment for reverse SAD occurring in the spring and summertime.
However, for now, treatment options that can benefit summer-onset SAD are:
1. Therapy
Therapy with a trained mental health professional can help tremendously. Coleman says cognitive behavioral therapy (CBT) is particularly helpful for the treatment of SAD. CBT enables you to learn healthy ways to cope with SAD, such as reducing your avoidance behaviors, scheduling meaningful activities to look forward to, and changing negative thoughts that are making you feel worse, she says.
Depression often comes along with a lot of negative and unhelpful ways of thinking, but CBT can empower you to take control of this and teach you new ways to look at your situation. You might realize that you have negative beliefs or behaviors that are worsening your depression.
CBT will allow you to challenge these beliefs and come up with healthier thoughts. You’ll also learn coping skills to effectively manage difficult emotions and other useful tools like stress management techniques.
There is even a specific type of CBT known as CBT-SAD that is used for treating the disorder.
This modality pairs the basic principles of CBT with what’s known as behavioral activation. It’s common for depressed people to want to withdraw and not engage in activities they used to love.
Behavioral activation challenges this. The idea is that behaviors can improve your mood, and engaging in pleasant, healthy, and helpful activities – even if you would rather stay in bed – can boost your mood.
Make sure you choose the right therapist for you who suits your needs. Opt for a therapist who specializes in depression for best results. Don’t be afraid to ask if they have experience treating reverse SAD or summer-onset SAD to get a better feel if they’re a good fit for you.
2. Medication
For people who experience severe reverse SAD symptoms, psychiatric medication may be an option.
Antidepressants are the most frequently prescribed meds for SAD. There are many different types of antidepressants available, and a psychiatrist can help determine which is the best one for you based on your medical history and symptoms.
Since it can take a few weeks for the effects of antidepressants to kick in, your psychiatrist might advise you to begin taking the medication shortly before your symptoms usually begin, if you have an idea of when your reverse SAD usually crops up. This will help prevent you from experiencing your usual symptoms or lessen their severity.
Lifestyle Changes
Small changes to your lifestyle and increased self-care can make a difference in improving your symptoms.
Some examples of beneficial lifestyle changes for SAD include:
- Exercising: Regular exercise is an excellent tool for boosting mood since exercise increases the body’s production of endorphins, hormones that improve your mood, Coleman says. Ideally, you should try to exercise for a minimum of 30 minutes three to five times a week for the best results.
- Eating well: Reverse SAD might cause you to lose your appetite, but it’s crucial to continue to try your best to eat healthy and balanced meals. Eating a healthy diet can aid in improving your overall physical and mental health if you struggle with depression.
- Getting enough sleep: Although reverse SAD can result in insomnia, it’s vital to get adequate sleep every night to optimize your physical and mental health. Adults should get at least seven hours of shut-eye each night. Insomnia can worsen depression, and vice versa, creating a vicious cycle. It is essential to address both.
- Staying social: SAD symptoms might make you want to isolate and avoid your friends or loved ones. However, withdrawing might worsen your depression. Maintaining social support is major for boosting morale and simply helping you when you’re feeling down.
- Avoiding alcohol and drugs: While it may be tempting to turn to substances for an “escape,” it isn’t the best idea. “These substances may make you feel better for a little while, but in the long term, they can make depression and anxiety symptoms worse,” Coleman says. You should especially use caution if you’re taking an antidepressant.
Dealing with either winter-onset or summer-onset SAD can be challenging.
Depression symptoms can cause you to feel sad, hopeless, and unmotivated, which can make seeking treatment feel even harder.
Summertime sadness doesn’t have to be your norm. It’s important to reach out for help if you’re struggling. “If you think you may be suffering from SAD, talk to your healthcare provider or a mental health provider about your concerns,” says Coleman. “SAD may be diagnosed after a thorough mental health exam and medical history completed by a psychiatrist or other mental health professional.”
