Sad in the Summer: Has COVID-19 Made It Worse?

During the winter, many who live in the northern tier of states long for the warmth of summer sunshine and the joy of going outside without spending 15 minutes putting on warm outdoor clothes and boots. But this year the reverse may be true. The very hot days of this summer, interspersed with too frequent thunderstorms, tropical storms, and hurricane warnings are eroding our delight in this season. And with the persistence of COVID-19, summer lemonade seems to be turning back into lemons.

Wearing masks, as we must, can make our face feel as if it is in a sauna and add to our physical discomfort. The casual social events that we yearned for as we endured the worst of the winter are rarely possible right now. If we gather for a backyard barbecue we have to be vigilant about social distancing. Casual sports are widely prohibited if they include physical contact. And this avoidance of physical contact extends to members of our family and friends whom we used to visit during the summer months.

Cooling off by going to a body of water, be it a wading pool or ocean, may be putting ourselves at risk if others don’t wear masks and practice social distancing. (Sharks near the beaches don’t help either.) Those who decided against returning to their air-conditioned gyms and yoga classes because of fear of sharing space with members who may be infected, but not symptomatic, now must try to exercise despite heat and humidity. The summertime entertainments have vanished. Fewer concerts, plays, or sporting events are available. Going to a botanical garden is by appointment only. And as the days pass, we realize that this week we were to have taken a long-planned vacation. But not this year.

So is it any wonder many of us are depressed, sad, and take little pleasure in daily activities? But for some, even if this were a normal summer with expected temperature readings, trips to the beach, cookouts and outdoor activities available, the depression would still be present. It is called seasonal summer depression.

Most of us are aware of a seasonal depression that starts during the late fall when the sun sets much too early and clouds, rain and/or snow reduce ambient sunlight even more. Fatigue, overeating, depressed mood, increased hours of sleep, and social withdrawal are some of the symptoms of Seasonal Affective Disorder and they may last until the longer days of spring. Exposure to light that mimics the light spectrum of sunlight was shown many decades ago to help when a patient sat in front of special lights upon awakening. Antidepressants that increase serotonin activity is also used as a therapeutic intervention.

Soon after identifying a seasonal depression associated with the decrease in sunlight of winter, scientists found its mirror image in a depression that occurs during the summer. Loss of appetite and insomnia are typical symptoms, along with depression and anxiety.

According to the National Alliance on Mental Illness (NAMI), the occurrence of summer depression is significantly lower than that of winter depression. But like the winter variant, it will go away as the seasons change.

A review of studies on summer depression by Batya Yasgur in Psychiatry Advisor suggested that heat and humidity, or increased hours of sunshine, might be a possible cause for the depression, anxiety and behavioral changes. In one study, there was an association between weeks of high temperatures and humidity, and an exacerbation of mental illness. The author suggests that a possible cause might be an inability of neurotransmitters to regulate body temperature.

A 40-year retrospective study of suicide among more than 69,000 individuals in Austria was linked to the first appearance of sunshine after days and weeks of cloudy weather. Suicide rates went up during the first 10 or so days of sunshine, but after the sun had been shining for many days, the rate of suicide decreased. The authors of this study suggest that persons with major depression may become agitated and impulsive when first exposed to the sun after months of its absence, and this could explain an increased suicide risk. Suicide attempts, although relatively rare, have also been described in patients with winter seasonal depression during the early stage of bright light therapy. In the long term, however, sunshine, similar to antidepressants, improves mood, and thereby may contribute to decreased suicide.

But were those patients referenced in these studies suffering from a seasonal depression that occurred during the late spring and summer or depression in general? According to the definition of seasonal summer depression, it must begin approximately the same time every year, last at least two weeks, and show the symptoms specific for this type of depression. This seems to eliminate heat and humidity as factors, and point to the long hours of sunshine as triggering its onset. And it also eliminates the many situational reasons for depression and anxiety, although these of course can exacerbate it.

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Other than moving to the southern hemisphere during our summers, most therapies suggested for this seasonal depressions are either not specific for this disorder (cognitive behaviorial therapy, antidepressants, etc.) or based on common sense (darkening shades avoiding sunshine during the brightest time of day, wearing sunglasses, and attempting to follow a winter pattern of awakening and sleep). The good news about summer depression is that it will likely disappear when the hours of daylight become noticeably shorter. The bad news is that the other reasons for feeling depressed may not.

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