August 13, 2002 (The New York Times News Service) --
No one looks forward to spring more than people with seasonal affective disorder, who grow depressed in the waning light of winter. A smaller group of people, however, suffer on the opposite side of the calendar.
Consider Violet Adair, a 39-year-old artist in Oakland, Calif., who gets ready for summer by filling plastic bottles with water. "I'll put them in my freezer and I'll sleep with them," she said. "I'll sleep hugging a 2-liter Pepsi bottle filled with ice."
These makeshift cooling devices help her cope with the distress that has come upon her each summer for roughly a decade. This year, she is going a step further.
Many of the rooms in Adair's loft are windowless, and she plans to paint the walls blue and aqua. She will hide out in these darkened chambers, equipped with a fan, avoiding the outdoors as much as possible until the nights again grow long.
At least Adair knows what she has: summer SAD, also known as reverse seasonal affective disorder. About 5 percent of adult Americans are thought to have winter seasonal affective disorder; researchers estimate that fewer than 1 percent have its summer variant.
Because it is a fairly esoteric condition whose origins are unknown, many people who become depressed in the summer may not realize they have SAD. They may simply think of their bouts of depression as new events rather than part of a pattern.
"We've kind of de-seasonalized ourselves as much as possible," said Thomas Wehr, a research psychiatrist at the National Institute of Mental Health and an expert on seasonal affective disorder. "You know, we turn the lights on after dark, we turn the heat on in winter, we turn the air-conditioning on in summer and you could almost not notice. We tend to think more in a linear way rather than in a cyclic way."
As with depression generally, more women than men appear to suffer from this condition, at a ratio some estimates put as high as 2-to-1. It is most common among women in their reproductive years, but its onset sometimes comes as early as childhood. Researchers think it may also have a genetic component; more than two-thirds of patients with SAD have a relative with a major affective disorder.
The symptoms of the two forms of the disorder often vary, heightening the confusion. People with the more common variety typically feel lethargic in the colder months, crave carbohydrates, gain weight and sleep excessively. Those afflicted during the summer often experience agitation, loss of appetite, insomnia and, in extreme cases, increased suicidal fantasies.
The cause may differ as well. Seasonal depression in the winter seems linked to increases in the production of melatonin, a chemical that helps set the brain's daily rhythm, set off by the decrease in light.
But "the seasonal trigger for the summer depression is less clear-cut," said Dr. Norman E. Rosenthal, a Washington psychiatrist and the author of "Winter Blues." "Conventionally, the thought has been that they are more sensitive to the heat - the question of whether it's too much heat or too much light has yet to be resolved."
Reports of summer seasonal affective disorder are often more frequent in hotter regions. A study published in the journal Comprehensive Psychiatry two years ago found that the rate of summer SAD among a group of students in Jining, 200 miles northwest of Beijing, exceeded that of students with the winter disorder. Similarly, epidemiological data in the United States have shown a higher proportion of people in the South depressed in the summer. In addition, the proportion rises as the latitude diminishes.
When moods deviate, Rosenthal said, the systems geared toward normalizing them generally take action. In seasonal affective disorder, he said, "The challenges encountered with changing seasons seem to overwhelm those internal regulating mechanisms."
Rosenthal and Wehr first identified winter SAD in 1984. Their findings prompted queries from many people who said they also felt depression, but in the summer.
To explore the summer disorder, Wehr manipulated patients' body temperatures. People with severe depression, he said, tend to have higher temperatures at night; among healthy people, temperatures tend to drop. Antidepressants have been shown to lower brain and body temperature.
Wehr tried to cool down patients with a kind of reverse thermal blanket, carefully making sure the environmental drop in temperature would not cause shivering as a defense against the cold. Once the treatment was over, however, the patients walked out of the building into summer heat, their body temperatures rose and the symptoms of their depression returned. The effect of re-entering a hot summer environment undid whatever effect the treatment might have had.
Like Adair, many summer SAD patients have developed strategies for combating symptoms. Air-conditioning seems to help some but not others, the doctors say. One man is meticulous about spending his time in air-conditioned environments, going from apartment to parking lot to office and back again. Another person takes frequent cold showers. A woman reportedly swam daily in the English Channel where the cold water gave her respite.
For many, the only reliable defense against summer is pharmacological.
A designer in Northern California in her early 50s takes a combination of mood stabilizers and a small dose of antidepressants throughout the year. Before summer begins, she increases the dosage as needed in consultation with her doctor.
She also is careful about staying inside - a frustrating challenge, she says, since she considers herself an outdoors person. She first suspected a seasonal link to her depression in her 30s, and became more attuned to it after she was diagnosed with bipolar disorder around age 40. She thinks it is the light more than the heat that affects her; she feels frantic and depressed as spring ends.
"I actually feel kind of attacked by the sun," she said. "I feel like it's piercing into me, and I start to feel more and more desperate to escape it. I have a hard time organizing and managing daily life. By August, I'm barely able to function and don't really recover until autumn."
"October is reliably a good month," she added. "I'm waking up, and I feel like I'm being released from my summer, what I would call, jail cell."
Copyright 2002 The New York Times News Service. All rights |
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