Hi Dr. Kim, I have heard about Winter depression, when people have a sad spell in Winter and come to life again in the Spring…but what is it called if you feel depressed at the end of Summer, or when there is a seasonal transition? Every year, like clockwork, I feel down at certain times. I plan for it to manage my stress but no matter what I still feel blue. Sometimes I have low energy and can barely function. My family says that I seem “flat” at those times and honestly that’s how I feel. What is this and what can I do about it? -Jim from Johnson City

Hi Jim, I’m sorry to hear that you have these blue times. We all go through them at some point in life, but if it is a regular pattern that you are experiencing, it could be a  medical condition known as Seasonal Depression, or Seasonal Affective Disorder (SAD). Summer depression can be part of Seasonal Affective Disorder. It isn’t all “in your mind,” either. Factors of nutrition, stress, serotonin levels, and sleep patterns all affect our mood stability. When one area of life overwhelms another, job demands taking away from family time or personal time, for example, our brain looks for ways to cope with the imbalance, and the extra emotional load can turn into depression. There is not anything strange about experiencing Summer depression rather than Winter depression. Some research shows that people who live closer to the equator, in hot or tropical climates, are more likely to experience depression in the Summer.

Summer Depression tends to look like: anxiety, worry, trouble sleeping, lack of energy, confusion, and perhaps weight loss or loss of appetite. Feeling overwhelmed or overburdened is common with Summer Depression.

Winter Depression has qualities of: sadness, lack of enthusiasm, tiredness, oversleeping, weight gain, or wanting to over-eat. Sufferers of Winter Depression may describe themselves as “profoundly sad” or “hopeless at times.”

When Seasonal Affective Disorder was first studied, there seemed to be a correlation between less sunlight and longer nights in the Winter time reducing serotonin in the brain. However, a second look is showing the medical community that it isn’t about just seeing less sunlight: Any time of year a disruption in your natural patterns and cycles can bring on depression symptoms. Each season has its own stressors, especially Summer. When the expectation is that Summer should be a relaxed time of year, the reality is that in the heat of Summer, we are all still hard at work, big projects come up, and we are expected to be out and about more often, because come on…the weather is nice! Or is it? Heat and humidity actually contribute to ‘“flare ups” of many medical problems. They contribute more to sleep disturbances, and some people cannot bear heat and find that Summer is their Winter…they spend more time indoors and miss out on fresh air. Whatever the reasons, the advice is the same. Become aware of the times of year when you feel your best, and when you feel your worst. An exercise for building this awareness is to make a simple rectangular chart. Divide it into six sections: Early Spring, Late Spring, Summer, Late Summer, Fall, and Winter. Think carefully about last year. When did you feel your best? Worst? Do the same for the year before that. Last, think about this year. If we are in Fall, now, how did the parts of Spring and Summer feel for you?

And then think about your symptoms. Having recurring symptoms at the same time every year is the hallmark sign of Seasonal Affective Disorder. Symptoms to watch out for include: Feeling sad, “down”, depressed, weepy, or anxious each day, with the feeling lasting almost all day. Feeling “blah” with a lack of enthusiasm, loss of interest, or a lack of a sense of fun, humor, or joy. Having low energy: Things you would normally find easy seem insurmountable, too hard, or you feel that you “just can’t make it happen”. Feeling agitated, anxious, or emotionally disturbed about situations that wouldn’t normally be a problem, or for no reason at all. Sleep problems, difficulty concentrating, and weight going up or down may be part of the picture. Men and women can experience depression differently, so whenever these kinds of problems come up, I tend to think about hormones and male/female physiology.

If you are a man, you may feel overburdened by responsibility. You may have difficulty concentrating if you are depressed and notice that you’re not doing as much as you used to, or as much as feels normal for you. You might experience weight gain or a lack of libido and performance. Perhaps you don’t have the energy to engage emotionally with your partner, and having a simple conversation feels like work. If your testosterone and estradiol levels come back in a normal range, speak to your provider about seasonal depression.

If you are a woman, you might be consumed with worry about your family’s well being or overwhelmed by juggling life’s details. Perhaps you are worried about going through menopause, or feel that your hormones just aren’t right. You might be stuck in the grey area with a desire for romantic connection on one hand and a lack of libido on the other. If your estrogen and progesterone levels were normal, and there is no sign of menopause, seasonal depression may be the cause of your woes.

Seasonal Depression can look similar to hormone imbalances, because part of the physiology of depression is hormonal in nature. Reduced levels of serotonin, a neurotransmitter that controls sleep cycles and mood, can contribute to feelings of depression. Melatonin, the hormone that produces restful sleep, is usually elevated in seasonal depression. If serotonin is imbalanced, melatonin usually is also.

Important actions to take if you think that you may have Seasonal Depression are: Speaking with your health care professional regularly. Seeking counseling to address unresolved emotional issues and manage stress. Sleeping and waking up at the same time each day whenever possible. Using good sleep hygiene practices, like turning off devices an hour before bed. Eating nutrient-dense foods like leafy greens, colorful vegetables, and healthy fats. Know that what you are experiencing is normal and even common. Take heart, because there is much you can do for yourself in this matter and many ways that your doctors and your family can help. The one gift of seasonal depression is awareness – of yourself and your health. Gaining awareness of the natural “high and low tide” is a valuable tool, and working with these tides rather than against them can help you live a more balanced life and create better health in the long term.

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Dr. Kimberly McMurtrey DNP, APRN, FNP-C is the Primary Provider at Tri Cities Health, located on West Elk Ave., Elizabethton. If you would like to submit a question for her to answer you can call 423-543-7000 or email your questions to tricitieshealth@outlook.com.

**Medical Disclaimer: The information contained in this column is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment.