Summer is upon us, bringing longer and warmer days and more sunshine. While many people look forward to the start of summer, for some of us, the summer can be a time when we do not feel our best. Do you or someone you know experience increased anxiety, low mood, or sleep disturbances in the summer months?  There are several potential reasons. I will review some of them and how you might assess and address them to support your mood and sleep this summer. 

You might be familiar with Seasonal Affective Disorder (SAD) - a cyclical depression that occurs in some people during the winter months where disturbances to our biological clocks related to shifts in melatonin and serotonin production lead to a seasonal depression that generally lifts with the coming of Spring.  

There is a less common variant of SAD called Reverse SAD. With reverse SAD., individuals generally feel well in the cooler, shorter winter days but tend to become more agitated and sleep disturbed during the warmer months.  The mechanism for reverse SAD is not well understood. Still, it is thought to relate to disruptions in the circadian rhythm, possibly brought on by staying up later, combined with insufficient exposure to darkness at night (e.g., from screens and lights in the bedroom). Both suppress melatonin levels and contribute to disrupted sleep which can drive anxiety and some degree of agitation. There are additional reasons why people may experience a downturn in energy and mood in the summer, not directly related to reverse S.A.D, which I also discuss below.   

As always, if your symptoms are severe or worsening, please seek an evaluation by a health professional.

Factors Contributing to Summertime Depression

Light exposure. Too much or too little. It is important to have balanced exposure to natural light and darkness. I wrote more about this here

If the longer days of Summer are leaving you feeling more agitated and anxious, it may be that your body is responding to much more light exposure than it is used to.  Hot weather and warm temperatures at night can further contribute to feelings of restlessness and agitation as the warmer temperatures may impair the natural fall n body temperature that helps to support sleep.

On the flip side, regardless of the season, many of us spend most of our time indoors. The level of indoor light, even in a well-lit office space, cannot come close to equaling the level of sunlight exposure when you are outside, even on an overcast day. This natural light exposure is essential for setting our body clock that orchestrates the symphony of hormones and chemical messengers that support alertness during the day and bring on the desire for sleep at night.  This can leave you feeling groggy and fatigued. 

Social Pressures and Anxiety. With the pandemic, many of us spent more time alone. It can be challenging to get used to being in large social settings.  But as the weather warms up, there are often more activities and social gatherings.  This can bring more opportunities and perceived pressure to attend gatherings and socialize.  Heightened anxiety levels can contribute to increased cortisol levels that may impair sleep, causing daytime fatigue and driving inflammatory processes in the body.  

Vitamin  D Deficiency. It is well-recognized that Vitamin D plays an important role in supporting a balanced immune response.  Low Vitamin D levels are associated with an ever-increasing array of health conditions, including Diabetes, Hypertension, and increased risk of some cancers and autoimmune conditions. Evidence supports an association between low vitamin D levels and several conditions that impact sleep quality, like chronic pain and sleep apnea. While natural light exposure is the main way to obtain vitamin D, modern lifestyle factors make adequate exposure more difficult. Half of the American population is estimated to have vitamin D deficiency or insufficiency.

Hidden Sources of Inflammation. Inflammation means immune system activation. This response may be protective and self-limited as in the case of trying to fight an acute infection or the repair of an injury.  However, with ongoing exposure to “hidden” threats, the body can become engaged in a feed-forward loop of continuing inflammation.  These “hidden” threats that elicit a strong inflammatory response may be from ongoing exposure to food that one is sensitive to, chronic emotional stress, or chronically disrupted sleep. Depression and Fatigue are conditions that both have strong associations with inflammation. 

So what can be done?

• Get some bright (preferably) natural light exposure early.  If possible, try to get outside in the early part of the day, ideally within an hour or so of waking.  If you can sit outside for a few minutes,  good. If you can take a morning walk, even better. If getting outside for natural light is not feasible or you are just able to do it for the briefest of moments, consider supplementing with bright light therapy.  These devices are much more affordable and compact than they used to be.  This is the brand that I use.*

• Keep your bedroom dark and cool at night, and stay off screens ideally for a few hours before bed. 

• Be kind to yourself.  A lot of the stress that we experience often comes from self-judgment and the sense that we “should” be or feel differently than we are.   Show yourself the kindness and compassion that you would show a good friend who might be dealing with a similar issue.  The paradox is that self-acceptance often makes it easier to move through resistance.  

• Know your numbers and get in range. Know your vitamin D level, and if it is in the deficient range (<20 ng/mL) or insufficient range (<30 ng/mL),  you likely would benefit from supplementation to bring it into the normal range.  You can chat with your healthcare provider to discuss the dose and a plan to recheck after a period of supplementation.  Liquid forms of vitamin D are often better absorbed than capsules or pill forms. Many people require some ongoing level of supplementation to maintain their levels.  Vitamin D is generally safe, but it can be important to ensure that if you are supplementing, you are doing this in the setting of adequate amounts of certain other important nutritional co-factors (aka helpers) for Vitamin D.  A functional medicine practitioner can assist you with this evaluation. Also, remember that Vitamin D has many benefits, as does natural light. Try to get adequate amounts of both. 

• Be observant of hidden sources of inflammation and support digestive health. Do you experience frequent digestive issues, painful monthly cycles, or achy joint aches? These are a few signs that you may be dealing with potential sources of chronic immune system activation. The first step is recognizing the symptoms. From here, it is possible to undertake various approaches to support and improve digestive health.  Impaired digestive function is often a common source point that drives a more generalized inflammatory response. 

Could you use additional support? Determining which of the above factors or others may impact you can be challenging to figure out on your own.  You do not have to figure it out on your own.  Dr. Winbush is available to support you and offers tailored approaches to answer questions and create actionable and sustainable plans to meet your health and wellness goals. 

You can learn more at sankofahealingarts.com

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 Yours in healing and solidarity, 

Nicole Winbush, M.D.
Dr. Winbush founded Sankofa Healing Arts & Functional Medicine, an interdisciplinary healing practice based in Durham, North Carolina. Through this practice and aligned partnerships, Dr. Winbush seeks to support others in their goals for their health and well-being and doing so in ways that are easeful, ecological, and enduring.  You can follow her at @sankofahealing on Instagram.

*provided for informational purposes. I have no relationship with this company.