Summer-pattern seasonal affective disorder: A case study and implications for primary care

Seasonal affective disorder (SAD) is most often recognized as a fall-winter subtype characterized by hypersomnia, hyperphagia, and anergia. Less commonly, patients experience a reverse presentation with spring-summer onset marked by irritability, insomnia, appetite loss, and psychomotor agitation. Pathophysiologic contributors to reverse SAD include circadian misalignment, neuroendocrine dysregulation, environmental stressors, and genetic susceptibility. Management requires a multimodal approach incorporating psychoeducation, psychotherapy (notably cognitive behavioral therapy [CBT]-SAD), pharmacotherapy tailored to symptom profile, vitamin D assessment, sleep hygiene, and lifestyle adjustments. Recognition of summer-onset depression is critical in primary care, as underdiagnosis may delay effective intervention. Rising global temperatures and prolonged light exposure underscore the importance of clinician awareness and proactive screening for reverse SAD to optimize patient outcomes. In this article, a fictional, illustrative case report describes a 35-year-old woman with a 3-year pattern of summer depression meeting DSM-5-TR criteria for major depressive disorder with seasonal pattern, summer onset. In this case, treatment with desvenlafaxine, sleep/environmental modification, and CBT leads to significant improvement.