Earlier this summer, I wrote about “summer SAD,” the very real worsening of mood, anxiety, agitation, and sleep that some people experience during the hottest and brightest months of the year.
After this weekend, I think the conversation needs to go further. Temperatures in the Sacramento area have exceeded 100°F, and over the past several days I have seen multiple previously stable patients experience abrupt and clinically significant psychiatric destabilization.
One patient with a history of a severe perinatal mood disorder, who had been stable enough to begin a very gradual medication taper, suddenly went two nights without sleeping and required an increase in medication. Another patient with bipolar I disorder experienced worsening mixed symptoms. A third experienced a marked increase in severe depression and suicidal thinking. My phone and email have been unusually busy as I have worked with patients and their families to stabilize symptoms safely in the outpatient setting, while continually assessing whether emergency evaluation or a higher level of care is needed…