Spring, traditionally considered the season of hope and renewal, actually can lead to despair for many depressed people. Statistics show that hospital admissions for alcoholism and depression peak in the spring, more shock therapy is given during these months, and April has more suicides than any other month.
Area therapists, too, say spring brings them substantial number of new patients.
"I think what happens is that people will feel badly through the winter, and then when spring comes, they expect to feel better," says Dr. Alan Savitz, psychiatry chairman at Greater Southeast Community Hospital. When they don't, "there is disappointment."
Savitz believes that people with a predisposition for depression are at a greater risk for suicide in the spring because the contrast between the way they feel and the way the world looks can aggravate an already serious disorder.
"The thought is that everyone else in the world is fine now and I feel badly," Savitz says. "What they forget is that they felt just as badly last week."
People subject to winter depression, termed SAD (seasonal affective disorder), are thought to be sensitive to the light deprivation that takes place as the days grow shorter and darker. Although these people are generally considered higher risk candidates for spring depression, experts say that SAD is mild by comparison.
"Those people tend to feel sleepy and crave carbohydrates," Savitz says. "It's not the same intense kind of depression that leads to suicide."
If light deprivation in winter can cause depression in some people, then it's possible that sudden changes in light exposure as the days grow longer and sunnier in spring can contribute to depression in others.
One theory, says Dr. Norman Rosenthal of the National Institute of Mental Health, is that "there are people whose physiologies cannot change with the climate." Perhaps discrepancies between the rate at which the seasons change and the rate at which certain people's bodies adjust to those changes trigger seasonal depression.
Rosenthal believes that the usual psychological reasons given for spring depression, such as an increased sense of isolation and hopelessness, are symptoms of the problem, rather than causes of it. "Since this is a phenomenon that has been documented in every hemisphere of the of the world, I think there is likely to be a physical explanation," he says.
But while most mental health specialists agree that spring depression does have some physiological factors, not everyone believes, as does Rosenthal, that the problem is entirely biologically based.
"It's certainly true that chemistry can change thoughts, but it's also true that thoughts can change chemistry," says Dr. Lawrence Sank of the Bethesda-based Center for Cognitive Therapy. "For instance, if I tell someone they have a spider crawling up their neck and they believe me, that can change their chemistry."
But brain chemistry also can change when a person has a distorted view of reality. That, Sank says, can cause depression.
The high expectations that people have in spring often aggravate these distortions. Therapists try to teach clients to recognize the distortions and acquire a more realistic view of the world, but it doesn't always work.
"I get depressed in the spring for three reasons," reports one man. "First, everyone is in love except me. Second, everyone feels good except me. Third, everyone looks good in shorts except me."
All three are common distortions, Sank says. "Springtime is a time of opportunity, and those who don't perceive themselves as having any opportunities feel especially bad."
Spring is also supposed to be a time of romance. People who are alone tend to feel more alone than usual.
And although no conclusive evidence exists to indicate that the human sex drive undergoes any radical changes in spring (Dr. Franz Halberg from the University of Minnesota discovered that testosterone levels peak in late summer and fall), it may appear that everyone is falling in love in spring simply because couples become more visible as the good weather brings them outside. Confronted with them, depressed people who are alone often experience heightened feelings of isolation.
Those who are not alone may also suffer from spring depression. Statistics show that the divorce rate rises between January and April and therapists report an increase in the number of patients with marital problems during those months.
Sometimes, says Dr. Carolyn Shaffer, also of the Center for Cognitive Therapy, a relationship that is tolerable in the winter may become unbearable in the spring.
"I see people who are unhappily married, and spring is a difficult time for them. It's tolerable in the winter that there's no love in their marriages, but now the paucity of their relationships becomes much clearer to them. Spring can provide the incentive to leave a bad relationship."
If a bad relationship can look worse in the spring, so too can a good one. With the arrival of good weather, depressed people often realize that they can no longer blame their problem on the bleakness of winter. They therefore look around for something else to blame, frequently focusing on their lovers or spouses.
"People are looking for a new excuse," says Savitz. "Now it's not the world, it's my spouse."
One difficulty, explains Savitz, is that people who don't feel good about themselves often don't appreciate their relationships. "They have that old Groucho Marx thing of not wanting to belong to a club that would accept them as a member. They think, 'Anyone who would marry me must have big problems.' "
Even so, any relationship may be better than no relationship for some depressed people.
In a study currently being cosponsored by NIMH's Center for Affective Disorders and the Center for Disease Control, preliminary data indicate that married people are at less risk for depression leading to suicide than their unmarried counterparts. This holds especially true for the elderly.
Another contributor to spring depression, especially among women, is the belief that looks determine worth.
"People start panicking if their bodies aren't perfect," says Shaffer, "Bathing suit season is coming and they feel disgusting. Also, depressed people may have gained a lot of weight over the winter, and they don't have to face that until spring comes and they have to wear different clothes."
"I dread taking off my coat," admits one young woman with a history of depression. "Whenever we have a freakish cold spell, I feel like I've been granted a reprieve."
Women whose problems tend to be related to body image (eating disorders, etc.) are particularly susceptible to this kind of thinking. "And nobody looks perfect," says Savitz. "A person with this could look like Christie Brinkley and be unhappy."