When Summer Isn’t Your Happy Season

For most people, summer is something to look forward to. Longer days, warmer weather, time at the cottage, vacations, and family gatherings all contribute to the idea that summer is the “feel-good” season.

But that isn’t everyone’s experience.

Some people notice that their mood actually worsens as the weather becomes warmer. They may feel anxious, restless, irritable, or unusually sad. Sleep becomes difficult, their appetite changes, and they find themselves withdrawing from activities they would normally enjoy. Instead of feeling energized by summer, they count the weeks until autumn arrives.

If this sounds familiar, you’re not imagining it.

Although most people associate seasonal depression with the darker months of fall and winter, mental health professionals also recognize a less common form that occurs during the spring and summer. Today, clinicians refer to this as Major Depressive Disorder with a seasonal pattern. Many people still know it by its former name—Seasonal Affective Disorder (SAD)—but current diagnostic guidelines describe it as a pattern of depression rather than a separate diagnosis.

Researchers are still working to understand why this happens. Unlike winter depression, which has been linked to reduced daylight, summer-pattern depression appears to involve a combination of biological vulnerability and environmental factors. Heat, disrupted sleep, changes in daily routines, and even the pressure to be out enjoying the season may all play a role. For some people, these factors create a perfect storm that affects both physical and emotional well-being.

The symptoms are much the same as those seen in other forms of depression. Some people experience persistent sadness, while others notice that anxiety and irritability are more prominent. Difficulty sleeping is particularly common, and many people find themselves feeling emotionally exhausted despite the longer days.

The important thing to remember is that depression doesn’t follow a calendar. If your mood changes predictably every summer, and those changes interfere with your relationships, work, or enjoyment of life, it’s worth talking with a mental health professional. Seasonal patterns can be identified, understood, and treated.

Treatment depends on each person’s needs but often includes psychotherapy, attention to sleep and daily routines, stress management, and, for some individuals, medication prescribed by their physician. Just as importantly, therapy can help people understand their own seasonal patterns so they can recognize early warning signs and develop strategies before symptoms become overwhelming.

Although summer-pattern depression is less common than its winter counterpart, it is no less real. You don’t have to force yourself to enjoy the season simply because everyone else seems to. With the right support, most people can learn to manage seasonal changes in mood and feel more like themselves throughout the year.

For help with summer depression contact Medipsy at info@medipsy.ca or 514 419-3005. 

⸻

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR).

Melrose, S. (2015). Seasonal affective disorder: An overview of assessment and treatment approaches. Depression Research and Treatment, 2015, Article 178564.

Rosenthal, N. E., & Wehr, T. A. (1987). Seasonal affective disorders. Psychiatric Annals, 17(10), 670–674.

Bipolar II Disorder: An Under-Recognized Illness Dominated by Depression

Bipolar II disorder is frequently mistaken for depression and often goes undiagnosed for years. Recent research suggests it is not simply a milder form of bipolar disorder but a distinct condition with its own challenges and treatment needs.

Editor's Note: This article is based primarily on a recent state-of-the-art review of Bipolar II disorder published in World Psychiatry in 2025, supplemented by current clinical knowledge and practice guidelines. The review synthesizes findings from a large body of research and informs many of the themes discussed below, including the predominance of depression in Bipolar II, the challenges of diagnosis, and current approaches to treatment.

---

Most people are familiar with the term "bipolar disorder." What comes to mind is usually dramatic mood swings, manic episodes, impulsive decisions, or psychiatric hospitalization. Yet this picture reflects only part of the bipolar spectrum. Many individuals with bipolar disorder never experience full mania. Instead, they live with Bipolar II disorder, a condition that is frequently overlooked because it presents very differently.

For many years, Bipolar II was viewed as a milder version of Bipolar I disorder. Recent research suggests a more nuanced picture. Although people with Bipolar II do not experience full manic episodes, they often spend far more time struggling with depression, and the overall burden of illness can be substantial. Increasingly, experts view Bipolar II not as a less severe form of bipolar disorder, but as a distinct condition with its own clinical characteristics, challenges, and treatment needs.

A Disorder Defined More by Depression Than Hypomania

The formal diagnosis of Bipolar II disorder requires a history of both major depressive episodes and episodes of hypomania. The term hypomania literally means "below mania." It refers to a period of increased energy, activity, confidence, or mood that is noticeable but does not reach the severity of a full manic episode. Unlike mania, hypomania does not typically cause profound impairment, psychosis, or the need for hospitalization.

This distinction may seem unimportant, but in practice it creates a diagnostic challenge. Many people do not experience hypomania as a problem. In fact, they may remember these periods as times when they felt unusually productive, creative, sociable, or capable. They may need less sleep, take on multiple projects, and feel more optimistic than usual, yet remain functional enough that neither they nor those around them view the experience as an illness.

Depression is another matter. Depressive episodes are often prolonged, distressing, and disabling. As a result, individuals with Bipolar II typically seek treatment because of depression, not because of hypomania.

One of the most striking findings from recent research is just how heavily weighted the illness is toward depression. People with Bipolar II spend far more time depressed than hypomanic. For many, depression is the dominant experience of the disorder. This helps explain why Bipolar II is so often diagnosed initially as major depressive disorder.

Why the Diagnosis Is Frequently Delayed

Many adults diagnosed with Bipolar II report years of treatment for depression before the bipolar nature of their illness becomes apparent.

There are several reasons for this. Hypomanic episodes may be brief. They may occur infrequently. Some people simply do not recognize them as unusual. Others view them positively and therefore fail to mention them during clinical assessments.

The distinction is important because recurrent depression and Bipolar II depression do not always respond to treatment in the same way. Before the diagnosis becomes clear, many people are prescribed antidepressants because their symptoms appear indistinguishable from major depressive disorder.

Antidepressants can be helpful for some individuals with Bipolar II, particularly when used alongside a mood stabilizer. However, when bipolar illness is not recognized, antidepressant treatment alone may sometimes be ineffective, contribute to mood instability, or trigger hypomanic symptoms. For this reason, clinicians are often cautious about relying on antidepressants alone when Bipolar II is suspected.

A person who appears to have treatment-resistant depression may therefore, in some cases, have an underlying bipolar-spectrum condition that has gone unrecognized.

For clinicians, diagnosis often depends less on identifying symptoms in a single appointment than on understanding patterns that have unfolded over many years. A careful review of mood history, family history, sleep patterns, and changes in energy levels can reveal a picture that is not immediately obvious.

Why the Correct Diagnosis Matters

For many people, Bipolar II is initially diagnosed as major depressive disorder because depression is the most visible part of the illness. While this is understandable, it can have important treatment implications.

When Bipolar II goes unrecognized, treatment may focus exclusively on depression without addressing the underlying pattern of mood instability. An accurate diagnosis allows treatment to be tailored more appropriately. It can guide decisions about medication, help patients recognize early warning signs of mood episodes, and support strategies that promote long-term mood stability.

For many individuals, receiving the correct diagnosis is not simply a matter of putting a name to their symptoms, it is the beginning of a more effective approach to treatment.

---

Could Bipolar II Be Part of Your Story?

If you have experienced recurrent depression along with periods of increased energy, reduced need for sleep, unusual confidence, or changes in your activity level, a comprehensive assessment can help clarify what is happening.

At Medipsy, our clinicians provide evaluations for mood disorders, including bipolar-spectrum conditions, and can help you understand your symptoms and explore appropriate treatment options. If you would like a consultation or to learn more about our services, you can reach our coordinator Maria at info@medipsy.ca; 514 419-3005.

Is Bipolar II Really a "Milder" Illness?

Traditionally, Bipolar II has been described as the less severe form of bipolar disorder because it does not involve mania. While that description is understandable, it can also be misleading. The absence of mania does not necessarily mean the illness causes less suffering.

Research consistently shows that people with Bipolar II experience substantial impairment in work, relationships, and overall quality of life. Recurrent depressive episodes can interfere with education, employment, parenting, and social functioning. Many individuals struggle with symptoms for years before receiving an accurate diagnosis.

Perhaps most concerning is the finding that the risk of suicide in Bipolar II appears comparable to that observed in Bipolar I disorder. This is one reason many experts have moved away from viewing Bipolar II as merely a "less serious" condition.  The challenges are different, but they are not necessarily smaller.

What Do We Know About the Causes of Bipolar II?

As with most psychiatric disorders, there is no single cause.

Genetics do play an important role. Bipolar disorders tend to cluster in families, although researchers have not identified a single gene responsible for the condition. Instead, risk appears to arise from the interaction of many genetic factors, each contributing a small effect.

Modern neuroscience has also identified differences in the brain networks involved in emotional regulation, reward processing, and executive functioning. At the same time, researchers are exploring a range of biological processes that may contribute to bipolar illness, including circadian rhythm disturbances, inflammatory pathways, mitochondrial function, and neurotransmitter systems.

These findings are advancing our understanding of the disorder, but they have not yet produced a laboratory test capable of confirming the diagnosis. Bipolar II remains a clinical diagnosis based on symptoms, history, and course of illness.

Environmental factors also matter. Sleep disruption, major life stressors, substance use, and psychological trauma may all influence the onset or recurrence of mood episodes in vulnerable individuals.

The Importance of Sleep

One of the most consistent findings in bipolar research concerns the role of sleep and biological rhythms.

People with bipolar disorders often show increased sensitivity to disruptions in their sleep-wake cycle. Shift work, jet lag, irregular schedules, and periods of sleep deprivation can sometimes precipitate mood episodes.

For this reason, treatment increasingly emphasizes the importance of maintaining regular daily routines. Consistent sleep patterns are not simply a matter of good lifestyle habits; they are often considered an essential component of long-term mood stability.

Current Approaches to Treatment

Treatment typically involves a combination of medication, psychotherapy, education, and self-management strategies.

Mood-stabilizing medications remain the foundation of treatment for many individuals. Depending on the person's symptoms and history, treatment may include lithium, lamotrigine, or certain atypical antipsychotic medications.

Psychotherapy also plays an important role. Evidence-based approaches such as cognitive behavioural therapy, family-focused therapy, and interpersonal and social rhythm work (helping stabilize daily routines, like the timing of sleep, waking, meals, work, exercise, and social activities) can help individuals understand their illness, recognize early warning signs, and develop strategies for managing stress and maintaining regular routines.

An important theme in recent reviews is that Bipolar II remains understudied compared with Bipolar I disorder. Many treatment recommendations are based on evidence drawn from broader bipolar populations rather than research focused specifically on Bipolar II. This gap is gradually narrowing, but more targeted research is still needed.

Looking Forward

Over the past decade, scientific interest in Bipolar II disorder has grown substantially. Researchers are investigating biomarkers, genetic risk profiles, digital monitoring technologies, and new treatment approaches that may eventually allow for earlier diagnosis and more personalized care.

At the same time, one conclusion has become increasingly difficult to ignore: Bipolar II is not simply depression with occasional mood elevation. It is a distinct and often under-recognized mood disorder whose effects can be profound.

For many people, receiving an accurate diagnosis is a turning point. Symptoms that once seemed confusing or contradictory begin to make sense. Treatment can be tailored more appropriately. Most importantly, individuals gain a clearer understanding of what they are experiencing and how best to manage it over time.

If recurrent depression has been accompanied by periods of unusually high energy, reduced need for sleep, increased confidence, or marked changes in activity and productivity, a comprehensive mental health assessment may be worthwhile.

Take the Next Step

If you are concerned that your symptoms may fit with Bipolar II disorder, an assessment with a mental health professional can provide clarity and direction.

Contact Medipsy's coordinator Maria (info@medipsy.ca; 514 419-3005) to schedule a consultation or learn more about our assessment services.

Further Reading

The primary source informing this article is:

Parker G, McIntyre RS, Carvalho AF, et al. Bipolar II Disorder: A State-of-the-Art Review. World Psychiatry. 2025;24(2):187–220.

This article is intended for educational purposes only and should not be considered medical advice. If you have concerns about bipolar disorder or other mental health symptoms, consult a qualified healthcare professional.

Who Gets to Decide If Therapy Is Working?

When people begin therapy, they are often looking for relief from something painful. They may be struggling with anxiety, depression, grief, relationship difficulties, trauma, stress, or a persistent sense that life is not meaningful.

Naturally, one question follows: How will I know if therapy is working?

At first glance, the answer may seem obvious. If symptoms improve, therapy is working. If depression lifts, anxiety decreases, or panic attacks become less frequent, most people consider that meaningful progress.

And they would be right. Reducing emotional suffering is one of the most important goals of psychotherapy. Yet there is a deeper question worth considering. Who gets to decide what success looks like for you?

Who Gets to Decide Whether Therapy Is Successful?

For researchers, successful therapy is often defined by measurable changes in symptoms and functioning. For insurance companies, symptom improvement is frequently an important consideration because treatment is generally funded to address identified mental health concerns. These measures serve important purposes. They help researchers evaluate treatments, compare approaches, and determine whether care is effective. They also help insurers determine whether treatment remains medically necessary.

At the same time, the way therapy is measured is influenced by the systems in which therapy takes place. For some people accessing care through insurance, the definition of progress may be shaped, at least in part, by what can be documented and measured, often through changes in symptoms and functioning. Those measures are important, but they represent only one part of the picture.

At Medipsy, we recognize and work within these realities. We understand that insurance requirements can place limits on how progress is defined and documented. Within those limits, we work collaboratively to focus on the changes that matter most to you.  Your therapist can help you make meaningful use of the financial support available while staying connected to your personal goals and what you hope to gain from therapy.

What do clients often want?

One person may come to therapy hoping to reduce panic attacks. Another may want to improve a relationship, recover from a painful loss, become a more present parent, develop greater confidence, or better understand patterns that have shaped their life.

These goals are not less important because they are harder to measure.

In fact, research increasingly suggests that many people define successful therapy in ways that extend beyond symptom reduction. A recent study by Lam and colleagues examining recovery from depression among young adults found that people often described recovery as involving hope, meaningful relationships, a stronger sense of identity, pursuing goals, and being able to participate more fully in life.

Similarly, the Psychotherapy Networker article The Tyranny of Time draws on psychotherapy outcome research, including the work of Michael Lambert and colleagues, to highlight an important tension in the field. While symptom change is important and easier to measure, many of the outcomes people value most—such as greater self-understanding, improved relationships, self-acceptance, and living more authentically—may develop gradually and are not always captured by traditional measures.

This does not mean symptoms are unimportant. For many people, reducing anxiety, depression, trauma symptoms, or emotional distress is a central goal of therapy.

Rather, it means that symptom relief is often part of a larger picture.

The Importance of Collaborative Goal Setting

If successful therapy is ultimately defined by meaningful change in a person's life, then goals cannot simply be prescribed by a therapist or inferred from a diagnosis. They need to be developed collaboratively.

At the beginning of therapy at Medipsy, clients and therapists work together to identify the concerns that brought someone to treatment and the changes they hope to achieve. Sometimes these goals are straightforward: reduce panic attacks, improve sleep, or manage symptoms of depression. At other times, goals are broader and more personal, such as improving relationships, building self-confidence, finding direction in life, or learning to navigate emotions more effectively.

Importantly, these goals often evolve.

If you begin therapy because of overwhelming anxiety, you may eventually discover that their deeper concerns involve perfectionism, self-worth, or difficulty setting boundaries. Another person might start treatment during a crisis and later become interested in questions of identity, meaning, or personal growth. These shifts are not signs that therapy has lost direction. They can be signs that therapy is helping clients understand themselves more fully.

For this reason, effective therapy involves regularly reviewing goals and discussing whether treatment continues to focus on what matters most to you. The therapist brings clinical expertise and knowledge of evidence-based interventions. You bring expertise about your own values, priorities, relationships, and lived experience. Meaningful goals emerge by drawing on both perspectives.

How Do We Monitor Progress?

At Medipsy, we believe that both objective measurement and personal experience are important sources of information. All our therapists have access to the Outcome Questionnaire-45 (OQ-45), one of the most widely researched measures of psychotherapy progress. Developed through the work of Michael Lambert and colleagues, the OQ-45 helps track changes in psychological distress, interpersonal functioning, and everyday life functioning over the course of treatment.

Research has shown that routinely monitoring outcomes can improve treatment effectiveness by helping therapists and clients identify when progress is occurring and when adjustments may be needed. The OQ-45 provides useful information about patterns of change that might otherwise be overlooked.

At the same time, no questionnaire can fully determine whether therapy is meaningful for a particular person. A measure can show improvement in symptoms while a the client still feels disconnected from their values or goals. Conversely, someone may be making profound changes in their relationships, self-understanding, or sense of purpose before those changes are fully reflected in symptom scores.

For that reason, we believe that outcome measures are most useful when they are part of a larger conversation. They inform treatment, but do not replace ongoing discussions about what you hope to achieve and whether therapy is helping.

How Will I Know If Therapy Is Working?

Sometimes progress is easy to recognize. People may sleep better, feel less anxious, experience fewer depressive symptoms, or find it easier to manage daily stress.

Often, however, progress appears in more subtle ways. You might notice that you recover more quickly after setbacks, communicate more openly, establish healthier boundaries, or respond differently in situations that once felt overwhelming. You might become less self-critical, more self-compassionate, or more willing to take risks that align with their values.

People tend to describe progress not as a dramatic breakthrough but as a gradual shift in how they relate to themselves, their emotions, and the people around them.

What If I'm Still Anxious Sometimes?

One common misconception is that successful therapy should eliminate anxiety, sadness, or other difficult emotions altogether.  But psychological health does not mean never experiencing distress. Anxiety, grief, disappointment, uncertainty, and sadness are a part of being human. The goal of therapy is not to eliminate these normal experiences.

Instead, therapy can help you develop a different relationship with these human difficulties. Difficult emotions may become less overwhelming, less controlling, and less likely to dictate important decisions. Many people find that they are increasingly able to pursue meaningful goals and maintain important relationships even when uncomfortable emotions are present.

Life continues to bring challenges, losses, transitions, disappointments, and uncertainty. Recovery is feeling more capable of navigating these inevitable difficulties. If you become more resilient, more connected to others, and more confident in your ability to respond to challenges without becoming overwhelmed by them, that might be success for you.

A Broader View of Success

At Medipsy, we care deeply about symptom relief because we know how much suffering anxiety, depression, trauma, and other mental health concerns can cause. We also recognize that meaningful change looks different for different people.  There is no single definition of successful therapy.

Research findings, outcome measures, diagnostic criteria, and insurance requirements all provide valuable information. However, none of them can fully determine what matters most to you. That is why conversations about goals are not limited to the first session. They continue throughout therapy, evolving as people gain insight, encounter new challenges, and clarify what they want for their lives.

Ultimately, successful therapy is not simply about reducing symptoms. It is about helping people move toward lives that feel more connected, meaningful, authentic, and aligned with their values. The person best positioned to determine whether that is happening is the person whose life is changing - you.

References

Lam, J. A., Mulvaney-Day, N., Dobbins, A. R., Aldis, R., Pasricha, I., Amonoo, H. L., & Progovac, A. M. (2024). What outcomes matter in recovery from depression? A pilot study of young adults.

Lambert, M. J. (2007). Presidential Address: What We Have Learned From a Decade of Research Aimed at Improving Psychotherapy Outcome in Routine Care. Psychotherapy Research, 17(1), 1–14.

Lambert, M. J. (2013). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (6th ed.).

Miller, S. D. (2024). The Tyranny of Time. Psychotherapy Networker.