Recurrent Summer Depressive Episodes: A Case-Report

BACKGROUND: Onset of major depressive disorder, recurrent, with seasonal pattern has a temporal relationship with particular time of year mostly fall-winter that remit by spring. Recurrent summer episodes occur only in a minority of cases. Present case has been having recurrent episodes for last 18 years. METHOD: A 36 year old female presented with complaints of low mood, suicidal attempts, repetitive suicidal thoughts, feelings of guilt, crying spells, loss of interest in household chores, irritability, disturbed sleep & reduced appetite for 11 months since March, 2020. Patient had 9 similar episodes of illness since 2003, each persisting from March to June. Patient was hospitalized. Detailed clinical evaluation including history taking, mental state examinations & relevant investigations was done. Patient had been on antidepressants(Escitalopram 20 mg, later Sertraline 150mg), benzodiazepine(Clonazepam 0.5 mg) & antipsychotic(Olanzapine 2.5 mg). She reached pre-morbid levels after each episode. Present episode continued even after adequate drug treatment. Electroconvulsive therapy was added to ongoing treatment & resulted in symptom remission. RESULT: Patient was diagnosed with major depressive disorder(recurrent), seasonal pattern – summer episodes. Post-ECT, Lithium was added, patient recovered & was discharged on April, 2021. Psychoeducation was provided regarding illness & treatment. Patient is on regular follow-up. CONCLUSION: Proper education about illness & treatment improves adherence which helps in preventing further episodes of recurrent illness.