Extreme Heat and Mental Health: Effective Ways to Safeguard Your Mental Well-Being

When you think about the dangers of rising temperatures, physical concerns like heat exhaustion, cramps or heatstroke probably come to mind. But that's not the only thing at stake. 

Heat can also harm your mental health, affecting your mood, sleep and more. The connection between heat and mental health is rooted in access. Your risk of being more or less affected by heat conditions is directly correlated to your access to air conditioning and water. Here's what you need to know to stay safe. 

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Mental health conditions may increase your risk for heat-related illness 

Your risk of heat-related illness can increase if you have a mental health condition. But it's not a simple line from point A (having a mental illness) to B (having a higher risk). It all comes down to what resources you have access to, your awareness of your condition and the medications you take. 

I spoke with Dr. Ken Duckworth, chief medical officer at National Alliance on Mental Illness. During our conversation, he stressed the importance of access: "People with mental health conditions are more likely to not have access to air conditioning, and isolation can result for people who feel like they can't move or leave."

One mental health condition can make it harder for your body to deal with high temperatures.  A review published in the Journal of Schizophrenia Research revealed that those with schizophrenia have more difficulty adapting to heat. This then contributes to the higher risk of hospitalization during extreme heat. 

"People who take medications for psychiatric needs have to be especially careful. It's not all medications, but some antipsychotic medications reduce the ability to control temperature," Duckworth said. 

If a person who takes one of these antipsychotic medications is in the heat, their body temperature is more likely to mimic outdoor temperature. Examples of antipsychotic medications are Risperdal and Seroquel. Add in that schizophrenia is disproportionately represented in homeless populations, and you can see how someone might be at greater risk. However, if someone with schizophrenia can access air conditioning and community support, they don't have an increased risk. 

Medications can also interact with the heat in other ways. Another example that Duckworth spoke about was lithium, the gold standard for treatment for bipolar disorder. Those who take lithium can experience higher rates of lithium toxicity in the heat because as dehydration sets in, lithium levels increase.

"People with bipolar disorder who know to stay hydrated are not really at risk of becoming lithium toxic," Duckworth said. The risk increases if you aren't aware of how your medication can interact with heat. "People who haven't been told that by their doctor or don't remember are more likely not to recognize they need to get their lithium levels checked."

Health risk in the extreme heat doesn't directly depend on whether you have a mental health condition. It depends if you have access to air conditioning, community and knowledge of your condition. 

How can heat affect your daily mental health? 

The impact of heat on mental health isn't limited to those with an established history. The temperature outside can negatively impact your mental wellness in subtle ways you might not notice. Studies have found that heat influences a person's mental health regardless of age, sex and geographical location. A study published in JAMA Psychiatry that analyzed medical records of more than 2.2 million adults from 2010 to 2019 found that mental health-related emergency room visits increased by 8% during the hottest summer days.

It's harder to sleep in the heat

To have good mental health, you need to sleep well. Unfortunately, that's easier said than done in the heat, especially if you live without air conditioning or sleep beside a human furnace. Sleep deprivation can amplify symptoms of anxiety and depression. Poor sleep makes it harder to regulate emotions, perceive stimuli and cope with stress. 

Aside from AC, there are ways to sleep cooler on hot nights:

• Freeze your bedding or socks before you get in bed. 
• Block out as much heat from your bedroom as possible during the day. Blackout curtains are a great option. 
• Use fans in your bedroom to keep air circulating. You can even add a bowl of ice in front of the fan for extra cooling. 

Anxiety is worse in the heat

When you're hot, cortisol (the stress hormone) levels in the body spike. Our body fights to regulate our internal temperature, which adds stress and inflammation. This can leave you feeling irritated and uncomfortable. It can also trigger feelings of anxiety.

There's also a broader toll that extreme heat conditions have on mental health. Climate anxiety is a real thing. According to Duckworth, rates of anxiety are higher in younger people. He attributes heat and climate change as one logical explanation that rates of generalized anxiety disorder are on the rise. "It's a sense of something terrifying that's out of our control," he said. 

Heat doesn't just affect anxiety in the moment. For many, it's a lasting concern that becomes a source of enduring anxious feelings. 

It's hard to regulate your mood in the heat

Several things contribute to depression symptoms associated with heat. First, heat suppresses the brain's serotonin circulation, the hormone essential for regulating mood. There are also things that happen during summer that can contribute to depressive episodes -- financial worry, body image issues, and disrupted eating and sleep schedules. 

Seasonal affective disorder is a mood disorder marked by depressive symptoms that occur during the same period each year. It's not a one-off thing; it has to be observed for multiple years and established as a pattern. When you hear seasonal affective disorder, you likely think of winter, but SAD isn't limited to cold months. It can happen in the summer as well. 

"The key to all mental health conditions in general and mood disorders, in particular, is to get a good understanding of the pattern, if there is one for you," Duckworth said. "Learn about yourself, understand your patterns and don't feel bad if your pattern happens to be when everyone else is going to the beach." 

Some mood disorders like bipolar disorder are also aggravated when there is more light. A systematic review of studies found that heat triggers bipolar episodes that require hospital stays at a higher rate than other temperatures. However, as Duckworth explained, light is just one variable and doesn't mean you'll have more episodes. Those with bipolar disorder can plan and anticipate to reduce their risk. 

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Tips to manage your daily mental health in the heat

Just because it's hot outside doesn't mean your mental health will suffer. Being intentional about nourishing your health and looking for triggers can help you manage your wellness and beat the heat. Many tactics used to protect your body also apply to your mental health. Use these practical tips to enjoy the summer while boosting your mental health. 

• Know how heat impacts your condition: Knowledge is one of the most essential components in the fight against heat. Talk to your doctor about how the heat may impact you or your medications, then plan accordingly. 
• Pay attention to your water intake: Dehydration is more prevalent during heat waves. Those with mental health conditions must pay special attention to how much water they drink, as dehydration can exacerbate symptoms. It also can compromise brain functioning and hamper serotonin production. 
• Keep taking your medication: Even though some psychiatric drugs can impact a person's ability to regulate body temperature, it's essential to keep taking your medication as prescribed. If you want to discontinue a prescription, you must speak with your doctor to establish a plan.
• Take a cool shower or bath: Bathing in cool water can help you manage the heat. It's imperative if you don't have an air conditioner. 
• Identify triggers: For those living with SAD or summertime blues, it's important to identify your triggers to establish coping mechanisms. Recognize the patterns you have and plan accordingly. 

Heat and mental health is everyone's problem 

Your mental wellness is more intertwined with the temperature outside than you may have expected. The relationship is two-fold. First, being in the heat can leave you feeling stressed and compromise your ability to regulate your mood. Second, having mental health conditions -- especially if you take medication for them -- can increase your risk for heat-related illnesses if you don't have resources and support. 

Those with mental health conditions like schizophrenia are overrepresented in at-risk and homeless populations. Change is a shared responsibility that we all should take seriously. To do your part, consider checking in on your neighbors and family members with mental health conditions to make sure they have access to water and fans and to reduce their social isolation. If your city has cooling centers, spread the word. Community support can be the key to making heat less dangerous to mental health.