Beating the Holiday Blues

WebMD Live Events Transcript

Does the feuding family in Home for the Holidays look like an upbeat version of your clan? Do you feel as though you're stuck in National Lampoon's Christmas Vacation without the laughs? So your holidays aren't exactly a Hallmark card experience. Don't be down. Read what psychiatrist Michael E. Thase, MD, had to say about beating the holiday blues, when he joined us on Dec. 8, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Thase. Thanks for joining us today. How should we define the holiday blues?

THASE:
That's an interesting question. Obviously it would be a mood disturbance that a person experiences at some point between the six-week period of time from Thanksgiving until shortly after New Year's. As such, it's not really a diagnosis, but a description that may have some meaning in our day-to-day world, but shouldn't really differ at a treatment level from other mood disturbances and other times of year.

MODERATOR:
If our blue feelings only last from November to December, but seem to occur every year, is it worth talking to a mental health professional about this yearly episode of the blues?

THASE:
That depends a lot on how much it negatively impacts your life. If it's simply a "feeling state" that reliably comes and goes, then professional intervention is probably not needed. If it is associated with significant impairment in one's relations or in the workplace, then of course it should be handled like any other depression.

MODERATOR:
I assume those with a history of depression or other mental health problems are more at risk for a dip in mood this time of year? Is that correct?

THASE:
People with a history of depression are at greater risk for the new onset of depression throughout the year. As people living in the northern hemisphere, we seem to be somewhat more prone to development of depression in the fall and winter months.

The fact that this period of risk coincides with our holidays is kind of like a bad coincidence. For example, I'm not sure that I've encountered any writing about the holiday blues in New Zealand, Australia, or South Africa.

MODERATOR:
The old song calls it the "Most Wonderful Time of the Year," but in my mind Christmas would have to take place in June for that to be true!

THASE:
That is part of the problem, I think, that there are high expectations for joy, mirth, and wonderful family relations, but of course, not all of our lives, or our family relations, are always joyous and mirthful. So there may be some violation of what you expect. If your family gatherings are always difficult and filled with conflict, the fact that popular writing, songs, and television programs are promising wondrous holiday times may slap you in the face.

"There are high expectations for joy, mirth, and wonderful family relations, but of course, not all of our lives, or our family relations, are always joyous and mirthful."

MODERATOR:
We have some questions that address that issue of family gatherings being difficult. Let's look at them.

MEMBER QUESTION:
Christmas has always been a downer from childhood on up. My moods change three or four times while I'm back home for the day. What can I do to stay focused just for the one day?

THASE:
I would first of all start with more accurate expectations. These visits have always been difficult; they are likely to continue to be difficult. Having set expectations appropriately, then I would encourage trying to put a good foot forward, namely not to open or reopen old conflicts or disagreements, perhaps even to go with the assumption that this is not a day to solve problems or to redress old grievances, but simply a day to celebrate family, at least within the limits of what can be celebrated.

MODERATOR:
So don't try to pretend your family is suddenly in a Norman Rockwell painting!

THASE:
That's right. Very few of us actually have Normal Rockwell painting families, which is part of what made his art so popular, because it conveyed a sense of ideal and was reassuring to many in that regard.

MEMBER QUESTION:
At Christmas present opening time, I have nieces and nephews ages 4 to 8. I try to be upbeat. I try to talk to them and say "nice toy" or whatever, but I just am not genuine. Can they pick up on my lack of happiness? Should I just say nothing or not even attend the family event?

THASE:
If it is torturous for you, truly torturous, then of course it is okay not to attend. But I think you may find that you feel worse not attending than if you attend and go through the motions the best that you can.

I would not worry that your lack of uncomplicated positive feelings will adversely affect your nieces and nephews. I suspect that their own thrill will enable them to overlook your conflicted feelings. It is generally a good idea not to share your conflicts with the children (with statements like enjoy it while you can, it only goes downhill from here). Part of human well-being involves the capacity to overlook such things.

Your gloomy feelings probably won't alter their holidays unless your feelings are translated into action.

MEMBER QUESTION:
I have bipolar disorder and my problem is how to handle the chaos of a large family gathering. I have a very difficult time sitting amidst several different conversations and the 10 small children screeching in delight at the festivities. Any suggestions for handling this chaos without overmedicating myself?

THASE:
My suggestions are as pertinent to you as they would be for people who don't have bipolar disorder. I think it would be useful to make sure you get sufficient sleep and resist the urge to stay up too late wrapping (or, for that matter, rapping). Likewise, it would be a good idea not to drink alcohol or take nonprescription drugs in an effort to numb your feelings.

If need be, why not position yourself on the outside or periphery of the circle? Take breathers as you need to; a short walk out of doors will no doubt help clear your head, and if people ask you what's the matter, simply say something like, "Well, you know how crowds or commotion get on my nerves. I'm glad to be here, but it's easier for me to move in and out than it is to sit still."

MODERATOR:
That does raise the issue of those who are taking medication for existing mental health issues. Is it recommended to stay the course, as far as medication dosages are concerned, or is a visit to your doctor to discuss an adjustment worthwhile, to help make it through the stress and ups and downs of the holidays?

THASE:
There are some people who do best with seasonal adjustments in their medications, and this can be as true for the tendency for mood elevation in the spring and summer as it is for mood worsening or depression in the fall and winter.

Obviously, if you are concerned, this would be an important issue to talk to your doctor or therapist about. It is not at all a cop-out to make an adjustment, even a temporary one, if what you're suffering from is part of a pre-existing disorder, both manic depression or bipolar disorder. And major depressive disorders are stress responsive conditions and do have a tendency to wax and wane in response to the presence or absence of stress.

MODERATOR:
But always adjust medications with your doctor's OK, right?

THASE:
Absolutely, in collaboration with your doctor's input.

"It usually is a good idea to talk to someone about your worries. And paradoxically, talking about these worries may help them to lessen."

MEMBER QUESTION:
You say winter blues is not an actual diagnosis, but is SAD? Is it sort of the same thing?

THASE:
Seasonal affective disorder, sometimes called SAD, is a research diagnosis that was developed in order to test treatments that might work through the photo period, or the amount of sunlight available on a daily basis, or other "chronotherapy" interventions, including the natural hormone melatonin. It refers to the tendency to have periods of major depression only in the fall and winter, which reliably lift as spring nears.

About 15 percent of the U.S. population does reliably feel worse, more depressed or less energetic in the fall and winter. A similar proportion of people with recurrent depression have this type of seasonal pattern. In official terms, this would be called recurrent major depressive disorder with seasonal pattern.

There is good evidence that people who have this type of recurrent depression feel better when they use bright light as a therapy or as an adjunct to other therapies during the fall and winter months. Bright light may have mood improving effects for other people, as well, but it's most clear-cut for those who have a seasonal pattern of recurrent depression.

MEMBER QUESTION:
I find the pressure of other people's expectations are what give me the blues this time of year. My kids think Christmas day will be perfect and overloaded with presents; my siblings try to outdo each other with "ooh and ahh" presents for each other and the nieces and nephews, and my parents want us to be the Waltons. We're not. We're normal. I can adjust my expectations and just take joy in being together, but they all want it to be a blowout event. Can I try to change them or just live with their antics?

THASE:
It borders on pop psychology, but it's nevertheless true, to keep in mind that you ultimately are not responsible for others' thoughts, feeling and expectations. So control what you can, your own expectations and reactions, and try to let go of being responsible for theirs.

It might help to have a one-to-one or offline conversation with one or two of your siblings to see if it might help their acceptance of you. I'm pretty sure it would not help to pick package opening time as the moment to have a family encounter group about unrealistic expectations.

MEMBER QUESTION:
I have been suffering from deep depression ever since my husband learned he is leaving for Iraq in January. This will make for a very sad holiday. I am currently going back to school full time and working two days a week. I am taking 10mg of Celexa daily. I am constantly a basket case and never know when I will break down and cry. I often lose my cool and fly off the handle for the smallest things. This is just not me. How would I know if I am suffering from a nervous break down?

THASE:
I see three clear problems:

Number one is the understandable sadness and grief and anticipation you feel about the absence of your partner and the danger he will be facing. It is not at all out of the ordinary to be apprehensive and sad about this. Express your concern and worry, knowing that most everyone else in your position would feel this way.

The second issue is your medication. The minimum therapeutic dose of Celexa is typically 20 milligrams, not 10. Perhaps you are sensitive to side effects and your dose has been carefully lowered to address your unique condition, but perhaps its side effects aren't a problem. You may feel better taking a higher dose. Please talk to your doctor if this is a consideration.

The third issue is the importance of family support in coping with difficult times. Although this is clearly a stressful year, it can go better if you receive extra support from your parents, in-laws, siblings, or friends. It usually is a good idea to talk to someone about your worries. And paradoxically, talking about these worries may help them to lessen. If you do not have much support from others, it may be useful to complement your level of medication management with counseling or psychotherapy.

MODERATOR:
You can also find great support in dealing with your feelings of depression and fear by posting on our message boards here at WebMD. You will be welcomed warmly.

MEMBER QUESTION:
What is Celexa?

THASE:
It's an antidepressant from the same modern class of medication made famous by Prozac -- known as selective serotonin reuptake inhibitors.