Holiday Spirit: The Highs and Lows -- Srini Pillay, MD. -- 12/10/02

WebMD Live Events Transcript

We discussed the emotional ups and downs of the holiday season with our guest, psychiatrist Srini Pillay, MD.

The opinions expressed herein are the guest's 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 The WebMD University Student Lounge, and to our "'Tis the Season to be Healthy" course, brought to you by Blue Cross Blue Shield of Massachusetts. Today's lounge guest is Srini Pillay, MD, a psychiatrist at McLean Hospital, affiliated with Harvard Medical School. Dr. Pillay, is it true that most people's anxiety levels go way up in this country around the holidays?


Pillay: Yes, it is. There are many causes for why anxiety levels go up, which includes the fact that people have a lot of expectations, and they have the desire for the perfect holiday. In addition, missing loved ones who are no longer with them can cause a certain amount of distress. Also, financial stresses usually escalate during the holidays. And family conflicts may also seem to be more intense during the holidays. In addition, I think that people tend to over commit during the holidays in many dimensions of their lives. And so they feel that they need to meet not only other people's expectations but their own expectations as well.


Moderator: You work in the field of anxiety and panic disorders. Do you have any advice for those of us who have a friend or family member with such a disorder, to help them make it through the holidays?


Pillay: Sure. I think that the holidays can be a stressful time for anyone without a baseline anxiety, so someone with baseline anxiety would potentially be more vulnerable during that time. I think that talking to people, to family and friends, who have anxiety disorders may be helpful to them, especially if you demonstrate that you have an understanding of what they are going through. In particular, reminding them through reassurance of the many stressful dimensions that may exacerbate their anxiety might help them focus on ways to deal with these anxieties in advance.


For example:


Advising them that they should know their spending limits ahead of time and plan accordingly.
Helping them to remember that organization goes a long way in reducing anxiety.
Making sure that holiday priorities do not interfere with other usual priorities such as exercise and nutrition.
Emphasizing the importance of relaxation so as to not always be on the go.
Remembering to breathe deeply, and remembering that responses do not have to be immediate if faced with an anxious situation.

If it seems that the anxiety is more out of control than it is usually, then it would be important to avoid anxiety provoking situations, so as not to contribute to the already escalating stress. If it seems that these interpersonal interventions are not reassuring enough, then seeking help from a professional either to adjust or start medication or psychotherapy could be helpful.


Moderator: We are inundated with messages that the holidays are "magical" and that good times just naturally occur this time of year, but it's actually a lot of work to get from here through the New Year!


Pillay: I think that that is true. And remembering that the holidays are both a time of good vibes and positive possibilities as well as a highly stressful time when expectations are sky high is important. It is important not to collude with the idea of having to be, feel, or do something that does not seem commensurate with whom one is. Research studies have shown that false expressions such as smiling with a strain may actually adversely impact one's general health.


Probably one of the most stressful notions is that everybody has to feel the same all the time throughout the holiday season. But people are individuals, feel differently, and have different lives. So that any one person's response to a given situation would be expected to be different from another's. It is important to remember that not all people will have the same feelings around the holidays, and if hosting a party, for instance, it is an important sensitivity not to overly pressure someone to join in the tone of celebration that the majority of people may feel.


Member: I'm on Celexa for mild depression. I've been on it for about six months and I've been doing very well, but wonder if I feel the depression taking over again during the holidays, which have always been a melancholy time for me, is that a sign that the meds aren't working, or are dips in mood to be expected?


Pillay: Dips in mood are to be expected if the holiday is usually a melancholy time. Therefore, it is probably not immediately advisable to assume that the medication is not working, since there is an easily identifiable external stressor. However, worsening of depression usually means that more than just mood is affected. Other parameters that may escalate are:




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