Holiday Depression, Anxiety, and Stress

Image of areas of the body that are affected by stress

• Many factors, including unrealistic expectations, financial pressures, and excessive commitments can cause stress and anxiety at holiday time.
• Certain people may feel anxious or depressed around the winter holidays due to seasonal affective disorder (SAD), sometimes referred to as seasonal depression.
• Headaches, excessive drinking, overeating, and insomnia are some of the possible consequences of poorly managed holiday stress.
• Those suffering from any type of holiday anxiety, depression, or stress can benefit from increased social support during this time of year. Counseling or support groups can also be beneficial.
• In addition to being an important step in preventing the symptoms of seasonal affective disorder, regular exposure to light that is bright, particularly fluorescent lights, significantly improves depression in people with SAD during the fall and winter.
• Setting realistic goals and expectations, reaching out to friends, sharing tasks with family members, finding inexpensive ways to enjoy yourself, and helping others are all ways to help beat holiday stress.

The winter holiday season, with celebrations such as Christmas, Hanukkah, and Thanksgiving, for most people is a fun time of the year filled with parties and social gatherings with family and friends. But for many people, it is a time filled with sadness, self-reflection, loneliness, and anxiety.

Sadness is a truly personal feeling. What makes one person feel sad may not affect another person. Typical sources of holiday sadness include

• stress,
• fatigue,
• unrealistic expectations,
• overcommercialization,
• financial stress,
• the inability to be with one's family and friends, and
• in addition to sadness, many people feel holiday anxiety or stress, particularly when they feel unable to cope with the demands upon them.

Nonhuman animals react to the changing season with changes in mood and behavior. People change behaviors, as well, when there is less sunlight. Most people find they eat and sleep slightly more in wintertime and dislike the dark mornings and short days. For some, however, other symptoms are severe enough to disrupt their lives and cause considerable distress.

Sadness or depression at holiday time can be a reaction to the stresses and demands of the season. In other cases, people may feel depressed around the winter holidays due to a condition known as seasonal affective disorder (SAD), sometimes referred to as seasonal depression. This is a type of depression that tends to occur (and recur) as the days grow shorter in the fall and winter. It is believed that affected people react to the decreasing amounts of sunlight and the colder temperatures as the fall and winter progress, resulting in feelings of depression. Although this disorder usually occurs in the fall and winter, there are those who suffer from this condition during the summer instead of, or in addition to, during the fall or winter. The incidence of seasonal affective disorder increases in people who are living farther away from the equator.

Risk factors for depression, anxiety, and stress during the holidays include having a mood disorder or experiencing depression at other times during the year and a lack of adequate social support systems. Other risk factors can include recent trauma, life changes, excessive alcohol intake, or concurrent illness. Having financial troubles may increase one's susceptibility to anxiety or stress during the holidays. Stressful family situations and illness in the family are also predisposing factors. Essentially, any factor that can cause depression, stress, or anxiety in an individual can worsen these conditions at holiday time.

Balancing the demands of shopping, parties, family obligations, and house guests may contribute to feelings of being overwhelmed and increased tension. People who do not view themselves as depressed may develop stress responses and may experience a number of physical and emotional symptoms including

• headaches,
• excessive drinking,
• overeating,
• insomnia.

Others may experience post-holiday sadness after New Year's/Jan. 1. This can result from built-up expectations and disappointments from the previous year, coupled with stress and fatigue.

In the case of seasonal affective disorder or a true depressive disorder, symptoms may persist beyond the holidays or may be more severe. The symptoms of seasonal affective disorder include tiredness, fatigue, depression, crying spells and mood swings, irritability, trouble concentrating, body aches, loss of sex drive, insomnia, decreased activity level, and overeating (especially of carbohydrates) with associated weight gain.

A simple history and physical exam may be all that is needed to diagnose a case of the holiday blues. Your health care professional may perform lab tests or other tests to rule out any medical conditions that may be causing your symptoms. Likewise, a full history of your symptoms is likely to provide clues that can help distinguish a mild case of the holiday blues from SAD or a more serious and chronic depressive disorder.

Anxiety, depression, and stress can be treated by a variety of medical and mental health professionals. Medical doctors, including family medicine physicians and internists, treat holiday depression. Psychiatrists are medical doctors who have special training in treating mental and emotional conditions. There are many other types of mental health professionals who may treat these conditions. These include psychologists, social workers, mental health counselors, marital and family therapists, nurse psychotherapists, psychiatric or mental health nurse practitioners, and others.

Those suffering from any type of holiday depression or stress may benefit from increased social support during this time of year. For uncomplicated holiday blues, improvement may be found by finding ways to reduce the stresses associated with the holiday, either by limiting commitments and outside activities, making arrangements to share family responsibilities such as gift shopping and meal preparation, agreeing upon financial limits for purchases, or taking extra time to rest and rejuvenate.

Counseling or support groups are another way to relieve some of the burdens of holiday stress or sadness. Knowing that others feel the same way and sharing your thoughts and experiences can help you manage your troubling feelings. Support groups also provide a further layer of social support during this vulnerable time period.

In addition to being an important step in preventing the symptoms of seasonal affective disorder, regular exposure to light that is bright, particularly fluorescent lights, significantly improves depression in people with SAD during the fall and winter. Phototherapy is commercially available in the form of light boxes, which are used for approximately 30 minutes daily. The light required must be of sufficient brightness, approximately 25 times as bright as a normal living room light. The light treatment is used daily in the morning and evening for best results.

Visiting other areas of the world that are characterized by more bright light (such as the Caribbean) can also improve the symptoms of SAD.

Antidepressant medications, particularly serotonin selective reuptake inhibitor (SSRI) medications, can be an effective treatment for seasonal affective disorder. Examples of SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa).

Complications of holiday depression can include worsening of the condition, leading to withdrawal from activities of daily living. As with all cases of depression, suicide or self-harm is a possible complication when severe.

Fortunately, holiday depression and stress can be well-managed by implementing the tips listed above as well as by seeking out social support. Counseling and support groups can be of benefit if the symptoms are too much to bear alone. Seasonal affective disorder generally responds well to bright light therapy (phototherapy). For some, medications may effectively relieve symptoms.

The following tips can help prevent stress, anxiety, and mild depression associated with the holiday season:

• Make realistic expectations for the holiday season.
• Set realistic goals for yourself.
• Pace yourself. Do not take on more responsibilities than you can handle.
• Make a list and prioritize the important activities. This can help make holiday tasks more manageable.
• Be realistic about what you can and cannot do.
• Do not put all your energy into just one day (for example, Thanksgiving Day, New Year's Eve). The holiday cheer can be spread from one holiday event to the next.
• Live "in the moment" and enjoy the present.
• Look to the future with optimism.
• Don't set yourself up for disappointment and sadness by comparing today with the "good old days" of the past.
• If you are lonely, try volunteering some of your time to help others.
• Find holiday activities that are free, such as looking at holiday decorations, going window shopping without buying, and watching the winter weather, whether it's a snowflake or a raindrop.
• Limit your consumption of alcohol, since excessive drinking will only increase your feelings of depression.
• Try something new. Celebrate the holidays in a new way.
• Spend time with supportive and caring people.
• Reach out and make new friends.
• Make time to contact a long lost friend or relative and spread some holiday cheer.
• Make time for yourself!
• Let others share the responsibilities of holiday tasks.
• Keep track of your holiday spending. Overspending can lead to depression when the bills arrive after the holidays are over. Extra bills with little budget to pay them can lead to further stress and depression.