For many people, the holiday season between Thanksgiving and New Year's brings with it an unwelcome bout of the blues. Images of holiday celebrations depict picture-perfect families, gourmet meals, piles of presents and plenty of cheer, an idealized perception that can be difficult to reproduce —try as we may. Experts in the mental health field advise turning unrealistic ideas and demands into manageable goals, taking care of our health and reaching out in order to prevent dipping into the doldrums.
Causes and Symptoms
"What happens over the holidays is that people overextend themselves or don't have realistic expectations," says Michael Santone, a psychiatric nurse practitioner whose practice includes child, adolescent and adult therapies. "We want the holidays to be the way we see them on TV. But that's actually not that common. Most holidays are also stressful for people."
In addition to unrealistic expectations and increased demands on time (going to holiday functions, shopping, cooking, cleaning and the like), Dr. Degan Dansereau, a psychiatrist and clinical assistant professor of psychiatry at Tulane University, points to the financial stress of holiday shopping, the break with one's normal routine, decreased sleep and the belief that we should be extra happy during the holidays.
The holidays may be particularly difficult for those already experiencing grief, relationship conflicts or economic hardships, says Robin Benton, a doctor of social work and therapist in private practice. "It's supposed to be all about community, getting together, eating and having fun. But if you have lost a loved one or have trauma in your current or past history, those losses are more poignantly and deeply felt. The empty chair at the table can be profound."
Financially, the recession and high unemployment have resulted in a greater divide between our commercialized notions of the season and our resources. And many locals are still recovering — economically and emotionally — from the effects of Hurricane Katrina and the BP oil disaster. "Many [New Orleanians] still have post-traumatic stress disorder," Benton says.
Mental health professionals say symptoms of depression can range from mild anxiety and sadness to hopelessness and suicidal thoughts. Common signs of holiday-related depression include weight loss or gain, sadness, anger, withdrawal, loss of motivation and enthusiasm for activities that normally bring pleasure, crying spells, and drug and alcohol use, the same symptoms typically associated with more serious forms of depression. The difference, Dansereau says, is that holiday-related depression or stress is usually milder, does not significantly disrupt one's functioning and lasts only a brief period of time.
Who's At Risk
While no one is exempt from depression, women are especially prone to these feelings. "Women are at much greater risk for depression than men in general, and the stress and burden of the holidays tends to fall on women more than men because they tend to be the ones who do most of the shopping, cooking, party planning, etcetera," Dansereau says. "Women are typically the keeper of relationships and family and home," Benton adds. "They feel the burden to make [the holidays] happen perfectly."
The holidays may trigger a worsening of symptoms in individuals with pre-existing conditions such as generalized anxiety, a history of depression or eating disorders. Those who have seasonal affective disorder, unhappy memories of the holidays, or a desire to recreate idealized Christmases may also be at risk.
Ways To Cope
Learning to handle holiday stressors, according to experts, begins with recognizing the feelings, then putting together a plan. "One of the biggest mistakes people make is not acknowledging that they might not be feeling as joyful as they should," Santone says. "Denying the problem through drinking or too much shopping is going to have consequences." Unlike self-medicating with overeating, drinking too much or overspending, caring for ourselves physically, emotionally and financially has long-term rewards.
Change your expectations/know your limitations
"Decrease the expectations you have for yourself, the people around you and holidays in general," Dansereau says. "Don't over-commit your time, money or emotional energy. You don't have to go to every party or family function. Cut yourself some slack and know that 'no' is a magical word that requires no further explanation." Planning, pacing yourself and learning to delegate can alleviate day-to-day burdens and help you relax and enjoy holiday festivities.
Eat Right, Get Enough Sleep, Exercise
Mom's counsel that you'll feel better after a healthy meal and a good night's sleep is sound advice. "Exercise, sleep and eating properly are going to be your three best friends during the holidays," Santone says.
Exercise helps elevate serotonin (a neurotransmitter that helps regulate mood) levels; adequate sleep alleviates stress and fatigue, and the medical community is realizing myriad ways a healthy, well-rounded diet — one rich in fiber, complex carbohydrates, omega-3 fatty acids, and protein — benefits mental health. In her book The Jungle Effect, San Francisco family practitioner Dr. Daphne Miller, who specializes in the therapeutic power of food, correlates the low incidence of depression in Iceland with a diet chock full of omega-3 fatty acids from fish. Dr. Kashi Rai, whose Elmwood-based medical practice specializes in the use of hormone therapies to optimize health and well-being, has found that stabilizing patients' blood sugar levels often helps stabilize their moods.
"My experience indicates that fluctuating blood sugar levels, which produce fluctuating insulin levels, seem to go hand-in-hand with fluctuating serotonin levels," she says. Rai adds that foods rich in protein and healthy fats, such as salmon, sardines, egg salad, almond butter and nuts; foods high in fiber; and even cinnamon, a spice frequently used during the holidays, help regulate blood sugar.
Minimizing alcohol and sweets consumption and taking natural supplements can help, too. Rai recommends chromium to stabilize blood sugar; SAM-e (a synthetic form of an energy-producing compound found in cells), B12 and methyl folate to stabilize nerves; combination supplements with GABA, theanine, and inositol to reduce anxiety; valerian, which mitigates insomnia; St. John's wort, which enhances one's sense of well-being; and 5HTP, which elevates serotonin levels.
"There are some supplements that have good data when it comes to treating very mild depression while ... someone (is) monitoring the person taking them," Dansereau says. He adds that in cases of more serious depression, supplements usually are not enough. Those already taking antidepressants should check with their physicians before taking supplements.
"One of the best things we can do as adults is to take ourselves out as a child," says Santone, who recommends reconnecting with things that brought you happiness in the past, like a trip to the French Quarter, viewing Christmas lights, enjoying Celebration in the Oaks, decorating the tree, spending time with friends and family or sending out Christmas cards. Planning activities can help combat isolation, cabin fever and loneliness.
Do Something For Others
Volunteering helps others and provides an outlet for meeting and interacting with people. Even small random acts of kindness can make someone's day. "When the shopping center is crowded, remember the importance of saying 'thank you' or 'excuse me' or helping someone with a large package," Santone says. "If you do say something off-key or snap at someone, the power of an apology can go far."
Create A New Tradition
Every tradition began somewhere. If the way you've been spending the holidays leaves you unfulfilled, try something new. "Think of what you can do to make this Christmas a special celebration that you will look forward to," Santone says.
If you're feeling lonely or sad, call a friend or family member and ask to spend some time together. Likewise, if you notice someone feeling depressed, don't wait for him or her to ask for help. Companionship is a gift that costs nothing.
Seek Professional Help If You Need It
"Therapy gives an individual an opportunity to sit and take stock of what's happening to them," Benton says. "In sorting through things, usually individuals feel less overwhelmed."
If you need professional help, call the customer service number on your insurance card to find a provider who's covered by your plan or speak with your primary care physician, who can prescribe medication or make a referral to a specialist like a psychiatrist. For the uninsured, Family Service of Greater New Orleans offers individual, couple and group counseling on a sliding scale. Social workers and psychologists can provide psychotherapy. A psychiatrist can provide psychotherapy and prescribe and monitor medications, such as antidepressants, when needed.
"If you are experiencing significant depression, not just holiday-related stress, then there is no substitute for professional help," Dansereau says.