by Sheri B. Doniger, DDS
Are the sounds of "Ho! Ho! Ho!" giving you the blues? Too much shopping to do? Are there too many happy people? Holiday depression may not be what you think. Some people suffer from the blues, while others suffer from a winter depression called seasonal affective disorder (SAD), which affects 2 to 4 percent of the population.
Holiday blues are real. There is a great deal of stress put upon us during the holiday season to keep up with the holiday cheer. Parties, shopping deadlines, unrealistic expectations of time management and financial budgets, dealing with over-commercialization (which now begins moments after the last trick or treater has left), and family issues may cause some people to be anxious about the present and thinking too much about the past and future. With too many commitments and too little time, a feeling of tension may manifest itself. (Contrary to popular belief, the suicide rate is not higher during the holidays; it is lower. May has the highest rate of suicides.)
Some people may also experience post-holiday letdown due to disappointments from the holiday season, and the toll of stress and fatigue. The "blues" may bring on stress-related responses such as drinking, overeating, and loss of sleep.
According to the National Mental Health Association, holiday blues can be managed with several coping responses. First and most important, make time for yourself. Share with others and spend time with caring people. By keeping expectations for the holidays manageable, one does not have unrealistic expectations of time, money, and commitments. Plan smaller gatherings. Shop in increments. Enjoy the season over a period of time and try not to condense everything into one or two days.
To get away from the stress of the holidays, volunteer to help those in need or try something new in your routine. Enjoy the beauty of the season — the holiday light displays, window shopping, the peace after a snowfall — to help spare the budget.
Different from the blues, seasonal affective disorder is a form of depression that usually begins in October or November, peaks in January and February, and is asymptomatic by March or April. It may have a biological basis. SAD usually affects women, and the initial incidence occurs in people in their early 20s. It was first documented in 1845, but actually "named" in the early 1980s.
Symptoms of SAD include overeating (especially carbohydrates), excessive sleeping, lethargy, sleep problems, and weight gain. Some people may exhibit difficulty concentrating or processing information. Also, headaches, irritability, anxiety and depression are common. Social isolation and other signs of depression may occur. As sunlight hours increase, a resurgence of energy occurs. One key factor in differentiating SAD from holiday blues is the recurrence of symptoms for at least two successive years during the same season. Seasonal affective disorder has been misdiagnosed as mononucleosis, hypothyroidism, hypoglycemia, and other infections.
The causes of SAD are unknown. Some believe it is a disturbance in the circadian rhythm during the shorter days of the winter months. SAD affects more people in areas far from the equator, where periods of light during the winter months are very short. Other researchers think that melatonin, a hormone related to sleep, may be an etiology. Melatonin production increases in winter. Lack of serotonin has also been considered as an etiology. Serotonin is stimulated by sunlight.
The most effective treatment for many patients with seasonal affective disorder is phototherapy. A bright light (full spectrum, 10,000 lux fluorescent) is utilized. Bright light has been shown to decrease the secretion of melatonin. Patients use the light for 30 to 45 minutes or more each day while going about their normal activities. This light simulates the light exposure a person receives while looking out the window on a bright, sunny day. Most patients experience relief after using the light source for only a few days. Several companies sell these lights, which are available through local retailers and online. Side effects from the bright light are rare. These include photophobia, headache and fatigue. Insomnia may occur if the light is used too late in the day.
Exposure to early morning or afternoon sunlight is an inexpensive way to incorporate light therapy into a daily routine. Taking walks outdoors when there is sunlight and exercising regularly are other ways to treat SAD. If financially feasible, a sunny and warm weather vacation is another good form of treatment. Another symptomatic management skill is increasing the amount of ambient light that comes into your home and office. Dawn simulators, which are lights timed to gradually brighten at a set time, are also recommended.
Depending on the depth of the depression caused by SAD, treatment may include antidepressant medications such as paroxetine, sertraline, fluoxetine and venlafaxine. Possible counseling or psychotherapy may also be necessary.
SAD may also occur in the summer, with patients becoming agitated and experiencing insomnia, decreased appetite and weight loss. Affecting less than 1 percent of the population, summer SAD affects mainly women in their early 20s. Like those who experience winter SAD, a majority of patients have a family history of mood disorders. These patients may want to go for a cold climate summer vacation, as opposed to the warm climate recommended for winter sufferers. Turning up the air conditioner, closing shades to limit sun exposure, and wearing sunglasses outside appear to limit symptoms. If symptoms persist, counseling should be sought.
Winter blahs or holiday blues? As they said in "Hair," let the sunshine in. Go out and play. Embrace the beauty of the winter. If you or someone you know suffers from the winter doldrums, professional assistance may establish balance. Seasonal affective disorder can be overcome. Bring on the sun.
The above question was posed to the San Francisco-based Society for Light Treatment and Biological Rhythms. Here is how they distinguished between the two conditions:
"Many people complain of feeling down, having less energy, putting on a few pounds, and having difficulty getting up in the morning throughout the dark, short days of winter. People suffering from SAD experience these and other symptoms to such a degree that they feel unable to function normally. They often feel chronically depressed and fatigued, and want to withdraw from the world and to avoid social contacts. They become less productive at work and complain that their quality of life has gone. In the extreme, they may increase their sleep by as much as four hours or more per day, have greatly increased appetite — sometimes accompanied by irresistible cravings for sweet and starchy foods — and gain a substantial amount of weight. Women frequently report worsening of premenstrual symptoms. People with SAD suffer in the extreme the kinds of changes that many others experience to a much lesser degree in wintertime."
Author's note: This article is based on information obtained from the American Psychiatric Association (www.psych.org) and the American Psychological Association.
Sheri B. Doniger, DDS, practices in Lincolnwood, Ill. She graduated from the University of Illinois College of Dentistry in 1983 and obtained her bachelor's degree in dental hygiene from Loyola University of Chicago in 1976. She can be reached at (847) 677-1101 or [email protected].