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Beating the holiday blues

Published: December 2008

Illustration: Art Glazer

While the holiday blues is not an official diagnosis, as a psychiatrist I often find that my schedule can get especially crowded when the winter celebrations begin. Consider these two recent cases.

Tammy, age 32, turned up one January day feeling listless, lethargic, and even sadder than usual about her divorce some eight years before. A joke could cheer her up briefly, but she was oversleeping and overeating, especially chocolate ice cream. Those symptoms had occurred off and on since before her divorce, particularly in the winter. And she had always been oversensitive to minor rejections.

Paul, 36, told his wife he didn't want any holiday decorations. Though he had a happy family, a good career, and good friends, he always dreaded the holiday season, and tried to ignore it. Christmas Day was especially hard. With the office closed, he'd stay home alone while his family went to church. Paul didn't know what the problem was, but worried because he wanted his kids to have some happy holidays to remember.

Is everyone happy but me?

Why do some people become sad during what's supposed to be a happy time of year? As with most mental health problems, there are both biological and emotional triggers.

The most common biological cause, seasonal affective disorder (SAD), stems from the declining hours of sunlight that come with winter. But don't assume you suffer from SAD just because your emotional problems become worse in the winter. Sometimes anxiety or depression just happen to crop up around the holidays.

Whether or not there are biological factors, the holidays are rife with psychological booby traps. Office parties can feel like just more work. Vacations can add stress if you have unresolved problems hanging over you, or if the cost is too high. Seeing more of your extended family over the holidays can, for many people, trigger unhappy or at least uncomfortable memories or behaviors. Pressure to give the right gift at the right price can be paralyzing.

The coming New Year may remind you of professional, financial, or personal disappointments suffered the prior year—and of the uncertainty that lies ahead. And for some, all the holiday parties can be a temptation for excessive alcohol and drug use.

Even good news can trigger unhappiness. A well-earned vacation makes some people feel guilty. Personal and family successes can lead to envy or even family squabbles. And does a good year mean you have to do even better next year?

Season's treatments

How do you know if you have a holiday problem? Keep an eye out for any of these warning signs: significant emotional pain; emotions or behaviors that interfere with everyday activities; and other people telling you that you have a problem.

Simply recognizing that you're in an emotional snarl can often go a long way toward untangling it. Use coping skills such as spending more (or less) time with your family, cooking your favorite meals, trying to avoid arguments during the holidays, and talking things through with trusted family and friends.

If those steps aren't sufficient, you should seek professional help. A thorough evaluation should look at possible biological, medical, and psychological causes. Once the causal factors have been identified, treatment can be planned and carried out. For holiday blues, that will usually involve some sort of psychotherapy and sometimes medication.

Holiday blues resolved

Since Tammy also had mild depression at other times of year, she decided against the bright-light therapy that is sometimes used to treat people with SAD. Instead, she opted for the antidepressant fluoxetine (Prozac and generic) combined with weekly psychotherapy. The drug provided some relief within three weeks. And with psychotherapy, she began to think less about her divorce and other losses, and more about how to improve her life.

Paul didn't need any medication. After several weeks in therapy he remembered more about the holidays of his childhood. They weren't happy. Instead, they were times of artificial family closeness with a lot of tension and argument. Church, for him, was an endurance trial rather than an uplifting experience.

And the fact that Paul was now so happy with his own wife and family just emphasized his painful childhood memories. The more he figured that out, the more successful he was in finding the true joy of the holidays, for himself and his children.

Jeffrey P. Kahn, a practicing psychiatrist and clinical associate professor of psychiatry at Weill-Cornell Medical College in New York City, an author and editor, and the CEO of WorkPsych Associates, which provides training to businesses on psychological issues.

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