The Most Wonderful Time of the Year?

"'Tis the season to be jolly!"
--- Words by J.P. McCaskey, 1881

Many of us couldn't disagree more, if statistics are correct.

In fact, the holidays themselves can trigger feelings of dread, anxiety or depression in some people. Many factors can contribute to tension and sadness during the holidays, including fatigue, unrealistic expectations, increased stress and unresolved family issues. Add in the demands of shopping, parties, family reunions and houseguests, and you have the perfect formula for producing high levels of stress.

For people with existing mental disorders - that includes an estimated 26.2 percent of Americans - periods of extra stress can set in motion a downward spiral that continues well into the new year.

Seasonal Affective Disorder
For some people, particularly those who live in the northern regions of the country, holiday blues might be caused by seasonal affective disorder (SAD). An essential feature of SAD is that the depression starts and stops at specific times of the year - in most cases, episodes begin in the in late fall or winter when daylight hours decrease and end in the spring, when the days get longer. Recurrent depressive episodes might also occur in the summer, but less frequently.

The prevalence of SAD is not very well known, although some studies report rates in the range of 2% to 10% of the American population.

The symptoms of SAD, which include energy loss, increased anxiety, oversleeping and overeating, may result from a change in the balance of brain chemicals associated with decreased sunlight. Although the exact reason for the association between light and mood is unknown, research suggests a connection with the sleep cycle. And there is hope for SAD sufferers: several studies have suggested that light therapy, which involves daily exposure to bright fluorescent light, may be an effective treatment for the disorder.

Social Phobia
The holiday season can spark such intense feelings of anxiety and dread for some people that they avoid social gatherings altogether.

People with social phobia (sometimes referred to as Social Anxiety Disorder) experience overwhelming, even disabling anxiety and excessive self-consciousness in everyday social situations. They have a persistent, intense fear of being watched and judged by others and being embarrassed or humiliated by their own actions.

Social phobia can be limited to only one type of situation - such as a fear of speaking in formal or informal situations, or eating or drinking in front of others - or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.

Physical symptoms often accompany the intense anxiety of social phobia and include blushing, profuse sweating, trembling, nausea, and difficulty talking. People with social phobia recognize that their fear may be excessive or unreasonable, but are unable to overcome it.

Fortunately, effective treatments - including medications and therapy - are available for people who need help overcoming extreme anxiety.

Depression
Depression strikes about 17 million American adults each year, according to the National Institute of Mental Health (NIMH), and the holidays can trigger intense sadness, melancholy, or bitterness in people who already find life difficult to manage.

Changes in lifestyle are important in the management of depression. Exercise, even in moderate doses, seems to enhance energy and reduce tension. Some research suggests that a rush of the hormone norepinephrine following exercise helps the brain deal with stress that often leads to depression and anxiety. A similar effect may be obtained through meditation, yoga, and certain diets.

The occasional sadness everyone feels due to life's ups and downs is very different from the serious illness caused by a brain disorder such as major depression. Depression profoundly impairs the ability to function in everyday situations by affecting moods, thoughts, and behaviors.

Fortunately, even major depression is treatable, often with the use of antidepressant medications, psychotherapy, or some combination of the two treatments. Unfortunately, many people fail to identify their symptoms or attribute them to lack of sleep or a poor diet, while others are just too fatigued or ashamed to seek help. Two-thirds of the people suffering from depression don't get the help they need. Fifteen percent of chronic depression cases end in suicide.

Ask for Help
Depression, social phobia, seasonal affective disorder and other mental disorders are treatable, and most people suffering from them can be helped with medications, psychotherapy and other treatments. Many do best with combined treatment: medication, meditation, diet and exercise help many people gain relatively quick symptom relief, while psychotherapy may help them learn more effective ways to deal with life's problems, including depression.

If you are experiencing symptoms of intense sadness, anxiety or depression that you can't resolve on your own, make an appointment to discuss your symptoms with your health care provider.

If you have any thought of suicide, get help immediately. The National Suicide Prevention Lifeline is a 24-hour, toll-free suicide prevention service available to anyone in suicidal crisis. If you need help, call 1-800-273-TALK (8255) to be routed to the closest possible crisis center.

If someone you care about seems to be having these problems, do everything you can to assist them - including offering to talk, listen, find a health care professional or just keep them company. Do not leave a suicidal person alone. Call 911, the National Suicide Prevention Lifeline, or a local crisis line for help.

The National Institute of Mental Health, the American Psychological Association, and the National Mental Health Association have a great deal of useful information about how to identify and prevent - or just make it through - the times when expectations are high but your mood is low.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.