I look inside myself and see my heart is black
I see my red door and must have it painted black
Maybe then I'll fade away and not have to face the facts
It's not easy facin' up when your whole world is black
The Rolling Stones
The Holiday Blues
The holiday season is typically a joyous time. We are often surrounded by loved ones exchanging gifts and good cheer. However, the holiday season can also be a stressful time. Shopping for gifts or sending out cards can be time-consuming and a financial strain. Many people travel to be with families, which can be tiring. Those who travel far might even suffer from jet lag. Being with one’s extended family can be emotionally draining. Dysfunctional family dynamics that have been dormant all year can rear their ugly head. Our expectations don’t always match up with the idyllic representations we see in the movies or on tv. New Years can bring up feelings of remorse and failure. To some the tinsel and bright colorful lights are nothing more than a reminder of the darkness and cold of winter that looms just below the ornaments.
During the holiday season many feel isolated, alone or unhappy with their current relationships. They might hate their jobs or even be unemployed. They might be physically ill or are close to someone who is sick or even dying. As we get older, the holidays can become an annual reminder of the loved ones we have lost over the years. We are flooded with childhood memories, some good and some bad. Many of the loved ones we grew up with are no longer with us.
When we gather with family and friends, we often over eat, drink too much, skip exercise routines, and don’t get enough sleep. It is common to feel exhausted and a bit grumpy around holidays. Moments of depression are not uncommon. It is easy to see how you can suffer from the holiday blues.
For many getting through the holidays can be a relief. Once you get back into your daily routines, much of the holiday malaise tends to pass. You are aware that the days will get longer, there will be more daylight, temperatures will warm up, and spring will soon be in the air — and you have 365 days until your next family gathering. You begin to exercise again, eat healthy and are glad to be back to work and your daily routines. But this is not the case for everyone. Depression can drag on beyond the holidays. Some people experience bouts of depression that can last the entire winter season, and in some instances even longer.
Seasonal Affective Disorder (SAD)
Seasonal Affective Disorder (SAD) is a type of depression that is related to the changes in the season. Symptoms typically start out mild in the fall and gradually become more severe as the winter approaches. This syndrome is often referred to as the "winter blues” because it is triggered by the lack of day light and the cold weather. Like other forms of depression, people who have SAD can be overwhelmed with feelings of guilt, anxiety and despair. They can feel like the energy in their body has been zapped resulting in sluggishness, poor concentration and little motivation to do activities that they once found to be pleasurable. Due to intrusive negative thoughts, they can easily become agitated. This high degree of irritability can make it hard to fall asleep and stay asleep, resulting in exhaustion and mood swings. One's appetite is often affected and accompanied by either weight gain or loss. Many people who have SAD suffer from low self-esteem.
Some of the factors that seem to play a role in the onset of SAD is a change in circadian rhythms. The research suggests the reduction in sunlight disrupts the body's internal clock and throws off one's sense of well-being. Not having enough sunlight can also cause of drop in serotonin, a neurotransmitter, that when lowered results in mood changes associated with depression and anxiety. The change in seasons can also disrupt the body's level of melatonin. Melatonin plays an important role in sleep patterns, affect and energy level.
There are several treatment options for individuals who suffer from Seasonal Affective Disorder. It is important to discuss your symptoms with your primary care physician (PCP) to rule out the possibility of other medical conditions that can cause mood changes. If your PCP does diagnose you with SAD, he will most likely refer you to a clinical psychologist for psychotherapy to learn strategies to identify and change negative thoughts and behaviors as well as learn relaxation techniques to reduce stress, bodily tension, and elevate one's mood.
Light Therapy, also called phototherapy is often utilized to treat SAD. Utilizing a special light box, a person sits in front of this special bright light for an hour each morning. The light therapy mimics the natural light that occurs in the spring and summer months and affects a change in the brain's chemicals linked to moods. Light therapy typically begins working within a few weeks and there are few negative side affects.
Some people benefit from medications. Wellbutrin is an anti-depressant that is often used to treat severe cases of SAD. The medication can be taken during the SAD season, from late fall until the end of winter each year. Exercise, meditation and stress management tools can also be helpful to reduce SAD symptoms.
Major Depressive Disorder (MDD)
Major depression is a disabling condition that can last for long periods of time. Without treatment, a major depressive episode can last months, years and even a lifetime. While the condition can worsen during the holiday season or winter months, it is most often triggered by a personal loss or negative situational event. MDD can run in families. In many cases, the mood disorder can be biologically or socially based or a combination of both. How one was raised as a child is an important contributing factor in MDD. Individuals who suffer from dysthymia, a low-grade continuous depression, are most vulnerable to bouts of major depressive episodes.
People who have never experienced major depression might not understand the depth or severity of the syndrome. There can be nothing more frustrating to a depressed person than someone telling them they should just “snap out of it,” “you have no reason to be unhappy,” or “you just need to pull yourself up with your own boot straps.” Major depression is not something that tends to go away on its own without professional intervention.
When you are clinically depressed you can feel totally helpless and have little hope that you will ever feel better. You tend to forget what it feels like not to be depressed. If someone tries to remind you of past times when you were happy, you quickly view their opinions as ill informed and agitating. You feel depressed and exhausted all the time. Your mind is occupied with negative obsessions, self-deprecating thoughts, and low self-esteem.
There is a melancholia to your mood. You might feel sad, overwhelmed and psychologically paralyzed. You might feel that your life has no purpose or meaning. You have a hard time falling asleep and if you do fall asleep you tend to wake in the middle of the night worried and frightened . You cannot shut off your mind. You thoughts are racing with irrational fears and anxiety provoking self doubts. When you are depressed you can become easily agitated and angry. Even the smallest gesture by another person can be misinterpreted and set off a tirade. Some people become so frustrated that their anger rises to the level of rage, whereby they become capable when provoked of doing bodily harm to themselves or others.
Depression can cause difficulties in focusing and concentration as well as deficits in abstract reasoning and memory. Being productive at school, work or at home can be difficult, if not impossible. In severe cases, a person might not have enough energy to get out of bed, care about their appearance or perform basic activities of daily living. Suicidal thoughts or actual attempts are not out of the question.
If you or someone you know suffers from clinical depression, it is important that seek professional help as soon as possible. Clinical psychologist are trained in the diagnosis and treatment of mood disorders. Depression is treatable. Utilizing a combination of cognitive behavioral therapy (CBT), insight oriented psychotherapy and sometimes medication, the clinical psychologist can come up with an action plan to alleviate your symptoms and make changes to how you think, behave, relate to others, and experience yourself and the world around you.
Dr. Martin Klein, Ph.D. is a clinical psychologist who practices in Westport and Branford CT. He works with children, adults and couples.