How to Prevent Holiday Stress and Anxiety
By the Medical College of Wisconsin


“’Tis the season to be jolly!”
Many modern Americans couldn’t disagree more, if current statistics are correct. Depression strikes about 17 million American adults each year, according to the National Institute of Mental Health (NIMH), and 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 house guests, and you have the perfect formula for producing high levels of stress. Common stress reactions during the holidays include headaches, excessive drinking, over-eating or not eating enough, and difficulty sleeping. And a post-holiday let down resulting from physical and emotional reactions during the holiday months may cause holiday blues to continue into the new year.

The Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA) and the National Mental Health Association (NMHA) 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.

Seasonal Affective Disorder
For some people, particularly those who live in the northern regions of the country, holiday blues may 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 may also occur in the summer, but less frequently.

The prevalence of SAD is not very well known, although some studies report rates between 2-10% of the American population. (Differences in how scientists measure SAD may explain these contrasting rates.)

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. "A lot of people have anxiety in social situations, such as when meeting new people at a holiday party, but the fear is not severe and typically passes," said Una McCann, M.D., of the Unit on Anxiety Disorders at the National Institute of Mental Health (NIMH). "For people with social phobia, however, the fear of embarrassment in social situations is excessive, extremely intrusive and can have debilitating effects on personal and professional relationships."

People with social phobia have an overwhelming and disabling fear of disapproval in social situations. They recognize that their fear may be excessive or unreasonable, but are unable to overcome it. Symptoms of social phobia include blushing, sweating, trembling, rapid heartbeat, muscle tension, nausea or other stomach discomfort, lightheadedness and other symptoms of anxiety. Effective treatments include medications, therapy, or some combination.

"Without treatment, social phobia can be extremely disabling to a person's work, social and family relationships. In extreme cases, a person may begin to avoid all social situations and become housebound," said Dr. McCann. "But the good news is that effective treatment for social phobia is available and can be tremendously helpful to people living with this disorder."

Depression
The occasional sadness everyone feels due to life's disappointments is very different from the serious illness caused by a brain disorder such as depression. Depression profoundly impairs the ability to function in everyday situations by affecting moods, thoughts, behaviors, and physical well-being, but many people simply don't understand it. "A lot of people still believe that depression is a character flaw or caused by bad parenting," says Mary Rappaport, a spokeswoman for the National Alliance for the Mentally Ill. She explains that depression cannot be overcome by willpower, but requires medical attention.

The National Institute of Mental Health says that about two-thirds of the people suffering from depression don't get the help they need, and 15% of chronic depression cases end in suicide. The American Psychiatric Association (APA) estimates that 80 - 90% of all cases of depression can be treated effectively, but 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.

Fortunately, depression is treatable, says Thomas Laughren, M.D., team leader for psychiatric drug products in the FDA's division of neuropharmacological drug products. One major approach for treating depressive disorders is the use of antidepressant medications. The effects of antidepressants on the brain are not fully understood, but there is substantial evidence that they restore the brain's chemical balance.

Changes in lifestyle are also 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.

For the long term, some people might need psychotherapy to address certain aspects of the illness that drugs cannot. "Although the biological features of depression may respond better to drugs," Laughren says, "people may need to relearn how to interact with their environment after the biological part of the depression is controlled."

Ask for Help
Seasonal Affective Disorder, social phobia and depression 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.