As the holiday season approaches, a sense of mirth and gladness begins to pervade the very air we breathe. The weather turns colder, the nights come on earlier, and spots of light become a striking feature of the streetscape. The media report on civic holiday preparations and the various hangups that these public works entail, the fliers and circulars begin rolling in advertising holiday sales and savings. Everybody seems to be having a good time. You get a few days off from work or school. You plan to spend some time with the family, maybe you go shopping for some Hanukkah gifts. But for many people, mistletoe and menorahs trigger feelings of emptiness and even depression. Though this can often seem inexplicable, the holiday blues are an increasingly common phenomenon.
Rivkah H.*, a 29 year old mother of three, came into my office complaining of a feeling of dread and sadness that would start around Thanksgiving and wouldn't go away until spring. She had gained some weight and reported feeling tired. While these complaints may simply be the result of dealing with a tighter schedule and inclement weather, often this pattern of symptoms is sufficiently severe to be consistent with a diagnosis of seasonal affective disorder (SAD).
We don't know precisely what causes SAD, but several seasonal factors are hypothesized to play a role. Longer nights increase your body's production of melatonin, while getting less sunlight may lead to a drop in serotonin. Earlier nightfall may alter the body's circadian rhythms and disrupt your normal sleep-wake cycles, which can have a negative impact on mood. Any combination of these factors may be responsible for the seasonal depression know as SAD, which affects about 4% to 15% of the population every year.
Another client, Jacob M.*, 21, reported feeling emptiness, hopelessness, and detachment that would come and go in brief spurts. Episodes would often last from a day or two to a week and then gradually recede until he would get back to feeling normal. During these episodes, Jacob would sleep longer than usual and become less interested in social interaction. If these symptoms caused "clinically significant distress or impairment in social, occupational, or other important areas of functioning", Jacob could be going through what psychiatrists call a Major Depressive Episode, the primary feature of Major Depressive Disorder.
(It is important to point out here that the methodology of the standard diagnostic manual used by the mental health profession today (DSM-IV) is based on symptomatology, not etiology. That is to say, disorders are differentiated primarily by their universe of symptoms, not by their cause. This means that even though Jacob's diagnosis is simply depression (or even depression, recurrent, with seasonal pattern) it is useful to go beyond this to try to understand his condition.)
During the clinical interview, it came to light that Jacob's depressive episodes would often coincide with the winter holidays. Although timing of onset and the similarity of symptoms make it easy to confuse holiday depression with SAD, there are a number of important differences. Holiday depression is often characterized by a more rapid onset and briefer duration; it is a more acute condition, while SAD is more chronic. Jacob's condition may have more to do with psychosocial triggers than seasonal ones.
The causes of holiday depression are manifold. First, the holiday season involves a breakup from the ordinary schedule for most people. Normal, comforting routines of work or school are interrupted. People are likely to travel or receive guests. Any disruption of the norm can trigger stress and anxiety and lead to feelings of unhappiness. Time off from our usual busy schedules can provide a chance for introspection and reevaluation. If we find we are not happy with where our lives are taking us, we may feel desolate and hopeless.
In addition, the holidays offer great expectations of familial warmth and religious meaning. For many, these high expectations may simply not materialize, leading to feelings of intense loneliness and abandonment. Conversations with friends and coworkers, together with media portrayals of "everyone else" enjoying vacations and family time can exacerbate feelings of loneliness for people who do not or cannot enjoy the holiday togetherness. For those who do not identify with the religious implications of the holidays, this season can stir up feelings of being different and aloof from society as a whole.
The fact is, most people do not have the Brady Bunch holiday Coca-Cola would like you to imagine (so that you buy lots of Coke to serve your many guests). Psychologists call this concept pluralistic ignorance. Everybody tries to conform to what they perceive is the group norm (in this case to put on a happy face and celebrate the holidays) even though each person privately disagrees with that perceived norm (people may not think of the standard holiday celebrations as their idea of a good time). Through better communication, it would have been apparent that the perceived group norm was actually incorrect: the others all agreed with the individual's assessment but they kept silent and also conformed to the perceived (nonexistent) norm.
Another factor has to do with the sense of self becoming threatened by holiday social situations. People tend to develop distinct social persona, or masks, that characterize them in each social situation. These distinct persona, rather than any underlying sense of true self, are powerful driving forces of personal behavior. When holiday season arrives and people are pressed into unusual social situations, they find that their familiar social persona is exchanged for a new one until they almost do not even recognize themselves. They may begin to act in different ways than usual or become confused and uncertain about how they should act.
Together, seasonal changes, disruption of routine, challenging social situations, pluralistic ignorance that causes us to think we are the only one "missing out", and crises of identity and meaning can lead to sadness, loneliness, and that horrible feeling in the pit of the stomach that we identify as holiday depression.
Holiday depression can often be treated successfully pharmacologically with anti-depressive agents or with psychotherapy, however the short duration of individual episodes means that symptoms will usually subside on their own before drugs or therapy take effect. If there is a SAD component, light therapy may be effective in alleviating some cases of holiday depression. It is crucial for family and caregivers to be aware that the brief duration of holiday depression episodes should not lead them to discount the painful, and for some, crippling, nature of this syndrome. Because it strikes at a time when people expect to be happy, it can be a devastating blow. By essentially "removing all the good parts" from life, holiday depression can make things look very bleak indeed.
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