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Holiday Blues of True Depression? It is Important to Know the Difference

We usually expect the holiday season to be a whirlwind of parties, presents, family gatherings and joyful feelings, but for some, it creates feelings of loneliness, painful memories, worry and anxiety about the future. The change in seasons, too, can affect our moods to various degrees. How do we know if these holiday and seasonal blues are something more?

Despite the many commercials for antidepressant medications on television and in print, there is a basic lack of awareness in the community about the signs and symptoms of depression. In general, clinical depression can be differentiated from normal sadness because it is more severe, it lasts longer and it interferes with a person’s daily functioning. Depression should not be dismissed as just a case of the blues or some personal weakness. It is an illness that often responds very well to treatment.

Common symptoms of depression include loss of energy, withdrawal from social activities, difficulties at work or school, irritability, difficulty sleeping, lack of enthusiasm for activities that were enjoyed in the past, loss of appetite, loss of general sense of well being, vague aches and pains, excessive worry, feelings of guilt, preoccupation with negative thoughts, hopelessness, and in some cases, suicidal thinking.

It is important to recognize that a depressed individual may have complaints that do not seem like symptoms of depression, such as headache, backache, chronic pains, lethargy, loss of sexual desire or other sexual complaints, or frequent medical consultations.

Women are particularly vulnerable to depression. Increased rates of depression have been studied to occur at key points in a woman’s reproductive cycle – puberty, the pre-menstrual period, pregnancy, the post-partum period and menopause. Changing hormone levels can cause chemical changes in the brain.

Depression may look different in different people. For example, depression in children may present totally different symptoms than depression in an adult. Children commonly experience changes in behavior such as conduct problems, missed school, falling grades or substance abuse.

In the elderly, depression is often undiagnosed and under treated, which is problematic since depression can cause false symptoms of dementia or make the early signs of dementia appear worse. When it is identified, depression in the elderly is just as responsive to treatment as in younger people.

The link between pain and depression is gaining greater recognition and understanding. It has been found that nearly 30 percent of visits to primary care physicians are psychosomatic in nature. In other words, the patient feels real symptoms, but no physical illness can be established to explain those symptoms.
Depression is increasingly being studied to occur as a prelude to some catastrophic cardiovascular or cerebrovascular events (heart attack or stroke) or as a consequence of such events, hindering the recovery process.

Equally important is to recognize depression that may co-exist with a chronic medical illness, such as hypertension or diabetes, as the treatment has a direct bearing on successful management of those maladies. As Henry Maudsley, a famous British psychiatrist once said, “The sorrow which has no vent in tears may make other organs weep.”

Clearly there is a need for all responsible people in the community – parents, family members, friends, co-workers, school teachers – to be alert to behaviors that may signal depression and to support and encourage such individuals to seek professional help and care.

If someone you know starts withdrawing, functioning poorly at school or work, or losing their enjoyment of life, listen to the alarm bells that signal the possibility of depression. It may be dangerous to wait until the symptoms become more serious and lead to problems with health, relationships, job performance, drug and alcohol use, or even a suicide attempt. The point to remember is not to delay or avoid getting medical help because the person may have legitimate reasons for feeling depressed, such as loss of a loved one, a medical illness or problems of aging.

People often are surprised to know that clinical depression is twice as responsive to appropriate medical treatment as is hypertension. The newest antidepressant medications are considerably safer and cause fewer drug interactions even when taken with most other prescribed medications (but should be taken only when prescribed by a physician).

This holiday season, while you watch for warning signs in others, you can take care of your own emotional health by following a few tips: Pace yourself and prioritize the most important activities. Keep your activities within your own comfort level rather than trying to meet someone else’s expectations. Anticipate feelings of sadness or loneliness as unavoidable, and plan to be with people who are understanding of this and are comforting to you.

As much as you can, try not to compare this holiday to those in the past. Volunteering to help others can bring a feeling of great satisfaction. Rather than overspending, try to enjoy free activities such as looking at holiday lights and window shopping. Avoid excessive drinking, since alcohol only increases feelings of sadness.

Visit www.moodchange.info and www.dbsalliance.org on the internet to find more information on depression and mood disorders and a screening assessment tool.

Murali Rao, MD
Associate Professor and Vice-Chair
Department of Psychiatry and Behavioral Neurosciences
Loyola University Chicago Stritch School of Medicine