Francisco R. Velázquez: For some, the most wonderful time of the year is full of stress and depression

By Francisco R. Velázquez, M.D., S.M., FCAP

Since its original recording in 1963, “It’s the Most Wonderful Time of the Year” has been one of the most recognizable holiday songs. For many, the winter holiday season is a time for joy, filled with family, friends, gatherings and celebrations. But for some it can be quite the opposite – a time of stress, sadness and even depression. And for others, January can be challenging and disorienting as we get back to business as usual.

Winter and holiday blues, post-holiday blues, feelings of anxiety and depression and clinical depression are all part of the spectrum of potential mental health and emotional issues experienced by many during this time of the year. According to 2021 survey data from the National Alliance on Mental Illness, 3 in 5 Americans feel their mental health is negatively impacted by the holidays. In addition, 64% of people with a diagnosed mental health issue or illness stated the holidays made their conditions worse. It is important to recognize that although many of these conditions can have similarities in terms of presentation signs or symptoms, these are not the same and cannot be aggregated together.

As an example, we know that seasonal affective disorder is a type of depression that typically occurs during the fall and winter months. It is estimated to affect 10% to 20% of the population. The common symptoms are mood swings, lack of energy, altered sleep patterns and other signs of depression. Research points to possible overproduction of melatonin as a factor in those impacted by SAD. Melatonin is a hormone produced in the brain that helps regulate other hormones such as dopamine, which impacts mood, behavior and sleep. In late fall and winter, shorter daylight hours decrease sun exposure, which signals the brain to create too much of the sleep-regulating hormone melatonin.

The “holiday blues” have been defined as temporary feelings of anxiety and depression during this season. Holidays can be stressful, and stress can contribute to other conditions such as depression. Holiday depression is similar to “winter blues,” but it may come and go in quick bursts as one event ends and another begins, or it can linger for the days or weeks leading up to and beyond the holiday season. According to a recent survey from the American Psychological Association, roughly 2 out of 5 people expressed increased stress levels during the holidays. Not enough time in the day, travel, financial pressures, missing loved ones and increased expectations all contribute to the increased tension felt by many.

Depression, also called major depressive disorder or clinical depression, is a mood disorder that features feelings of sadness, hopelessness and loss of interest in activities once enjoyed. It can also lead to self-harm or death by suicide. It is a treatable condition that can significantly improve if managed appropriately. Depressive disorders affect approximately 280 million people globally, and according to many experts, the symptoms can be aggravated during the holiday season.

Holiday gatherings, parties and other activities can trigger anxiety for some. Anyone can experience anxiety at some point. It is not abnormal to worry when things seem to be out of control. The season generates an unrealistic level of perfection expectation for most of us, thus the stress. In addition, approximately 15 million Americans experience social anxiety, which can be exacerbated by gatherings with unfamiliar faces, large groups of people, and other activities.

The post-holiday blues, which bring feelings of distress, anxiety or sadness usually present as a temporary condition for some time after the holidays. Although we don’t have a single or definitive cause for these symptoms, many experts agree that it may be related to a drop in adrenaline after the heightened emotional state of the holidays. Coincidentally, some people experience a similar condition after returning from prolonged vacations, perhaps for similar reasons.

What can we do to either prevent some of these symptoms and feelings, or at least mitigate their impact? First, be aware of yourself and your circumstances. Set realistic expectations for yourself and the season in general. Rest, eat well, take care of yourself, exercise if possible and enjoy the beautiful outdoors. Some fresh air, sunshine, time to yourself and relaxation can go a long way to help. For people who suffer from SAD, light therapy, vitamin D, psychotherapy, and antidepressants can be prescribed. If you suffer from clinical depression or anxiety disorders, please make sure you consult with your provider as to the best way to navigate the complexities of the holidays.

Be kind to those around you. If someone is having a hard time, often just being a concerned and attentive listener goes a long way. If we all show support for one another, it can certainly be the best time of the year.

Francisco R. Velázquez, M.D., S.M., FCAP, is the health officer for the Spokane Regional Health District.