Holidays Are Not Always Happy

Dec. 27, 2007— -- 'Tis the season to be jolly … and many of us are. With the colorful lights, the cheerful songs, the office parties, the presents, the gatherings with family, the reunions with old friends, the warm fires, the turkey dinners -- how can we help but be jolly?

The trouble is that while most of us are visited by St. Nicholas offering his good tidings, some could also use visits from St. Dymphna.

Never heard of St. Dymphna?

Legend has it that this beautiful Irish princess was pursued by her deranged father and was finally decapitated by him in the Belgian town of Gheel. She's the patron saint of those suffering from mental afflictions.

The holiday season can be a difficult time for people with mood disorders, and this group constitutes a substantial chunk of the population, as about 2 percent of people have a diagnosis of bipolar disorder and 16 percent have major depression at some point in their lives.

One of the difficulties is that some people who are depressed feel inclined to isolate themselves. This may be because of feelings of inadequacy; they may feel that others who see them are judging them negatively, or can see how "bad" they are.

Some people are quick to suspect friends, colleagues and acquaintances of talking about them, making fun of them, or disparaging them.

For others with depression, the desire for social isolation has more to do with feeling they simply do not have the energy that interacting with people requires. They may feel that thinking of what to say requires a level of motivation that they cannot summon.

Yet another difficulty comes from feeling that navigating the many decisions that often accompany the holidays is more than they can handle.

Decisions such as which family members to spend Christmas with, who to buy gifts for, which gifts to buy, whether to send out holiday cards, what to say in them, who to send them to -- all of that requires a level of functioning that some people with depression cannot rise to if they are ill.

December Is the Darkest Month

I had one middle-aged patient tell me that Christmas stood out for her as the worst time of the year. She recalled dark days being upstairs in her room feeling desperate and miserable while listening to the sounds of her family downstairs enjoying their presents, eating, chatting, singing and being merry.

There are patients whose moods are worst in the winter. Some of them describe their moods steadily declining as the grayness of the fall sets in and the darkness of winter follows.

This phenomenon was given a name in 1984 in a paper by Norman Rosenthal and his colleagues at the National Institute of Mental Health. Using the older name for mood disorder, they described seasonal "affective disorder," coining the clever acronym SAD.

They emphasized that these patients generally had particular depressive features, including sleeping too much and overeating.

These patients also often had bipolar II disorder, meaning that they had occasional hypomanias -- mild periods of unusually elevated mood. They also seemed to respond to changes in climate and latitude.

I have seen two patients with bipolar II disorder who spent much of the time depressed whose symptoms largely disappeared after they moved away from the East Coast to regions of the United States where the sun is almost always shining brightly.

Interestingly though, you do not have to move to Los Angeles or Phoenix, or Miami to catch the rays.

You can also catch them in the comfort of your own home using a light box. These devices come in a variety of shapes and sizes, but they all deliver light at about 10 to 20 times the brightness of ordinary indoor lighting.

Sitting or reading under these lights for 30 minutes to two hours in the morning over days to weeks can substantially improve mood in people with SAD.

Medications can also help. Prozac and Zoloft, two of the serotonin-selective reuptake inhibitor antidepressants, have been shown to effectively treat SAD patients. Another antidepressant, Wellbutrin, has been shown to prevent SAD when started in the autumn.

Light therapy and medications were shown to be equally effective in several studies, though side effects are probably less frequent among those treated with the light.

Can anything else help with depressive symptoms at this time of year?

Of course! The holiday season can be a wonderfully uplifting experience as most of us know abundantly well. It can lift the spirits of those who are feeling low. It can be about rebirth and renewal, about generosity and love, and about strengthening the connections among us.

These connections can serve as pillars of strength for those with clinical depression, sometimes shielding them from the worst that the illness can dish out.

So this holiday season, may we all reach out to those we love, recommitting ourselves to them, and deepening the ties that bind us all.

Dr. James Potash is an associate professor of psychiatry and co-director of the Mood Disorders Program at the Johns Hopkins School of Medicine in Baltimore. If you have questions or comments, please e-mail at moods@jhu.edu. To participate in our genetic and clinical studies, call 877-MOODS-JH.