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December 17, 2017

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Southern Hills Hospital and Medical Center

How to hold it together when the holidays stress you out

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Changing seasons can affect people’s daily habits, schedules, behaviors and general sense of well-being. And perhaps no season brings more significant changes than winter. Even in sunny Nevada, we’re not immune to experiencing the winter blues.

“Seasonal affective disorder is more serious than many people realize,” said Dr. Jacob Manjooran, M.D., a board-certified psychiatrist at Southern Hills Hospital and Medical Center.“It’s not simply a feeling of sadness; it causes chemical changes in the brain that lead to depression.”

Add stress brought on by the holidays, and it can be a recipe for disaster. While there’s no way to prevent the seasons from changing, we can modify how we respond to the changes.

What is seasonal affective disorder (SAD)?

SAD is a clinical depressive disorder that recurs during a specific season every year. “Most people who have seasonal affective disorder have it during the dark winter months, though some people experience it in the spring or summer,” Manjooran said.

While the exact physiological mechanism that causes SAD is unknown, it is thought to be triggered by changes in daylight hours during different seasons, more so than by weather or temperature changes.

Light can influence the production of serotonin, a chemical within the brain that affects mood and behavior.

Symptoms

The telltale symptom of SAD is experiencing its effects during the same season annually. Symptoms generally coincide with the major symptoms of depression but may include others.

The major symptoms of depression are:

• Feelings of sadness, guilt or worthlessness

• Severe and sudden social withdrawal

• Suicidal thoughts

• Insomnia or constant fatigue and low energy

• Lack of appetite or other sudden changes in eating habits

• Strong cravings for carbohydrates

• Increased appetite

• Lack of interest in activities

• Oversleeping

• Irritability

Treatment for seasonal affective disorder

Because the symptoms of SAD appear suddenly and are resolved suddenly when the seasons change, treatment options include typical methods of depression treatment as well as SAD-specific options.

“Treatment for depression usually follows a three-pronged approach that includes addressing the biological factor, the psychological factor and the social factor. This usually means medication, therapy and social efforts, respectively,” Manjooran said.

Antidepressants such SSRIs (selective serotonin reuptake inhibitors) can work for some patients with SAD by helping to increase serotonin levels in their brain.

Regular therapy for patients leading up to the troublesome months and during those months also is important.

Keeping a consistent routine and making time for friends and family are critical social components as well.

There are other treatment options that are effective for SAD and may fall beyond typical depression treatment methods.

“Light-box therapy tends to work very well for patients,” Manjooran said. “Light boxes imitate sunlight but filter out most the harmful UV rays, allowing patients to receive all the positive benefits of sunlight from an artificial source.”

Light boxes are considered a first-line treatment method. They can be purchased for a relatively low cost and can be used at home daily during the darker months.

Another at-home treatment option is a negatively ionized air purifier. “We don’t know exactly why this works, but it has up to a 50 percent efficacy for people with seasonal affective disorder,” Manjooran said. “It’s especially beneficial when used in tandem with light box therapy.”

Other treatment options can include regular, daily cardiovascular exercise and cognitive behavioral therapy.

Even in Nevada?

Instances of SAD are higher in locations with longer, darker winters such as Alaska, the Midwest and the Northeast. However, Manjooran speculates that SAD may be under-diagnosed in Nevada. “Because it’s generally less common here, it is also not screened for as regularly,” he said.

Holiday stress

Higher stress levels also tend to be reported during the winter holidays regardless of geographical location.“Holiday stress is a different kind of depression that many people experience,” Manjooran said.

Though causes vary from person to person, financial burdens, over commercialization, unrealistic expectations and social anxiety (because of either too many or too few social commitments) are the most common offenders.

Tips for managing holiday stress

“For patients with SAD and patients experiencing holiday stress, the single most important thing they can do to help fight it is maintain a very consistent daily routine,” Manjooran said.

While the holidays tend to disrupt routines with an influx of parties, shopping and traditions, there are many activities people can do to help maintain inner peace.

Manjooran recommends the following:

• Wake up and go to sleep at the same time every day

• Do a minimum of 30 minutes of cardiovascular exercise every day

• Maintain a well-rounded diet and avoid overindulging in alcohol and high-carbohydrate foods

• Practice 15 minutes of Transcendental Meditation daily

• Reach out for professional help when needed

• Make an effort to socialize daily; avoid isolating yourself because of stress

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