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Not-So-Happy Holidays?

Dealing with the Holiday Blues
by David Palmquist, MD

iStock 000003574934SmallYear after year, the holiday season ushers in grand expectations of celebration, happiness, sharing, and joy. Each one of us has our own stories about how perfect things should be and how happy we should be—ideals that can sometimes leave us feeling empty and hopeless when reality does not match fantasy. While people of any age can be affected by this dynamic, the elderly are even more predisposed to holiday depression.

Signs of depression are usually more obvious in younger, more active people and may be dismissed as “normal” signs of aging in older adults. It’s true that, as we age, neurotransmitter levels in our brains decrease and can leave us feeling sad. In fact, between age 60 and age 80, our serotonin levels, which directly affect mood, can decrease by as much as 2/3!

Any time of year, we should pay attention to any of the following indications:

  • withdrawl from normal activities and social interaction;
  • change in mental status, such as confusion or disorientation;
  • weight loss and/or decreased food intake;
  • thoughts or statements about suicide (e.g., “I have no reason to be around any more”).

During the holidays, emotions can become more painful than usual for people who are isolated, have lost loved ones, are ill, have physical disabilities, or who are no longer able to participate fully in life the way they’re accustomed to doing. What positive steps can we take to avoid or minimize holiday depression?

Stay in connection. There is no drug as effective as social interaction. Even if you may not feel like it, try to find ways to get out and be with other people as much as possible. If your family is not around, get involved in a group or activity through your recreation center or the facility where you live. Volunteer to help out at your church or a soup kitchen if you’re able. Isolating yourself from others is the worst thing to do, especially if you are feeling depressed.

Of course, everyone gets very busy during this time of year, so you may have to take the initiative to remind family members that you’d like to be involved in their holiday bustle. And if you are someone who has an older family member or friend who lives alone or in a facility, please remember to include them in the activities leading up to the holiday gathering or meal. Take them shopping with you or invite them to help trim the tree, decorate cookies, go to the kids’ pageant, or wrap presents. There is an entire season of opportunities to be together--not just a single day.

Get outside.
It’s well documented that the shorter, colder days of winter, when we often stay cooped up inside, can contribute to depression. If you are able, try to bundle up and get outside for even a short while every day. Get a little bit of sunshine on your face and breathe the fresh air. Take a walk if you are able.

Don’t self-medicate. 
It may be true that having a drink might “take the edge off” and give the illusion of feeling better for a short time, but alcohol is actually a neurodepressant that will leave you feeling worse in the long run. Alcohol has no benefits at all to the body and is, in fact, toxic to your brain. It can numb, but it can’t really make you feel better.

Some people also turn to prescription medications, such as valium, in an attempt to feel better. This is dangerous. In addition to the risk of possible overdose, they can also increase your risk for accidents, falls and fractures. Only take medications as prescribed by your physician.

Eat well. Try to stick to a healthy, well-rounded diet. Depression can result in diminished enjoyment of food and appetite. Even if you don’t feel like eating, it is critical to give your body the nutrients it needs to keep your brain and body functioning well and support your immune system.

Conversely, overeating can also leave you feeling sluggish and empty. Sometimes we use food to mask painful emotions and just end up feeling worse. When you catch yourself reaching for the junk food, ask yourself: is my body really hungry, or is my brain hungry? If it’s your brain, distract yourself with something else—needlework, a puzzle, a walk—to shift your attention away from food.

Get your rest. As we age, we spend less time in the restorative stages of sleep and awake more frequently during the night. Depression and lack of sleep can be a vicious cycle, each contributing to the other. If you are having trouble getting to sleep or staying asleep at night, you may want to consult with your physician to understand why.

See you primary care provider.
It’s always a good idea to check in with your physician or other primary care provider regularly, and especially if you are feeling depressed. Your doctor can determine if there is something going on with you physiologically that needs to be addressed.

In some cases, an antidepressant medication (“SSRIs” such as Paxil, Zoloft, Lexapro, or Celexa; or “SNRIs” like Cymblata or Effexor) could be exactly what you need to feel happier and more like yourself again. Many of these medications are well-tolerated by older adults, although it can take up to two months for the beneficial effects to kick in.

The holiday season can bring happy, joyful times, and can also summon or aggravate feelings of sadness and depression. But you don’t have to suffer through the holidays in silence—reach out to the people and resources around you. And have a happy, healthy holiday season!

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