12-Dec-02

With the Holiday celebrations to attend and family gatherings to prepare for, the winter season can be a busy and joyful time of year. But for many, changes in light and temperature combined with the stresses of holiday events and heightened expectations can increase anxiety and cause depression. Seasonal Affective Disorder (SAD) is a mood disorder associated with depression episodes and related to seasonal variations in light. Andrea Rogers, Supervisor for Intensive Outpatient Programs in the Department of Psychiatry at Cedars-Sinai, offers warning signs and suggestions to combat seasonal affective disorder this Holiday season.

"As Seasons change, there is a shift in our "biological internal clocks" or circadian rhythm due partly because of changes in sunlight patterns," says Rogers, "These changes combined with the stresses of Holiday travel, sensitive family dynamics and managing expectations can build a recipe for depression during the winter months. Juggling these variables can be challenging and can make it difficult to enjoy the joys of the season."

According to the National Mental Health Association, the most difficult months for SAD sufferers are January and February, and younger persons and women are at higher risk.

According to Rogers, melatonin, a sleep-related hormone secreted by the pineal gland in the brain, is produced at increased levels in the dark. Melatonin also may cause symptoms of depression. When daylight savings time ends, and it begins getting dark earlier in the day, production of the hormone increases, which may cause depressive episodes. These biological variables mixed with environmental conditions such as cold weather, emotional reactions to holidays and anxiety can create a recipe for depression that can cast a "blue" cloud over the holiday season.

Phototherapy or bright light therapy has been shown to suppress the brain's secretion of melatonin. The device most often used today is a bank of white fluorescent lights on a metal reflector and shield with a plastic screen. For mild symptoms, spending time outdoors during the day or arranging homes and work places to receive more sunlight can be helpful.

Rogers recommends the following 6 tips to proactively reduce or eliminate environmental stressors and symptoms of SAD:

* Let go of the past! The holidays bring out the "traditionalist" in most people, and many of us get caught up in trying to make the holidays just like years past. The reality is, every year brings about new circumstances, surprises and colorful characters who are bound to "rock the boat" during your "perfect" holiday celebration. "Reduce your anxiety about holiday traditions by acknowledging your opportunity to maximize your current circumstances to build new traditions, build on old ones, and abandon unrealistic expectations." Says Rogers
* Pace yourself. Unlike any other time of year, the holiday season is a time of celebrations, family gatherings, winter activities and entertaining visitors. These variables added on to an already busy lifestyle can cause unnecessary anxiety and hopelessness when projects begin "falling through the cracks". The key to managing additional responsibilities and social commitments during this time is to pace yourself and organize your time. Make a list and prioritize your most important activities. Accept help, and allow for quiet time at regular intervals.
* Acknowledge your feelings. The holiday season does not automatically banish reasons for feeling sad or lonely. If you have experienced the loss of a loved one, are far from family and/or friends, or are generally affected by changes in weather and light, it is ok to acknowledge that these feelings are present -- even if you choose not to express them.
* Don't drink too much! Excessive drinking only perpetuates anxiety and depression. If you are prone to depression around this time of year, keep your alcohol intake to a minimum.
* Create a support system. Spend time with people who are supportive and care about you. If that isn't your family, then spend this time with friends. If you are far from home or alone during special times, make a proactive effort to build new friendships or contact someone you have lost touch with.
* Seek treatment. Sometimes, SAD can get the best of us, even when proactively reducing stressors. If you are experiencing symptoms of depression during the winter months that are uncommon for you any other time of year, contact a mental health professional who can provide counseling and treatment to help you "weather the storm."

---Cedars-Sinai Medical Center