Winter holidays prime time for depression

By Keith Herrell

(Medical Xpress) -- The music playing in the background as we do our Christmas shopping may tell us it’s "the most wonderful time of the year.” But it’s also prime time for depression, a UC Health psychiatrist says.

"This is the time of the year when days are noticeably shorter, and that absence of light in the late-afternoon hours really seems to affect some people—they feel an acute lowering of their mood,” says Erik Nelson, MD, an associate professor of psychiatry and behavioral neuroscience who specializes in mood disorders and depression at UC Health Psychiatry in Clifton.

"Additionally, the holidays can play a role in depression. Some people might have painful memories related to loss of loved ones or stressful childhoods. These are memories with a lot of emotional and psychological significance, and the holidays tend to bring that out.”

When assessing a patient for winter depression, Nelson says, it’s important to determine what triggers their feelings before prescribing a course of treatment.

Some people, for instance, might feel fine for most of the year but report feelings of depression as the days grow shorter. In such cases, known as winter-onset seasonal affective disorder (SAD), treatment with a light box, known as therapeutic light, can be affective.

Symptoms of winter-onset SAD include depressed mood, changes in appetite and weight, fatigue, difficulty concentrating, changes in sleep (often oversleeping) and loss of interest in formerly enjoyable activities.

As with any mood disorder, Nelson says, "If the condition is interfering with your normal life, it’s time to seek help.”

Therapeutic light involves a specially designed lamp giving off an intensity of light that mimics the full spectrum and intensity of sunlight. Such devices are generally used for about 15 to 30 minutes in the morning, with the light shining indirectly on the person’s face, and can be used while he or she is involved in another activity such as reading or exercising.

The antidepressant  bupropion (trade name Wellbutrin) has been approved by the FDA to treat seasonal major depressive episodes, but the proper medication for any individual case should be determined in consultation with a physician. Another treatment option is cognitive behavioral therapy, a pragmatic interactive therapy that has the goal of changing specific thoughts and behaviors.

Moreover, some people who are already being treated for depression notice a worsening of their symptoms during the winter months. If this appears to be related to the decreased hours of daylight, adding light therapy to the person’s current treatments for depression is often helpful, Nelson says.

For worsening of that appears to be related to the emotions or stress associated with the holidays, Nelson says, a change in the person’s current regimen, which would typically include psychotherapy and/or antidepressant medication, would be the likely course of treatment.

"There are a lot of factors that can affect a person’s mood this time of year, and it is helpful to assess the likely cause to determine the best course of treatment such as therapeutic light, medications, psychotherapy or behavioral changes that can be made.”

If people have milder seasonal symptoms that do not reach the level of a major depressive episode, Nelson says, they should try exercise and getting outdoors more to see if that helps their symptoms.

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