Dr. Mark Schiller: Blues Worse After Holidays

Friday, 02 Jan 2009 12:11 PM

By Mark Schiller, MD

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Conventional wisdom holds that the holiday season is the roughest time of year for anxiety, depression, and other emotional problems. But we may be able to toss that into the trash can as an urban myth.

Psychiatric admissions actually are at their lowest levels in the weeks around the holidays. A study at the University of California, San Francisco, documents that psychiatric admissions spike more on rainy days than on holidays. And multiple studies show that suicides actually decrease during the holly-jolly season.

So as dutiful families wrap up the holiday marathon and trudge home this week, we can all breathe a sigh of relief and get back to normal, knowing that we’ve made it through another year unscarred by family crisis, right?

Not really. Statistics show that the worst may be yet to come, and that the period AFTER the holidays is the most dangerous, with escalating hospital admissions and 40 percent more suicide attempts. Now is actually the time for friends and families to be extremely watchful of those at risk.

Psychiatrists call this the “broken-promise effect.” High expectations for the holidays go unmet, and the disappointment finally catches up with people. Everyone is supposed to be happy at this time of year, so patients may have been reluctant to let on and, instead, hid their symptoms. Some may delay getting help because they don’t want to interfere with holiday activities.

For many, the stress, loneliness, disappointment, and other negatives of the holidays may set off a process that eventually develops into a more distinct depressive or anxiety disorder some weeks or months after the holidays. Unfortunately, this may be even more likely this year, given the country’s serious financial strains.

For others who really enjoy the extra dose of holiday cheer and social interaction, taking down the decorations and the letdown of the return to “normal” can be the trigger.

The exception to the holiday rule is New Year’s Day, with studies showing that suicide attempts do increase on the first day of the year.

Throw in the New Year’s resolution ritual and the taking stock of your life that goes with it. The beginning of the year is when people evaluate their achievements of the past year. If the failures and disappointments seem to outweigh the successes, the conditions can be ripe for a psychiatric free fall.

Many believe that a key factor limiting psychiatric problems during the holidays is the increased level of emotional support from families and friends. People are nicer, and social interaction increases. The post-holiday social withdrawal makes it harder to cope. If you have someone who might be at risk, stay in touch. An unhurried dinner in January may have more meaning than the holiday gathering.

Create a positive ritual for the New Year. The past one’s been rough for a lot of people, but instead of clinging to the failures, try to sort it out. Make a list of all the things that happened to you this past year, both the good and the bad. Most will find that they have some pretty good pluses, even in a year that seems pretty bad.

It may seem like a no-brainer, but breathe. Most of us forget to breathe well, and just a few deep breaths can help. In my practice, I encourage mental well-being through breathing exercises, meditation classes, qigong, and tai chi.

And finally, if you’re in emotional pain, admit it. Many times, just beginning to address a growing problem makes you feel better. Check Web sites for the signs of depression or other illnesses. If you recognize yourself, get help. Many practices use rapidly developing technologies to identify, target, and treat psychiatric problems more objectively. We can start to alleviate symptoms more quickly than ever before.

If you’re having emotional problems, you deserve to have hope, no matter your situation. This really can be a happy new near.

Mark Schiller, M.D., a Marin County, Calif., psychiatrist, is founder of MindTherapy Clinic and is on staff at Marin County Crisis Service.

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