Lingering Holiday Blues, or Something More?

Entering the new year means saying goodbye to the holiday season, a time typically regarded as the happiest time of the year, associated with things like traveling, food, family, friends, gifts galore, and more. After the holidays, you may have struggled to transition back to business as usual, and you may have found yourself experiencing some feelings of depression and anxiety following the holidays (post-holiday blues). You may have not felt ready to adjust back to your normal routine after spending time with relatives and friends. Maybe you felt slightly more sluggish or unmotivated after the holidays. You, like many other people, may have had a case of the post-holiday blues.

Depression rates are known to rise around the holidays; according to a 2014 survey by NAMI, 64% of people with mental illness reported that the holidays make their conditions worse. For many people, the transition after the holidays is not easy, although it is important to pay attention to the length of those feelings. The post-holiday blues can mimic symptoms of Seasonal Affective Disorder (SAD), commonly referred to as “the holiday blues” or “seasonal depression”.

As we wrap up the first month of the new year, you should be feeling back to yourself. If not, it may be a sign that there is something else going on.

What is Seasonal Affective Disorder (SAD)?

Seasonal Affective Disorder, also known as Major Depressive Disorder with a seasonal pattern in the DSM-5, is a type of recurring major depressive disorder that begins and ends during specific seasons and times of the year. SAD impacts around 10 million Americans yearly, and like any other psychiatric disorder, severity varies from mild to debilitating depending on the individual. To qualify for the official DSM-5 diagnosis, individuals must have depressive symptoms that occur during the same seasons for at least two years, with their symptoms fully remitting at other times of the year.

Most individuals with SAD experience depressive symptoms throughout the fall and winter, with symptoms stopping during the spring and summer. Although a less frequent pattern, other individuals with SAD experience depressive symptoms throughout the spring and summer, with symptoms stopping during fall and winter. SAD can be particularly distressing as individuals learn to dread certain seasons, knowing their depressive symptoms will follow.

Common symptoms include:

• Feelings of sadness or suppressed mood nearly every day
• Fluctuations in sleep patterns, categorized by insomnia or hypersomnia
• Overall fatigue and low energy
• Decreased concentration
• Changes in appetite, cravings, or overall food intake (overeating or undereating)
• Feelings of worthlessness and burdensomeness
• Lack of motivation and pleasure in activities you typically enjoy
• Irritability.

It’s perfectly normal to have occasional “off" days when you feel a little down or in a funk. However, if you find yourself experiencing any of the above symptoms or having more “off" days than not, it may be helpful to seek out help from a mental health professional.

The causes of SAD

Researchers have proposed several causes of SAD, although the disorder itself is still not yet fully understood. SAD was first described by Norman E. Rosenthal and colleagues in 1984, making it a relatively new concept. Interestingly, Rosenthal's research was inspired by his own personal experiences of sadness that coincided with the winter months, which he proposed was caused by the decreased exposure to natural light. Lack of natural light can impact the body’s circadian rhythm and cause physiological changes in the brain. Disruptions in the production and uptake of neurotransmitters including serotonin, melatonin, and vitamin D have been observed in individuals with SAD.

Research has found that some individuals are predisposed to and at a higher risk for developing SAD. Those at higher risk include women, those who live farther from the equator, individuals with a family history of depressive disorders (including bipolar disorder), younger people, and those with occupations that have limited access to sunlight.

Treatment

Treatment usually includes a combination of treatment options including:

• Cognitive Behavioral Therapy (CBT). CBT is the gold standard treatment for SAD (combined with other treatment methods), and research has shown it produces the longest-lasting relief of depressive symptoms.
• Light therapy. Exposure to bright artificial light has been shown to reduce depressive symptoms.
• Antidepressant medications. Like any other type of depressive disorder, antidepressants, including selective serotonin reuptake inhibitors (SSRIs), have been shown to relieve depressive symptoms.
• Vitamin D increases. Increasing vitamin D intake before the typical onset of SAD may help relieve depressive symptoms. This can be achieved with vitamin D supplements as well as spending more time outdoors exposed to sunshine.

Ways to cope

Unlike many other psychiatric disorders, SAD often has a typical, predictable trajectory. But coping with SAD may be no easier than coping with any other psychiatric disorder. An analysis in 2017 found that “struggling to adapt to the inevitable” was one of the main themes of patients’ experiences of SAD. Seasonal depression most commonly coincides with fall and winter, which explains why the holiday months can be the toughest. Even though the holiday season has ended, these feelings can linger.

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It’s okay to ask other people around you for help or to ask for extra space. Maybe this means spending more time with loved ones, being more intentional about your daily routine, or being mindful of things that typically exacerbate your depression. Below are a few suggestions to help cope with depressive symptoms.

• Reach out for support. Contacting a mental health professional or talking to your friends and family can be therapeutic.
• Think about your expectations. Depression can be exacerbated (1) by too much stress or (2) by too much rest and inactivity. When planning your day or week, think about what is realistic for you. Try to balance your needs for stress relief with your need to be active and engaged with what you care about.
• Check in. Checking in with yourself or those around you is always important. Check in and assess whether things are working for you or not, and if they’re not, take the time to make changes.
• Routines and self-care. Routines can help people feel more grounded and in control when feeling out of control. Self-care routines can include yoga, meditation, journaling, exercising, and much more.

Julia Myerson, Ph.D., is a senior research coordinator at The Menninger Clinic. Her work includes patient outcomes collection for adolescent inpatients. Benjamin Berry, Ph.D., is a staff psychologist on Menninger's Adolescent Treatment Program. He is also an assistant professor at Baylor College of Medicine. He has special expertise in performance-based personality testing, dimensional assessment of personality functioning, and psychoanalytic psychotherapy.