Depression - whether it is clinical or brought on by a bereavement, divorce or work - is often at its worst for some people during the holiday season.
There is such an emphasis placed on 'perfection' at this time of year that it can make people feel terrible if they aren't living up to that ideal.
HuffPost UK Lifestyle asked the experts for their take on how to handle depression at this time of year.
Dr Paul Zollinger-Read, chief medical officer at Bupa said: "Everyone can have off days, or feel blue for a short time, but for most people this usually passes relatively quickly. However, being depressed is a medical condition and you can experience intense emotions of anxiety, hopelessness, negativity and helplessness that simply won’t go away.
“Unfortunately, although the festive season is often one associated with joy, it can also be a stressful, lonely or sad time for many people. For those affected by depression, Christmas can actually be the worst time of year and something many of us need to be more aware of."
Why is it the worst time of year though? For a lot of people, it's a combination of financial pressures and work stress. Karin Sieger, psychotherapist and HuffPost UK blogger said:
"We all face a combination of different challenges including: financial, because of the extra expense; physical, because less sunlight means low Vitamin D and serotonin levels, which affect our mood and sleep. Social, because we may have no family or friends to spend time with, or we may have gatherings with relatives where disagreements and difficult character styles are ready to erupt; and emotional, because in the midst of the seasonal hustle and bustle we may feel isolated and lonely, or we may feel stressed, anxious and vulnerable."
Dr Zollinger-Read adds: "For employees, meeting deadlines and the pressure to wrap up at work before Christmas can also cause stress, anxiety and depression."
So what can you do about it? Dr Sheri Jacobson, clinical director at Harley Therapy says: "The loneliness can be overwhelming, or we feel an outcast. Don't be too proud to accept invites if it makes you feel good- and if it doesn't, if it honestly makes you feel worse to spend Christmas with someone else's family, then don't let guilt make you feel you must say yes. It's not at all selfish to prioritise yourself during this delicate time, it's wise."
Also, if you aren't in a position to go out, do embrace the positives. "You can sleep in, hit the boxing day sales, and eat all the mince pies you want with nobody complaining. And indulge yourself a little if it helps. Buy yourself a gift. It's a great time to celebrate you."
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Stomach problems are common in people with depression or anxiety, especially in children and adolescents. “Lots of kids have tummy problems and when you look into them, you find they’re often related to school anxiety or their peer relationships,” Haight says. Adults with depression also may have digestive issues, such as queasiness, nausea, and diarrhea. Some digestive disorders, such as Crohn’s disease, colitis, or ulcers, can be worsened by stress and depression.
Headaches can have many causes, and sometimes they can be signs of depression. Headaches that are related to depression are usually dull and generalized. Also, people with depression often report their headaches are worse in the morning and in the evening. They are likely tension headaches, which occur when the muscles in your neck and scalp become tense or contract. “When people are depressed, they may be tensing this muscle group — not realizing it and creating a lot of head pain,” Haight says.
Trouble sleeping is one clue to diagnosing depression. People with depression can have difficulty falling asleep or they may wake up in the middle of the night and can’t get back to sleep. “Everyone has stress and can’t sleep now and then,” Haight says. “But if your problems sleeping go on for more than a few weeks, you need to start thinking about whether it’s an emotional difficulty that needs to be addressed.” About a third of people with depression may sleep much more than normal.
Back or muscle aches can be another physical sign of depression. “There’s a relationship between how well people take care of themselves and depression,” Haight says. “People with depression tend to exercise less and are less likely to focus on healthy eating. When you don’t treat your body in the most healthful ways, you may have more physical pain, possibly in your back and muscles or joints.” Also, if you’re already living with any kind of chronic pain, depression can make it worse.
Exhaustion and fatigue or lack of energy are classic hallmarks of depression, Haight says. Depression and fatigue tend to feed off each other, so much so that in many people with depression, it’s hard to say what came first, their depression or their fatigue. When people treat their anxieties and depression, “it’s amazing how much more alive they feel and how much more energy they have,” Haight says.
Are you eating too much and gaining weight? Or have you lost interest in food and are losing weight? Any change in appetite can be a sign of depression. “People often use food to deal with emotional stress and feelings of sadness,” Haight says. If your change in appetite lasts for more than a few weeks, talk to your doctor to find out if it’s related to depression or another medical problem — or both.
Fluctuations in weight can be related to changes in your eating habits and activity level. “Sometimes people with depression sleep a lot — as much as 12 hours a day — and so they’re not as active,” Haight says. “Because they’re not as active, they may gain weight.” On the other hand, if your appetite has changed and you aren’t eating enough, you may experience weight loss. If you have unexplained weight loss or gain, talk to your doctor as it could be a sign of depression or another health condition.
If you experience chest pain, don’t delay seeking medical treatment. Chest pain can be a sign of a heart attack or other serious heart condition. However, chest pain also can be related to your emotional health. “Chest pain is often associated with panic attacks, which is an anxiety issue,” Haight says. “When people are having a panic attack, they can have heart palpitations and have difficulty breathing, just like they were having a heart attack.” If your doctor concludes that your chest pain is not indicative of a heart attack or other heart condition, ask whether it could be a sign of depression or anxiety.
Doctors tend to look for basic depression symptoms — sadness, crying, lack of energy or interest — when diagnosing depression. But if you have any of the physical symptoms described here that last for more than a few weeks and that can’t be explained by another health condition, talk to your doctor about whether your symptoms could have an emotional root. You should be able to find relief and treat your depression with a combination of talk therapy, lifestyle changes, and medication.
If you are able to, make an appointment with your GP ahead of time. However, there several things you can do to help deal with depression at Christmas.
- Make sure you exercise regularly and stay as physically active as possible. Even if it’s cold outside, try to do an indoor activity or simply wrap up well and enjoy the great outdoors.
- Some relaxation techniques, such as deep breathing or meditation, may also help ease your symptoms. Make time over the festive period to relax and unwind, however busy you may be.
- Space out your shopping and other preparations and start in advance, which helps avoid spending too much money.
- If you are worried about potential arguments with family members or friends, try and have a word with them about your concerns in advance. If this is not possible, try and have an 'ally' on the day, who can support you, and be on your side. Have a think about how you can diffuse or literally walk away from difficult situations, by giving yourself time out.
- If you are visiting others, have a think whether your stay can be kept short.
One of the most frustrating things with depression is that it can't be controlled - in terms of onset and severity. But one thing that can be controlled and is guaranteed to make things worse is alcohol.
"It can be tempting to use alcohol to cover up how you are feeling or ease feelings of stress and anxiety, says Dr Zollinger-Read, "but alcohol will only make you feel worse in the long run. Christmas is a time of year where people often drink more than recommended.
"Remember that alcohol is a depressant and can enhance the symptoms of depression. If you’re taking anti-depressants, then I would avoid alcohol altogether."
If your family don't know you have depression, as hard as it may be - now might be the time to talk to them about it. On the other hand, if you'd like to keep busy but don't want to hang out with the family, then there are plenty of support groups and volunteer work with the homeless around this time of year.
How To Do Exercise Mindfully
An extract from Richard Gilpin's book on depression: Mindfulness for Black Dogs and Blue Days
• Take a walk for the experience of walking. Perhaps around a park or any quiet, open space. Rather than needing to get somewhere, use this time as a break from having to ‘do’ anything.
• Walk naturally. The only diff erence to how you normally walk is that you are deliberately applying your mind to what you are doing as you are doing it.
• Adjust your pace to suit your state of mind. Walk faster if drowsy or if there is a lot of thinking. Walk slower if you feel restless or irritable. Gaze softly ahead.
• As you take each step, tune into the sensations that accompany the motion of the body. Give particular attention to the contact between the soles of the feet and the ground. Use this contact point as a way of anchoring yourself in the present. Allow awareness to inhabit the body and senses.
• Notice each step. Notice the changing pattern of physical sensations in the legs and feet as they alternately receive the weight of the body. Relax. Let go of any concepts about walking. Let the body walk itself. Walking is automatic. It doesn’t require thought. It just happens. Let it just happen.
• Distractions will arise. The mind will get caught up in chains of thoughts, sounds or visual phenomena. This is normal. As soon as you realize the mind has wandered, gently and patiently escort the attention back to the sensations of contact between the feet and the ground.
• Don’t expect the mind to be still. Allow whatever arises in the mind to pass through. Stay with the experience of walking, the sensations of touch and movement.
- Call Mind, the mental health charity on 0300 123 3393 or the Samaritans on 08457 90 90 90.
- Mindfulness for Black Dogs and Blue Days by Richard Gilpin, £8.99, is published by Leaping Hare Press