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KEY POINTS

  • More than 60% of people who have an existing mental illness report that the holidays worsen their symptoms.
  • Although the “holiday blues” and seasonal affective disorder share some common characteristics, they are different disorders.
  • With the complexity in distinguishing between the two, the best approach is to do a thorough assessment of the duration and severity of symptoms.

Although “the most wonderful time of the year” may be joyful for most people, others may have the complete opposite experience. In fact, the holiday season can be quite difficult for those experiencing painful reflections, sadness, and loneliness, and especially for those individuals living with an underlying mental health condition.

According to the National Alliance for Mental Illness (NAMI), 64 percent of people who have an existing mental illness report that the holidays, unfortunately, worsen their symptoms. The typical holiday happiness and cheer can trigger stress and sadness for those who have suffered the loss of a loved one, which is now the case for an increasing number of people because of the ongoing COVID-19 pandemic, which may have left them to face the first holiday season without their loved one(s).

During the holidays, many may experience what is often interchangeably called the “holiday blues” or seasonal affective disorder (SAD). Although they share some common characteristics, they are different disorders. But how can we distinguish between the two? To do so and be prepared to reach for help, it is crucial that we understand the signs and symptoms of each.

Duration

The main difference stems from seasonal patterns. The holiday blues are characterized by feelings of sadness that last throughout the annual end-of-year holiday season, particularly during the months of November (Thanksgiving) and December (Christmas and Hanukkah), whereas SAD is a form of major depressive disorder that occurs in seasonal patterns during certain months of the year.

With the complexity in distinguishing between the two, the best approach is to first do a thorough assessment of the duration and severity of the symptoms.

The holiday blues typically starts around the months of November or December and reaches a resolution shortly after the New Year’s celebration. On the other hand, SAD usually lasts about 40 percent of the year, often starting around late fall or the beginning of winter, and fades away during the spring and summer.

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Symptoms

The holiday blues are typically mild, while the symptoms of SAD are more severe and debilitating. Different factors may interact and lead to the holiday blues. Some of its most common causes include:

  • Lack of sleep – Likely due to a stressful holiday schedule
  • Excess eating and/or alcohol consumption – People may turn into unhealthy coping mechanisms such as overeating and drinking excessively during the holidays.
  • Financial stress – Some people overspend money on gifts they can’t afford, adding an unnecessary burden on themselves.
  • Isolation and loneliness – Not being able to spend the holidays with loved ones could translate to loneliness for some.
  • Unrealistic expectations – Even when we have high hopes for the season, the over-commercialization of the holidays in our culture can trigger the false expectation that people are supposed to feel overjoyed, which could add pressure to feel a certain way and result in negative feelings if this doesn’t materialize.

In the case of SAD, it’s important to clarify that the condition is not considered a separate disorder, but a type of depression categorized by its recurring seasonal patterns with symptoms lasting about four to five months. Hence, the signs and symptoms of SAD include those associated with major depressive disorder, in addition to certain symptoms that differ for winter-pattern and summer-pattern SAD.

Although not every person with SAD will exhibit the same symptoms, the following are some of the most commonly experienced:

  • Feeling depressed most of the day and nearly every day
  • Losing interest in activities once enjoyed
  • Difficulty with falling asleep, as well as changes in appetite
  • Feeling sluggish or agitated
  • Finding it difficult to concentrate
  • Frequent thoughts of death or suicide

For winter-pattern SAD, additional symptoms may include:

  • Oversleeping
  • Overeating (particularly carbohydrates)
  • Weight gain
  • Social withdrawal (feeling like hibernating)

For summer-pattern SAD, the symptoms could be the following:

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Demographics and Environment

Through research, we have learned that millions of American adults may actually suffer from SAD but may not know it. SAD seems to occur more in women, and more predominantly in those living in northern locations with shorter daylight hours in the winter. For example, people who live in Alaska may have a higher risk of developing SAD than people living in Florida.

Although scientists don’t fully grasp the causes of SAD, some studies have shown that people who suffer from it may have reduced activity of the neurotransmitter serotonin, which is a brain chemical that plays a role in regulating mood.

Sunlight controls the body’s levels of molecules that help maintain normal serotonin levels, but in individuals with SAD, this regulation system does not seem to properly function, leading to decreased serotonin levels during the colder months of the year.

Other findings indicate that people with SAD may produce too much melatonin. Since this is the hormone in charge of regulating normal sleep, high production of melatonin increases sleepiness.

Another cause for SAD may be related to deficits of vitamin D, which produces a condition that hinders serotonin activity. With less exposure to daylight during wintertime, those with SAD may have lower vitamin D levels.

Treatment

There are various treatment options available for both the holiday blues and SAD, some of which involve lifestyle changes (e.g. physical exercise, improving sleeping and nutritional habits), and others that may require the help of professionals.

Although the holiday blues are often short-term, coordinating consultation with a mental health professional can also help, especially when it comes to identifying distorted thinking patterns that contribute to feelings of sadness and depression.

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In addition, mental health professionals can facilitate the replacement of negative thoughts with more helpful ones and provide advice on new coping skills, as well as apply a treatment modality known as cognitive behavioral therapy.

For those diagnosed with SAD, the four main types of treatment options available are light therapy, psychotherapy, antidepressants, and vitamin D nutritional supplements, all of which may be used alone or combined with one another.

As a final note, becoming aware of the things that contribute to one’s stress and anxiety, as well as knowing how those triggers lead to seasonal sadness or depression, could be key to having control over them before they steal your seasonal joy.