'Tis the Season for … Depression?

With the holiday season already in full swing, be ever vigilant for patients whose emotional downturn during the holidays reaches the depths of depression. Many patients will minimize sadness during the holiday season as “expected” or “natural” given physical ailments or losses that alter their ability to enjoy the usual array of parties, religious observances, and family events. Stay alert for family caregivers among your patients since about 40% of all American families are caring for a loved one, according to the National Alliance for Caregiving. Though caregivers are at increased risk for depression, they may never admit their stress. No matter how reasonable the emotion, if it is severe or persistent and becomes the source of physical decline, it can be a sign of full-fledged depression that needs evaluation, diagnosis, and treatment.

Keep in mind the usual presenting symptoms of major depression. If five or more of the symptoms listed below are present most days for more than two weeks, depression is likely and a full evaluation is indicated:

• depressed mood, such as feeling sad, empty, or tearful (in children and teens, depressed mood can appear as constant irritability);
• significantly diminished interest or feeling no pleasure in all—or almost all—activities;
• significant weight loss when not dieting, weight gain, or decrease or increase in appetite;
• insomnia or increased desire to sleep;
• either restlessness or slowed behavior that can be observed by others;
• fatigue or loss of energy;
• feelings of worthlessness, or excessive or inappropriate guilt;
• difficulty making decisions, or with thinking or concentrating; and
• recurrent thoughts of death or suicide, or a suicide attempt.

Another common form of depression that may complicate the holidays is seasonal affective disorder. In this form of depression, limited access to sunlight during the fall/winter leads to a depressed emotional response. Other medical conditions, especially thyroid abnormalities, anemia, and electrolyte derangement should be ruled out before making final diagnosis and planning treatment.

Thanks for caring about older adults. Best wishes to you for the year to come. I look forward to hearing from more of you in the year to come about topics you’d like to see discussed.

Patient Handout Information
With flu shots behind us, it’s time for the holidays. I hope you find yourself full of the happiness of the season. I know, however, that for many people the holidays bring mixed emotions. While there is much joy and cheer during parties and family gatherings, loneliness, reflection on losses, and anxiety about an uncertain future can also emerge. Given all the challenges family caregivers face, perhaps more than ever, attention must be focused on taking care not to end the year on a sour note. Here are some tips to help caregivers cope with the stress and emotions that can accompany the holiday season.

• Take care of any health care needs now. If caregivers are going to need a medical appointment before January, schedule your appointment as early in the month of December as possible. Ensure that there is an adequate medication supply, especially if traveling out of town.
• Spend time with supportive and caring people. Take care not to let grudges or family challenges totally absorb and dominate holiday gatherings. Consider reaching out to make new friends, or contact someone you haven’t heard from for a while. Often new connections with family or old friends bring unexpected rewards. The now somewhat “old-fashioned” Christmas card still holds power to spread happiness even in this electronic age. Add your phone number when you sign and you’ll likely have some enjoyable conversations over the coming days.
• Save time for yourself. Recharge your batteries. Let others share responsibility for activities. Just because you have always hosted Thanksgiving doesn’t mean you must continue to do it all. Instead, accept an offer to bring the turkey, and focus instead on a signature dish or a special desert.
• Keep expectations for the holiday season manageable. Try to set realistic goals for yourself. Pace yourself. Organize your time. Make a list and prioritize the important activities. Be realistic about what you can and cannot do. Don’t put the entire focus on just one day (eg, Thanksgiving Day) but remember it is a season of holiday sentiment, and activities can be spread over several days or weeks to lessen stress and increase enjoyment.
• Leave yesteryear in the past and look toward the future. Life brings changes. Each season is different and can be enjoyed in its own way. Don’t set yourself up in comparing today with the “good old days.”
• Do something for someone else. Try volunteering some time to help others. Many churches have opportunities to volunteer, so check there as well as at a local senior center.
• Enjoy free activities. Driving around to look at holiday decorations, going window shopping without buying, attending children’s concerts at a local school or church, and enjoying holiday concerts on the radio can add holiday warmth and happiness.
• Be aware that excessive drinking only increases feelings of depression.
• Try something new. While there is tremendous value in tradition, it can also be good to break out of your usual habits and celebrate the holidays in a new way. Think about small changes you can make to enliven your spirits this season. It can be as simple as going to a different worship service, or eating your favorite meal instead of turkey, or taking a trip to your daughter’s home for Thanksgiving rather than celebrating at your home.

Here’s my holiday gift to you: These days when I talk about brain fitness and improving memory, I emphasize that doing something new is one of the best things you can do to stay sharp. So shake up your plans this year, keep these tips in mind, and look forward to 2015. My hope is that January 1 arrives and with it you find a renewed sense of excitement and anticipation for the coming year. Happy holidays!

— Rosemary Laird, MD, MHSA, AGSF, is a geriatrician, medical director of the Health First Aging Institute, and past president of the Florida Geriatrics Society. She is a coauthor of Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One With Memory Loss.