Depression often comes home for the holidays

By Carey Hamilton
The Salt Lake Tribune

Maureen suffered bouts of depression most of her adult life, but her problem became so severe four years ago that she couldn't get out of bed for days at a time.

The 57-year-old Salt Lake County woman, who doesn't want her last name used, avoided crowds and felt purposeless and lethargic. Her depression became worse around the holidays, and sometimes she would retreat to her room away from her family.

" A lot of it was the anxiety and anticipation," she said. "The holidays are always hard 'cause I've lost both my parents. It's also a hard time for me when it's gray and cloudy. It makes me a lot more subdued."

Maureen hopes this year will be different. After trying almost every antidepressant on the market, she is now on a new mix of five anti-anxiety and antidepressant drugs, and it seems to be working.

Maureen is one of nearly 19 million Americans -- about 9.5 percent of the adult population -- who struggle with depression, an illness that hits Utah harder than most states.

Suicide rates in Utah are higher than the national average -- 16.3 per 100,000 people compared with 12 per 100,000 -- according to the U.S. Centers for Disease Control and Prevention. And a higher percentage of Utahns reported having bad mental-health days than what is typical in the United States -- 42 percent compared to 33 percent, the Utah Department of Health found.

Antidepressant use also is higher here than any other state, with 16 percent of Utah's population taking them, according to Express Scripts, a company that compiles a yearly drug trend report.

Feeling blue around the holidays is fairly common. Along with turkey and the trimmings and gift-giving, the holidays bring a rise in depression.

For many people, the holidays are a time of joy to be shared with friends and family. Others, however, may feel stress, loneliness, unmet expectations or grief over lost loved ones. To deal with their problems, some people overeat or drink excessively.

"I t's a very sad time of the year because we have expectations of what the holidays will be like that never come true," said Mary Talboys, a clinical social worker with the University of Utah Neuropsychiatric Institute. "We're told by the culture and the media about how it should be picture-perfect. Most of us don't have picture-perfect families."

Family squabbling can dampen festivities. So can financial constraints. Parents may feel inadequate if they can't afford to buy the presents their kids want. The demands of shopping, entertaining, traveling and visiting family also can contribute to tension.

For the elderly, factors leading to holiday depression can include financial limitations, loss of independence, being separated from family, failing eyesight and loss of mobility.

Gloomy early-winter weather also may afflict people with seasonal affective disorder, which can make sufferers more depressed as daylight wanes.

Realizing depression is a problem around the holidays and year-round, Intermountain Health Care has expanded a program that addresses the clinical, organizational and financial barriers to treatment.

The program was piloted at IHC's Bryner Clinic in Salt Lake City in 1998 and is now in effect at 20 other primary-care health clinics along the Wasatch Front. It is used to diagnose depression, study the cost of care and measure improvement in patients.

"We've trained the care managers how to talk to the families about mental health in a nonstigmatizing fashion," said Brenda Reiss-Brennan, leader of the IHC Mental Health Integration Program. "The program we're working on is depression year-round. When the rate goes up in the holidays, we want them to already have something to help."

The program teaches primary-care physicians how to better diagnose depression. Psychiatrists and case managers follow up with patients to make sure they are taking their medications and going to therapy appointments.

Maureen said the integrative approach at the Bryner Clinic helped her. Still, she knows there is a long way to go before depression is thought of as a valid and treatable disease.

Maureen has advice for people who tend to get depressed around the holidays: Don't overexert yourself, and seek professional help.

"There are people walking around every day like I was, and people aren't living [full lives]," she said. "You really can get help for this."

chamilton@sltrib.com

Coping with stress and depression during the holidays:

• Be realistic: Keep expectations for the holiday season manageable. Set realistic goals and pace yourself.
• Organize your time: Make a list and prioritize important activities. Do not put entire focus on one day (i.e., Thanksgiving Day); spread activities to lessen stress and increase enjoyment.
• Real feelings: The holidays do not banish reasons for feeling sad or lonely; there is room for these feelings, even if the person chooses not to express them.
• Past is past: Look toward the future. Life brings changes. Each season is different and can be enjoyed in its own way. Don't set yourself up by comparing today with the "good ol' days."
• Think of others: Do something for someone else. Volunteer some time.
• Find simple enjoyment: Try activities that are free, such as driving around to look at holiday decorations, going window shopping and helping children build a snowman.
• Drink sensibly: Be aware that excessive drinking will only increase your feelings of depression.
• Try something new: Celebrate the holidays by participating in some new activity.
• Seek good company: Spend some time with supportive and caring people. Reach out and make new friends or contact someone you have not heard from for awhile.
• Don't forget yourself: Save time for yourself! Recharge your batteries! Let others share responsibility of activities.
  
  -- Source: National Mental Health Association