POST-HOLIDAY DEPRESSION

Victor Bloom MD

The holidays are over. Which of us is depressed? And why? And how? You would think that after an enjoyable holiday season, we would all be smiling in the afterglow. Probably most of us are in a warm and jovial mood after a good time with family, friends and Santa. The food, the music, the decorations, the spirituality would all be positive and fulfilling.

But some of my patients feel left out of the goodness and warmth. "It is as if everybody else is having a good time, everybody else but me. Why is it that I am smiling on the outside and crying on the inside? Why don't I appreciate the good things in life? I have a nice family, a good job, a good income, I am well-respected, but somehow, I am not happy. Why do I feel like crying from time to time?"

"Why do I bawl at movies, especially the parts where people come together after being distant or apart for years? What is wrong with me? Why don't I just grit my teeth and get on with it? I don't want to be a baby, I don't want to reveal any weaknesses. I can take care of myself. I am an adult with responsibilities; this is the real world, nobody promised me a rose garden."

"I worry that I may carry some family gene for mental illness. My mother was once hospitalized and had shock treatments. She was OK after that, but the whole thought is frightening and no one ever mentions it; it is a deep and dark family secret. And my father drank a lot; we always wondered if he were an alcoholic. But it couldn't be, he was a successful businessman. But he had to have his evening cocktails, two doubles and then mom and dad would finish off a bottle of wine over dinner. He would fall asleep watching television. My parents never hugged or kissed, were always at each other, distant or bickering. Isn't that normal?"

"And my sister weighs three hundred pounds; she dearly loves her sweets and snacks, and can really put it away. She gained a lot of weight after stopping smoking. And yes, my other sister is thin as a rail, but she chain-smokes. That nicotine can be quite a habit. But these things have nothing to do with me. I was told to stay away from psychiatrists, they are always trying to get you to go into psychotherapy. If it ain't broke, don't fix it, is what I always say. Let sleeping dogs lie. And don't let anybody know the family secrets. You don't wash your laundry in public."

"I heard you can get dependent on your therapist, you can just get hooked. And it is expensive and a waste of money to see a psychiatrist. A person ought to be able to figure out his own problems, not lean on anyone else. It is not good to show weakness; people will only take advantage."

"So why am I left with an empty feeling after the holidays? Why am I irritable or want to cry? It can't be because I didn't have a good childhood. My mother reminds me all the time whenever I complain about anything, we gave you everything; we did everything for you, what are you belly-aching about? Snap out of it, be a grownup!"

Every now and then one of these people break down and come in for a consultation. I listen to his or her story. I ask all about the family and childhood. I wonder about a family history of moodiness, irritability or alcoholism. It is now known that depression often has a family history, that there is a genetic factor that leads to neurochemical imbalance, and so there is a pervasive undercurrent of negative feeling. This may have been going on for a lifetime, and the family reaction to this negativity is often that it is 'normal', because the world is a veil of tears, that life is full of struggle, pain, suffering, frustration and disappointment. This is the defense mechanism of denial. We are supposed to bear up and keep a stiff upper lip. That's what all the smiley faces are all about. Have a nice day!

"How are you? I'm fine. That's the answer; don't look any deeper. Whatever the trouble is, nothing can be done about it. Things will be better in the next world, in the next life."

Actually, there is a lot of undiagnosed and untreated depression in our society, despite the fact that with the accumulated experience of the last two decades, most depression can be successfully treated. Many patients have told me that after taking an appropriate medication, a veil has been lifted. It is not a false euphoria, but a 'normal' feeling; the irritability, tension and anxiety are gone, along with the tendency to dwell on the negative. One experiences the relief which comes from the diminishment of repetitive, obsessive thoughts, a worrisome muddling that leads from vexation to panic and withdrawal from relationships. Often, with appropriate medication, focus and concentration return, along with a more positive and outgoing nature and more adaptive and mature behavior.

In some cases, psychotherapy which leads to self knowledge is additionally helpful. Experience has shown that intellectual and emotions insight leads to more adaptive and successful behavior as well.

So there is no need to continually drag around day after day, year after year, and wonder why everyone else is happy and fulfilled. Medical treatment is available and more often than not, successful.