Part two of three in our series on depression and the holidays.

Holiday stress can be tough for anyone to handle, but it’s especially difficult for those of us who are prone to depression or going through personal challenges. Tense family gatherings, debilitating weather, high expectations, and the strain on our wallets can bring on the holiday blues or trigger depression.
We can relieve holiday stress by setting boundaries and having realistic expectations:
- Avoid overbooking. With advance planning you can prioritize events and make sure you have needed down time.
- Limit time with difficult relatives. If a family member causes you excessive stress, limit your time at events where he or she is sure to make an appearance.
- Agree to a family truce. If old arguments resurface, make plans to talk about your conflict after the holidays wind down.
- Have compassion for yourself and others. Remember that most people are just trying to get love or validation, even if they seem insulting or narcissistic. If nothing else, practicing compassion for others will reduce your anger and frustration, and help you practice going easier on yourself.
- Limit gifts and plan low-cost outings. Find ways to spend valuable time with the people you love, like baking, taking walks, or going window shopping.
- Honor your emotions. The holidays don’t take away depression, loneliness, or grief for anyone. Focus on small, concrete steps you can take, each day, to feel better.
- Find new opportunities to connect. If you don’t have family around, or find yourself with free time on your hands, look for volunteer opportunities or social functions. You’ll lift yourself out of your usual routine, make new connections, feel good about helping others, and broaden your support system.

If you’ve been experiencing symptoms of depression for more than two weeks, visit your physician to discuss your health. Whether you have the blues or depression, your doctor can provide a diagnosis and help you get the appropriate treatment.

Your physician may recommend one or more of the following:
- Counseling: Visit a support group or psychologist to talk through your feelings and patterns of behavior. Counseling lends emotional support, provides an objective perspective, and encourages problem-solving skills, which are critical to improving your mood.

- Medication: If you’re suffering from major depression, counseling alone can’t lift your mood. Your doctor will test you for thyroid conditions, Vitamin D deficiency, and other factors that may be affecting your health.

Your doctor may refer you to a psychiatrist, who can prescribe medications such as antidepressants or anti-anxiety drugs for short- or long-term use. You’ll work closely with your doctor to monitor your reaction--while anti-depressants can be very effective, they often include side effects such as insomnia, weight gain or loss, decreased libido, and even anxiety or thoughts of suicide. You may need to alter doses or switch medications to find the optimal treatment.

- Brain Stimulation Therapies: For patients who do not tolerate or respond to medication, physicians may recommend outpatient brain stimulation treatments like Electroconvulsive Therapy (ECT) or Transcranial Magnetic Stimulation (TMS). During ECT, the patient is anesthetized and electrical pulses are passed through the brain. The currents are thought to impact neurotransmitter function or adjust the stress hormone response. Although doctors have fine-tuned ECT to minimize discomfort to the patient, the procedure may still cause some side effects including headaches and memory loss.

Doctors may also suggest TMS, a powerful, non-invasive treatment that uses magnetic energy to stimulate brain receptors, with minimal side effects. Patients are not sedated for treatment and most report no discomfort. Approved by the FDA in 2008, TMS is effective in about 60% of patients, or twice as effective as antidepressants.

No matter your course of therapy, it’s important to:
- Stick to your treatment plan. Attend counseling sessions and keep taking your medication. It may take at least a few weeks for the drugs to take effect. If you start to feel better you may be tempted to cease taking medication, but stopping cold can induce withdrawal and mean a return of depression.
- Avoid alcohol and drugs. These substances can trigger or exacerbate feelings of depression.
- Eat well. Proper nutrients support wellness and can boost your recovery.
- Get enough sleep. Depression, and sometimes antidepressants, can cause insomnia or oversleeping. Tell your doctor if you have trouble falling or staying asleep.
- Exercise. Just a short walk or jog can take the edge off symptoms.
- Be your own advocate. Research your options, and speak up if you feel you have been misdiagnosed or your doctor has missed a critical detail.

Be sure to read next week’s blog for more on TMS, an alternative treatment option for patients with major depression.