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Ho-Ho-Holiday Disorders: When Seasonal Holidays Are Not As Merry

Discussion in 'Family Medicine' started by dr.omarislam, Dec 27, 2017.

  1. dr.omarislam

    dr.omarislam Golden Member

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    The holidays are a time for merriment, except for those suffering from Seasonal Affective Disorder and those who sees no cause for celebration.

    Christmas used to be the festive season overflowing with joy for Mary Rittenburg – full of love, festive décor, homemade delicacies and surprising gifts underneath the Christmas tree. It was not until this year, however, when her father passed away in March, a little less than two years after her mother.

    “I’ve felt really lost,” she said through tears. "I don't know what to do on Christmas Eve or Christmas Day. I don't even have a tree up this year. It's just been really hard to even think about."

    Christmas is different this year for Rittenburg as she has to face the stressing holiday blues for this season. However, for others, it is not a temporary feeling.

    In parts of the world shy from the equator, the short and dark days of winter can be an unwelcome guest, with seasonal affective disorder (SAD) striking many. SAD – quite a self-explanatory abbreviation – is a mood disorder that comes about when there are low levels of sunlight; typically affecting people in the cold winter months. SAD shares the same symptoms as depression, but it comes and goes with the seasons. If the same cycle is repeated at least two years, chances are the winter blues are actually SAD.

    SAD can lead to bipolar disorder
    Sufferers of SAD may be relieved when the frosty winter days start to warm up in spring – as the symptoms go into remission. However, for those with bipolar disorder, the coming of spring may mean the start of the other extreme state of hyperactivity and mania, called “May Mania” in the northern hemisphere. With the highs and lows of emotional states consistent with the changing of the seasons, SAD can be seasonal bipolar disorder instead.

    Ken Duckworth, medical director of National Alliance on Mental Illness (NAMI) and assistant professional at Harvard University Medical School said, “if you do not experience the manic highs during the spring or have a history of them, you probably do not have bipolar disorder.”

    In a study done in 2014 reviewed the data of bipolar disorder and the changing of the seasons, it was noted that there was a 15% seasonal pattern for manic episodes in the spring and summer months, and 25% depressive episodes in the winter and autumn months.

    A similar study done on a Taiwan population-based study published in 2006, found 57% of manic episodes occurred in the spring and summer months, 14% depressive episodes happened in the winter months and the remaining 29% were of mixed episodes.

    Binge eating disorder a co-occurring issue

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    Binge eating is likely to occur during the holiday season among SAD sufferers.

    As with all holidays, indulging in holiday treats and busting the caloric restriction is expected, but SAD sufferers may go overboard in satisfying carbohydrate cravings and overeating. This result in a binge eating disorder (BED) or other types of eating disorders like bulimia nervosa. The bulk of the SAD sufferers are in fact young women in their 20s with eating disorders.

    Beth McMurray, co-founder and co-clinical director of A Centre for Eating Disorders in the US said, “Admissions to our treatment centre are up at this time [winter] for all types of eating disorders. We purposely engage the milieu in outside activities as much as possible from January to March.”

    SAD is similar to eating disorders, where it is a mix of genetic propensity and environment. Though according to Alan Stewart, research leader and associate professor at the UGA Department of Education, who said “few minutes of sunlight exposure each day should be enough for most people to maintain an adequate vitamin D status”, it may not be enough for SAD sufferers.

    Although SAD sounds depressing, there is some hope in managing it. Exercising, having enough sleep and having a plan for the next season, are some of the methods that can be used to manage it. Bright artificial light therapy also helps alleviate 50% to 80% of the symptoms; on top of anti-depressant medication and cognitive-behavioural therapy.

    Ultimately, setting realistic expectations, communication and reaching out for support can help rid out the anxiety and bring the fun back in the holidays.

    As for Rittenburg, she is just taking the time to honour her parents’ memories, while trying to continue the old traditions and make new ones with other family as well. “At the end of the day, remember, there are others also struggling,” said Rittenburg. “Find someone to be with or something to do on the holidays and begin to make it meaningful again.”

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