Is it a Depressive or Anxiety Disorder or the “Post-Holiday Blues”?

The holidays are over, and you made it through, and it was even fun despite the work and stress! So why do you feel down and find it difficult to get back into the swing of day-to-day life? Some people call it “post-holiday blues” or “vacation syndrome” and while anyone can experience it, according to the National Alliance on Mental Illness (NAMI), 64% of those with mental illness say the holidays make their conditions worse. Some of the reasons for this include financial stress, loneliness, feelings of pressure to be happy and joyful, unrealistic expectations, and inability to be with loved ones.

What Are Holiday Blues and Tips for Avoiding Them from NAMI:

NAMI stresses that even though the holiday blues are not the same as mental illness, they are considered short term mental health problems and need to be taken seriously by not only those with depression, but also family, friends, and behavioral health providers because they can lead to  more serious disorders such as clinical anxiety and depression (NAMI Mental Health and the Holiday Blues website, 2021).

What Is Depression?

Depression, also called major depressive disorder or clinical depression, is a mood disorder that features feelings of sadness, hopelessness, and loss of interest in activities once enjoyed. Physical symptoms such as digestive issues and fatigue may also be part of depression. The American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for diagnosis include the following:

1. “Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

The symptoms must include either depressed mood or loss of interest or pleasure and the individual must experience five or more symptoms during a 2-week period, cause significant distress or impairment in social, occupational, or other areas of function, and not be the result of substance abuse or other medical conditions” (DSM-5, 2013).

Depression is different from sadness because sadness is just one of the elements of depression, the impact affects all parts of life, and results in self-diminishing or negative thought patterns.

What are Anxiety Disorders?

While anxiety is a normal reaction to stress, anxiety disorders are extreme feelings of nervousness and anxiousness coupled with tensions and physical changes to the body, such as increased blood pressure. For Generalized Anxiety Disorder, the DSM-5 criteria include:

“ A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

1. The individual finds it difficult to control the worry.
2. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
3. Restlessness or feeling keyed up or on edge.
4. Being easily fatigued.
5. Difficulty concentrating or mind going blank.
6. Irritability.
7. Muscle tension.
8. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
9. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
10. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
11. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).” (DSM-5-2013).

Other types of anxiety disorders include Panic Disorder, Phobias, Agoraphobia, Social Anxiety Disorder, and Separation Anxiety Disorder. Anxiety over the holidays is common for many people, but for those with generalized anxiety disorder (GAD) or other anxiety disorders the extra holiday stress can serve as a trigger. Some of the following suggestions from verywellmind may help anyone, but are great ideas for those with anxiety disorders:

• Simplify holiday plans to reduce stress
• Focus on eating healthy foods and being physically active
• Rather than worry constantly, schedule “worry time”
• Take care of yourself in ways that give you opportunities to relax
• Plan ahead for social and other situations to lessen anxiety
• Say “no” if need be
• Have an action plan for how to reduce anxiety when it occurs
• Ask for help or support when needed

For behavioral health providers who are looking for ways to help clients and themselves to change thinking patterns that can lead to depression and anxiety disorders, a self-paced, online course is offered by CASAT Learning and is good for 4 continuing education units (CEUs) for most behavioral health providers. Here is the course description:

Overactive brain circuitry can trap clients in cycles of rumination that can keep them anxious and depressed. Letting go of ruminating worries, or banishing persistent thoughts, like I’m not good enough or I’m worthless, isn’t easy for clients and when ruminations don’t shift, therapists can begin to feel stuck themselves. Watch Margaret Wehrenberg and she will examine why clients lock into depressive thought patterns and why they feel they need to hold on to worry. You will learn practical interventions to use in-session for eliminating these patterns and replacing them with attitudes of calm and competency. 

Objectives for the course:

1. Apply basic understanding of neurological causes of rumination to assess and change rumination in anxious and depressed clients
2. Explore four underlying causes of depression and be able to apply the immediate therapy responses that improve those conditions
3. Frame 4 purposes of worry and apply the techniques that break the hold of worry, such as methods that “erase the trace” of worry, transferring worry to another person, using ritual to contain worry, and put off health anxiety.
4. Interrupt the ruminative cognitions that decrease energy and then apply self-reinforcing techniques that can energize clients, such as ‘Start Where You Already Are’ and ‘Get the Train Rolling.”
5. Teach clients to identify the impact of situational stressors be able to apply the four approaches that reduce and eliminate the damage of stress.

About the Presenter: Margaret Wehrenberg, Psy.D., is a practicing clinical psychologist. She coaches professionals for anxiety management and has been training mental health professionals for 25 years. She is a sought-after speaker for conferences and trainings, consistently getting the highest ratings for her dynamic style and high-quality content. Margaret has contributed articles to the award-winning Psychotherapy Networker Magazine and blogs on depression for Psychology Today. Her 7 books on topics of anxiety and depression are published by W.W. Norton, and The 10 Best-Ever Anxiety Management Techniques and its workbook were released in 2018 in revised editions. Her new e-book, Pandemic Anxiety: Fear, Stress and Loss in Traumatic Times is being released in January 2021.

Learn more and register for Disrupting Rumination: Changing the Cognitions that Underlie Anxiety and Depression on the CASAT Learning continuing education website.

For additional posts and resources related to depressive disorder and anxiety disorders, visit the Catalyst blog and the Resources & Downloads page of CASAT OnDemand.

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013.

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