By Morgan Ramey, Pharmacy Resident, Baptist Health Medical Center-Little Rock
Do the holidays stress you out? The holiday season may bring you joy, but it might also be a time that causes you to feel overwhelmed or anxious. Factors that can contribute to holiday blues include facing the loss of a loved one, being away from family and friends, feeling isolated from others, complicated family dynamics, and financial hardship, to mention a few.
Regardless of the reason, most people tend to feel a higher amount of tension during this time of the year. This article will discuss the symptoms associated with each condition as well as the many treatment options.
It is completely normal to have short episodes of feeling anxious or nervous. When anyone remains anxious over a prolonged period of time, it is classified as generalized anxiety disorder (GAD). GAD is quite common, especially in adults, but this does not mean it is normal.
Symptoms include persistent worrying about small or large concerns out of proportion, inability to relax, indecisiveness, and worrying about excessive worrying. GAD is difficult to control and causes normal tasks to become impossible to complete, and can lead to a diminished quality of life.
Depression affects many Americans annually and shows up in different forms. Since the holidays may be a period where people experience increased depression symptoms, it is important to recognize the characteristics of major depression. They are loss of interest in things you normally find pleasure in, separation from others, feelings of hopelessness, sleeping more than normal, and changes in appetite.
Seasonal Affective Disorder (SAD) is a form of depression that comes and goes with particular seasons. There is fall-onset SAD and spring-onset SAD. Those who experience fall-onset SAD might see symptoms such as sleeping for prolonged periods of time, increased appetite leading to weight gain, and increased irritability. People with spring-onset SAD usually experience opposite symptoms including sleep loss, decreased appetite, and weight loss.
There are several ways to treat different forms of stress, anxiety, and depression.
Cognitive behavioral therapy (CBT) is a first-line treatment option for general anxiety disorder. CBT is usually hour-long sessions several times a week. During these sessions, patients will train their brain to think other thoughts when they are feeling anxious, stressed, or depressed. Having a licensed counselor assist in talking through your feelings is proven to make patients feel better.
CBT needs to be tailored to each patient because some patients may benefit from delayed therapy. Delayed therapy is for patients who are suicidal, actively grieving, or have experienced avoidance in response to the trauma.
Exercise is a treatment option that sheds pounds from your body instead of shedding money from your wallet. It tremendously helps with negative feelings due to its release of endorphins, a hormone that triggers a positive feeling in your body. Clinical trials support exercising to help those with anxiety decrease their daily symptoms. Exercising three to four times a week for 20 to 30 minutes can drastically help improve your symptoms. A follow-up study found exercise as a longer treatment option than medications.
Sleep hygiene is a treatment option many people do not think about. This includes setting aside time to worry during the day instead of lying in bed thinking about it all night. It also includes not drinking caffeine past noon or cutting down altogether since caffeine can worsen anxiety. Consider exercising more than four or five hours before bedtime and try getting out of bed when you first wake up.
Light therapy helps patients who are experiencing seasonal affective disorder. This involves sitting in front of bright lamps during the day. This should be done with the assistance of a physician or therapist who is appropriately trained.
All of the above-mentioned modalities are non-pharmacological treatment options. If those options have failed or are not indicated as initial therapy, medications can be considered.
Benzodiazepines are medications used for the short-term treatment of anxiety. These medications include alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan), to name a few. The most common side effects seen are trouble falling asleep, weakness, dizziness, and shakiness. You will not want to take these medications if you are pregnant. They are taken on an as-needed basis versus daily medications such as antidepressants. If you take these medications too long, you can develop tolerance to them and they will lose their effectiveness and make your anxiety worse. If you need a long-term solution, antidepressants are the first-line treatment option for long-term generalized anxiety disorder or depression.
There are a wide variety of antidepressants and it may take a few trials with different agents to find the right medication for you. These medications include fluoxetine (Prozac), venlafaxine (Effexor), and duloxetine (Cymbalta), to name a few. Since these medications work in your brain, it can take some time to adjust the levels of chemicals on the receptors. It could take as long as four to six weeks to see an adjustment in your mood when you are starting an antidepressant for the first time or changing your current dose.
You may also see changes in side effects before you see a change in your mood. The most common side effects include a decreased sex drive, weight gain, not being able to sleep or sleeping too much, nausea, weakness, dizziness, and headache. Some of these medications do not need to be taken if you are pregnant.
Seasonal affective disorder drug therapy is only taken during certain months of the year and discontinuation of medications may be necessary. Whether you are taking benzodiazepines or antidepressants, they both require tapering. Tapering your medication means you will reduce your daily dose steadily over time until you get to a low-enough dose where you can stop taking your medication altogether. Talk to your physician about scheduling a safe and effective tapering strategy.
DO NOT abruptly stop your medication unless instructed to by your physician due to the possibility of developing withdrawal-type side effects. Make sure and let your physician or pharmacist know all of your current medications as both antidepressants and benzodiazepines can interact with other medications.
Relieving depression and anxiety is a journey and these medications work best when you also implement the non-drug therapies as listed above. If you are experiencing any of the conditions as described in this article, talk to your physician or pharmacist about different treatment options. Your health-care team can work with you to optimize therapy to help improve your quality of life while minimizing side effects.
Don’t let the holidays become something you dread, and take steps to beat the holiday blues.