Merry and bright?

According to the song, it’s the most wonderful time of the year. But for many, it’s the time of year filled with added pressures, demands, and unrealistic expectations that leave them feeling decidedly less than wonderful.

To better understand how the holiday season can trigger the blues ­— and how to avoid them ­— the Gazette spoke with Natalie Dattilo, director of psychology in the psychiatry department at Brigham and Women’s Hospital, who specializes in the treatment of depression and anxiety.

Q&A

Natalie Dattilo

GAZETTE: This is supposed to be a happy, joyous time of year, so why do so many end up feeling down around the holidays?

DATTILO: With my patients I talk about stress being something we experience when the real and/or perceived demands of a situation outweigh our real or perceived resources. That’s one way to frame any sort of problem for which we are experiencing an overwhelming amount of stress or pressure or even burnout — in other words, what’s being asked of us is more than we have to offer.

So what are our resources that we bring to a situation? We have our time, energy, money, in some cases, effort, and interest. Sometimes there’s just an imbalance when those resources are being depleted. And I think the holiday season is a good example of a time in which there’s an imbalance, that what’s being asked of us is more than what’s usually being asked of us, and that can be pretty stressful at baseline.

And what’s being asked of us around the holidays? Well, we’re working hard to finish tasks and projects so that we can go enjoy some time with family and friends. So that time crunch is a real experience for people. There are social activities, and events, and people, and wrapping presents, and cooking meals, an entire additional list of things to do that are all really important, or supposed to be important, which I think is another perceived demand of the situation that can exacerbate our feelings of stress. So there are real demands, and then there are things that we put on top of that, like the expectation that it should be fun, and joyful, and everybody should be getting along, and feeling merry. Those expectations are all just adding more pressure to the situation because we might not be able to match them.

GAZETTE: Do you draw a distinction between stress and depression around the holidays?

DATTILO: I do make a distinction, although it’s a fine distinction. For those of us who may be prone to experience bouts of depression, our risk for that is elevated during times of stress. If that is something that you know about yourself, that you are prone to bouts of depression, this time of year you could be particularly vulnerable simply because the stress at baseline is elevated and that’s a risk factor for episodes of depressive relapse.

The connection for me between periods of prolonged stress and depression is when we begin to feel ineffective in our ability to meet the demands of a situation and really helpless in our ability to do well under such circumstances. Around the holidays we often feel we can’t perform well, be happy all the time, buy great presents, remember everybody, wrap all the presents. When that gap feels really wide, we can feel really helpless and powerless to the demands of the situation and that can be enough to trigger a state of dysphoria or depression for some people because it feels helpless, but it can also feel hopeless. Some people feel there is no way they can ever participate in the way that is being asked of them.

GAZETTE: Do you have any sense if men and women suffer differently or in greater numbers, or if children are particularly at risk?

DATTILO: I think one of the things about the holidays that might be a unique feature for people is the emphasis on family, and if you have lost loved ones, I think the same would hold true for men, women, or children when the holidays serve as an anniversary or as a reminder of people who are no longer with us. If that is an area that is sensitive for people, that might be one factor that is a little bit different this time of year. There are also just difficult family dynamics. To me that speaks to the expectation about how families ought to function and if you are not in one of those “happy” situations you can feel particularly vulnerable this time of year.

GAZETTE: Do you relate the holiday blues to seasonal affective disorder?

DATTILO: The timing of the holidays as it relates to seasonal affective disorder is unfortunate because I think people can experience seasonal affective disorder and struggle during the winter months, and that may affect their ability to engage in the holidays in a way that they would enjoy. It’s a little bit again the chicken and the egg. I don’t know if the seasonal affective disorder would be triggered by the holidays, but the holidays certainly don’t help some people who are suffering with the shorter days and fewer hours of sunlight. But I would also suggest that for some people who do suffer with seasonal affective disorder that the holidays might actually be helpful. The holidays might give them a boost in their mood if they are able to experience them in an uplifting way and bring them some relief, as opposed to the other way around.

GAZETTE: The holidays are so often overrun with food. Is the tendency to overeat connected to how we might be feeling?

DATTILO: One hundred percent. It’s cause and effect. It’s hard to know which of those is affecting the other. Do we feel more stressed and so we are eating more, or is it the other way around?

GAZETTE: What are your suggestions for how people can cope with the stress of the season?

DATTILO: One of the things that is important for people to keep in mind is self-care. We don’t take a break from self-care during the holidays. It might be a bit more challenging, especially if we are operating outside our normal routine and traveling, or visiting family, but making self-care a priority can be an important antidote.

Sleep is key. Often during the holidays your sleep schedule can be thrown off, so remembering to get enough sleep is important.

Alcohol use can go up around the holidays, so being mindful of that is important.

Monitoring your expectations and the mindset that you bring to either events or the holiday season itself is critical. Sometimes we talk about the holidays being stressful, and as a result we then expect them to be stressful. And when we expect things to be stressful, that can in turn become the reality. It doesn’t have to be that way. If you can adjust your mindset in such a way to remind yourself that while it may be stressful, it’s also a time to practice gratitude, and connection. And even if you are not doing that with other people, you can still use the holidays as a time for self-reflection, for self-appreciation and joy.

If you find that this is a time of year that you struggle, I recommend that you take a minute to sit down and make a list of the things about this time of year that are important to you and that you value, and then make sure the things that you are doing are in line with those things that are on that list.