Beyond the Holiday Blues
Jennifer Wider, M.D.
Society for Women’s Health Research
December 2, 2004
With the holidays around the corner, expectations for good cheer are in the air. For some people, this time of year is accompanied by a marked increase in stress, which can easily turn into depression. Women may be especially vulnerable to holiday stress because in general, they are 2-3 times more likely to suffer from depression than men.
Nearly two-thirds of women surveyed by the National Women’s Health Research Center reported that they had suffered from depression during the holidays last year. For many, the depression interfered with their daily activities, as they skipped parties and family functions.
Typically caretakers for the family, many women assume responsibilities that men might not consider. During the holiday season, the workload can cause stress and anxiety.
“The stresses of holiday shopping and other preparations may further overload women who are already multi-tasking,” Laura Fochtmann, M.D., a psychiatrist at Stony Brook University Medical Center on Long Island, said. This can contribute to mood changes and possibly depression.
For some people, feeling sad or having the blues can last for a prolonged period of time. These feelings are often accompanied by a loss of interest or pleasure in activity, changes in sleep patterns, changes in weight status or appetite, feelings of hopelessness and helplessness, an inability to concentrate, loss of energy or preoccupation with suicide or death.
"Compared to men, women with depression tend to report more frequent bodily symptoms, such as fatigue and appetite or sleep disturbances,” Sherry Marts, Ph.D., vice president of scientific affairs for the Society for Women’s Health Research, a Washington, D.C., based advocacy organization.
"Men who have been treated for depression,” Marts said, “tend to report more problems at work or to be unemployed. Women with chronic depression are more likely to be unmarried or complain of greater marital problems, suffer a younger age of depression onset, or a greater family history of depression or related health problems.”
Marts added that women are more likely to develop alcohol problems within a few years of their first depressive episode, while no such link has been found in men. Individuals should be aware of the connection between the holidays, alcohol use, and depression.
Anti-depressants are often part of the treatment for people suffering from clinical depression. They can relieve the symptoms of depression by altering the way certain chemicals work in the brain. These chemicals don’t seem to work properly when a person is depressed and the anti-depressant helps correct the problem.
There are many types of antidepressants available; the most common ones include selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and monoamine oxidase inhibitors. There is some evidence that women respond differently than men to certain types of antidepressants.
Researchers at the University of Pittsburgh examined sex differences in the response to certain medications.
“In general, lower response rates to tricyclic antidepressants in women versus men have been shown,” Robert R. Bies, Pharm.D., Ph.D., of the department of pharmaceutical sciences at the University of Pittsburgh in Pennsylvania, said. “It seems that women tend to respond more readily to monoamine oxidase inhibitors than men as well.”
For women suffering from depression during the holidays, “psychotherapy alone would be a reasonable first approach,” Fochtmann added. “Antidepressant therapy would likely be considered for someone with severe or persistent symptoms, particularly in combination with a personal or family history of depression.”
Women who have been treated for depression are more likely to use emotional outlets and religion to help them cope with symptoms. “Men, however, tend to turn to sports and hobbies to help them cope,” Marts said.
Antidepressants usually take time to work.
“Antidepressant treatment is not like taking a pain reliever when one has a headache and obtains fairly immediate relief,” Fochtmann explained. “They typically require at least several weeks of daily use to have a full effect, although improvements will sometimes be seen earlier.” And sometimes the dose or medication needs to be adjusted.
National Institute of Mental Health, Depression:What Every Woman Should Know, 2004.
Bies RR, Bigos KL, Pollock BG. Gender differences in the pharmacokinetics and pharmacodynamics of antidepressants. J Gend Specif Med. 2003;6(3):12-20.
© December 2, 2004 Society for Women's Health Research