Christmas blues

Dear Dr. Jao,

I used to like and love Christmas very much. Well, I still do. But lately things just don’t seem to be very much quite the same. I could still vividly recall the time when I was about three years old. I would close all the lights in our living room, open the Christmas lights and play under our Christmas tree and Belen for hours. For some reason, this seemed to be the happiest moment of my life.

Lately, I have found myself to be always "shopping to death" to buy gifts for everyone for the coming yuletide season. Please don’t get me wrong. We are not rich. Because it made me happy to give, gift-giving had become a tradition for me. Until one day, I began to question why I was keeping myself busy buying gifts all these years. It was only lately that I unearthed the answer to my question. I then started to realize that I must have an unconscious personal agenda – which was to hide the fact from myself that I was lonely. It’s not that I am no longer happy in giving, it’s more of I am just sad. Period.

After the Christmas rush, I would realize that the feeling of sadness has finally caught up with me. It seems I have been running all these time. Perhaps, I just did not understand before or maybe I must have been coping with my depression by denying its existence. 

When the day finally came that I learned to accept that I was suffering from depression, I told myself, "If I can’t find a way to make myself happy, I might as well make other people happy in my own little ways of course."

Why am I feeling blue on what is supposed to be such a festive season?

Juan

Dear Juan,

First of all, thank you for writing this letter and for keeping the spirit of Christmas alive despite your depressive mood. Christmas is by tradition the time we share our blessings to significant others without expecting anything in return.

Secondly, I don’t think you’re nuts. You’re depressed. The fact that you have uncovered your depression and learned to accept it is the first step towards its abatement. The possible roots of your dysphoric (depressive) mood must still be explored and then processed through psychotherapy.

If you have been feeling depressed for so long now and your depression is just heightened during the Christmas holidays, then most likely you have a major depressive disorder. Consultation with a mental health professional is warranted at this point in time.

If you’re depressed, however, only during the Christmas season, then most likely you’re suffering from "Christmas blues," which in psychiatric jargon is called the Seasonal Affective Disorder (SAD). 

SAD had been observed and recognized even before 1845, but it was not officially labeled as such until the early 1980s. We know that sunlight, for example, has affected the seasonal activities of animals’ reproductive periods and hibernation. In the same way, SAD may be the result of the seasonal light variation in us humans. So as the seasons change, there is a shift in our "biological internal clocks" or circadian rhythm. This is partly secondary to these changes in the sunlight patterns. Thus, our biological clocks are somehow altered. It is said that the most difficult and affected months for people who experience SAD are January and February. It has also been observed that the younger people and women are at higher risk to suffer from SAD. The recurring symptoms of depression manifesting as excessive eating, excessive sleeping and weight gain during the cold months of December, January and February are indicative of SAD. Some SAD sufferers have been reported to also have a craving for sugary and/or starchy foods.

So, what causes SAD? Researchers have pointed to melatonin as the possible biological correlate and cause of SAD. Melatonin is a sleep-related hormone secreted by the pineal gland in the brain. Melatonin, which had also been linked as a triggering cause in the symptoms of depression, is apparently produced at increased levels in the dark. Therefore, when the days are shorter and darker, the production of melatonin increases.

How can a SAD afflicted person be helped? Phototherapy or bright light therapy has been observed to suppress the brain’s secretion of melatonin. There have been no research findings, however, to definitely and directly link bright light therapy with an anti-depressant effect. The phototherapy device most frequently used today is a bank of white fluorescent lights on a metal reflector and shield with a plastic screen. For the mild form of SAD, spending time outdoors during the day or arranging the home and office setting to receive more sunlight may be effective in abating the illness. One research study showed that one hour’s sunlight in the cold or winter months was as effective as two and a half hours under bright artificial light.

If phototherapy fails as a SAD treatment strategy, an anti-depressant drug may prove effective in reducing or eliminating SAD symptoms. Again, let me stress to you the need to discuss your symptoms thoroughly with your family physician and/or a mental health professional. Remember, if you are a SAD sufferer, candle lights and yellow lights are out! White and bright lights are in!

You can still have a truly blissful Christmas, Juan, if you act now and follow my advice.

Merry Christmas to all of you!

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Congratulations to the UP College of Medicine and UP-PGH for its centennial anniversary!

(In case you have other problems particularly about love, looks and relationships you would want me to discuss in this column, send your letters to The Philippine Star c/o Allure Section or send them directly to Suite 506 Medico Bldg., Lourdes Street cor. San Miguel Avenue, Pasig; Tel. no. 633-3898; Medical Arts Building, St. Luke’s Medical Center; Telefax: 723-11-03; E-mail: ninahalili_allure2001@yahoo.com.)