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Ask Stanford Med: David Spiegel answers your questions on holiday stress and depression

A friend recently told me she hopes to get all her holiday shopping done within the next two weeks. "I just don't want to stress out about it, and December is always so busy," she said. I could tell by the look on her face that she, like many of us, was already anxious about finding time to do other seasonal activities like prepare elaborate meals, wrap presents and travel to visit family. While the holidays are often joyful occasions, the time can also make us worry about our to-do lists and boost our stress levels, and the dark, short days of winter can dampen our moods.

So this month we asked David Spiegel, MD, director of the Stanford Center for Stress and Health and medical director of the Stanford Center for Integrative Medicine, to respond to readers' inquiries about stress and depression during the holidays. Below he answers a selection of the questions submitted via Scope and our @SUMedicine Twitter feed.

Dave P. asks: Research shows that when it comes to long-term health, how you react to stress is really what matters. Limiting sources of stress seems nearly impossible during the holidays, [so can] you share some tips for how to better deal with stress and potentially reduce its negative health effects?

You are right that in most cases we cannot eliminate stress. We do, especially at holiday time, often take on more than we can handle. So it is wise to prioritize stressors. If you add some new tasks, such as preparing parties, cooking extra food, tree decorating, buying presents or sending holiday letters, you may want to plan to reduce other activities. Take some leave time from work or ask for help. The key is taking stressors one at a time and developing a plan for dealing with them. Feeling overwhelmed by stressors is yet another stressor. You want to be active rather than passive in managing your holiday assortment of stressors.

Serena asks: What does the scientific evidence indicate about the effectiveness of using natural remedies, such as fish oil, Vitamin B6 or St. John’s wort to treat seasonal stress and/or depression?

There had been great enthusiasm about St. John’s wort in particular in the treatment of mild to moderate depression since it has an effect on the serotonin brain neurotransmitter system (preventing reuptake in the synapse – the connecting space between neurons) that is similar to the action of many currently used antidepressant medications. However, recent studies do not indicate much of an effect on depression.

With that said, there is a substantial placebo component to the treatment of stress and depression. So some of the benefit of any treatment comes from doing something that provides an expectation of improvement. Even when people know they are taking placebos, they sometimes benefit. Fish oil has other dietary benefits, as does Vitamin B6, so taken in moderation they could help and won’t hurt. There is recent evidence from a 25-week multicenter randomized clinical trial that RCT WS 1490 (a special extract from kava-kava) is effective in treating mild anxiety in comparison with placebo.

L. Reed asks: What are some signs that seasonal depression could be part of a larger mental health concern?

There are people who feel blue during the holidays because they are separated from loved ones or miss family and friends who are gone. Some may feel that others seem to have more holiday activities than they do. But if the sadness goes beyond feeling like a response to specific problems or losses and starts to generalize to how you feel about yourself as a person, it is time to seek professional help. If you start to feel hopeless, helpless, and/or worthless, or have thoughts of harming yourself, it is a larger mental health concern.

James asks: Is it true that suicides decrease during the holidays? Wouldn’t that be an argument that depression [also] decreases during holidays?

Depression is as high or higher than usual during the holidays because, among other reasons, of seasonal affective disorder. Those who are especially sensitive to the short period of light in the dead of winter are prone to become more depressed. Two things may reduce the actual rate of suicide during the holidays. First, there are more people around because it's a time that friends and family come together, so individuals are less likely to be alone even if they are depressed. Second, the most dangerous time for suicide is not during the depths of depression – many people in that situation are just overwhelmed and miserable and cannot plan and carry out anything, including their own deaths. A more dangerous period is when they are pulling out of their depression because they now have more energy but still carry with them the self-loathing and despair that goes with it. Then they may be more prone to act on their self-destructive thoughts.

Scott asks: Regarding depression, specifically Bipolar I, are there any new studies on alternative medicine as a treatment?

I don’t know of any studies of effective alternative medicine treatments for Bipolar I. It is a serious mental disorder, either in the manic or depressive phase, and usually requires psychiatric intervention. It is worth noting, however, that one of the best and most effective treatments is in a way a natural remedy – lithium carbonate. Lithium is just the third element in the period table and the carbonate form a natural salt. The amounts used need to be monitored carefully, but in many cases it stabilizes mood for people with bipolar disorder very well.

@CGhaznavi asks: Do changing daylight patterns alter daily melatonin regulation and metabolism? Is so, how can this change be normalized?

The secretion of melatonin by our pineal gland is very sensitive to light. Light exposure, even for brief periods at night, will rapidly suppress melatonin levels. Normally, the greater length of darkness in the winter season should increase our melatonin production and secretion. However, we humans tend to defeat nature’s call for sleep with household lights, computers and television screens. These definitely suppress melatonin levels. There is not much evidence that taking melatonin improves sleep under ordinary circumstances, but it does help with jet lag. The best thing to do is not let the excitement or extra holiday activities impinge upon normal sleep time and the darkness that goes with it.

Previously: Ask Stanford Med: David Spiegel taking questions on holiday stress and depression, How gender differences shape attitudes toward depression, Anxiety shown to be important risk factor for workplace absence, Study offers insights into how yoga eases stress, Revealed: the brain’s molecular mechanism behind why we get the blues and Stanford health psychologist Kelly McGonigal discusses how stress shapes us

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