Thanksgiving Woes: Anxiety, Depression

Thanksgiving brings some families together that would rather be apart.

“There is a picture-postcard myth that we all see everywhere we look – that everyone is going to be sitting down at the dining room table with the traditional family dinner,” says Dr. John Oldham, chief of staff and senior vice president of The Menninger Clinic in Houston. “That’s not going to be the case for many families.”

The reality of Thanksgiving for some Americans is rife with family tension, arguments, sorrow and loss. Others face the stress of hosting, or the dread of being asked questions about their lives that they are not ready to answer.

In a recent online poll conducted by the Anxiety and Depression Association of America, nearly three-fourths of participants reported feeling more anxious or depressed during the holiday season.

Creating an ideal environment can bring about stressful demands that come with the holidays – entertaining, shopping, cooking – can lead to mental anxiety or depression.

People may feel overwhelmed by the amount of money they will need to spend. They may have high expectations from friends about receiving gifts or cards.

But experts report these kinds of expectations can raise stress and anxiety levels, resulting in depression, family fights, or even mental breakdowns. For those who already have depression or anxiety year-round, symptoms can worsen significantly.

“A lot of times it’s the disconnect for many people between what is supposed to be a really warm family gathering and what it’s really like for some families,” Oldham says.

They may be remembering happier times, facing the loss of an estranged father or the death of a grandparent. Some families are separated by divorce for the first time.

According to the National Alliance on Mental Illness, child and adolescent psychiatric hospitalizations peak during winter months, including the holiday season. Oldham, who is also executive vice chair and a professor of psychiatry and behavioral sciences at Baylor College of Medicine, says most inquiries for mental health assistance come after individual holidays or the holiday season, not on particular holiday days.

It is a myth, however, that suicides rise during the holidays. In fact, suicides are lower in winter than any other time of year, according to the National Alliance on Mental Illness. Still, suicide is the 10th leading cause of death in the U.S., and is considered by the Centers for Disease Control and Prevention to be a major public health problem.

For family members who have a known psychiatric disorder, like severe depression, Thanksgiving gatherings can be particularly difficult, Oldham says. “It is difficult for them to see other members of the family do so well while they may be struggling to cope,” he says.

People with social anxiety disorders have trouble in any large groups, which tend to be a staple of the Thanksgiving holiday. They have an extreme fear of humiliating or embarrassing themselves, of being scrutinized or judged by others. They sometimes will avoid large groups, but doing so only makes them more afraid, according to the Anxiety and Depression Association of America.

Even for people who do not regularly suffer from depression or anxiety, the idea of entering a crowded room and chatting up co-workers or strangers at a party, exchanging gifts with friends, traveling from home, or attending large family gatherings can trigger intense anxiety, depression, or both, says the Anxiety Association of America. Some people may withdraw from group activities or have crying spells.

People without mental health difficulties also may become stressed about being asked a particular set of questions from perhaps well-meaning friends or relatives, such as, “Do you have a boyfriend?” “When are you having children?” “When are you getting married?” “How do you like your job?”

Oldham says people who are asked these questions may feel there is a general expectation for them to do what they have been told to do to meet a family’s approval. “It reactivates and rekindles some old feelings that can be pretty emotional,” he says. Some young people may have chosen to go into a field that their parents may not have chosen for them, or may not have come out about their sexual orientation, he explains.

“It can set the stage for feeling on edge, feeling as though you are going to be criticized," he says. "Young people can feel like they’ve never been loved or have never been supported by their parents. When they get together they don’t see it as a welcome thing, but as a burden to toughen out. Not all families are happy families.”
Some families have never gotten along, he explains, and the patterns do not change after they haven’t seen each other for a while, perhaps because of distance. “Old familiar dust starts to fill the air,” he says. “It may not happen immediately but those old patterns can re-emerge, which can be stressful and discouraging to families.”

Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults age 18 and older – or 18 percent of U.S. population, according to the Anxiety and Depression Association of America.

People with anxiety are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders, says the Anxiety and Depression Association of America.

Depression is a life-long mood state that goes beyond feeling blue, and affects 25 million Americans each year, according to the National Alliance on Mental Illness. Symptoms include sadness, poor concentration, insomnia, fatigue, appetite disturbances, excessive guilt and thoughts of suicide.

But anxiety and depression can build during the holidays even among people who do not have a history with the disorders.

“The Holiday Blues” is a condition that begins around the Thanksgiving holiday, causing stress and anxiety throughout the winter and until after New Year’s. According to the National Alliance on Mental Illness, the feelings may be associated with extra stress, unrealistic expectations or sentimental memories. During this time, people may feel lonely, frustrated or tense.

The difference between the “Holiday Blues” and people who have clinical depression and anxiety is that the former is temporary. A recent survey by the National Alliance on Mental Illness found that 64 percent of people with mental illness report that the holidays make their conditions worse.

Turning to alcohol during this time is common, but it only serves to make depression worse. The Anxiety and Depression Association of America says it may trigger panic attacks. People with anxiety disorders are two to three times more likely to have an alcohol or other substance abuse disorder at some point in their lives than the general population, the organization says.

Oldham says he hopes people will seek professional help if they need it. "That's the best way to get back on your feet," he says.

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