Depression and Stress - a vicious cycle
with Howard Croft, M.D., Emergency Medicine, Columbia St. Mary's

Related Information • Depression & Stress • Women & Depression • Seniors & Depression • Seasonal Affective Disorder

"We see a fair amount of people around the holiday season who are depressed and have no place to go. They come to ER for that, and they should come in if they are so depressed that they are hopeless and contemplating hurting themselves or others."
- Howard Croft, M.D., Emergency Medicine, Columbia St. Mary's

"The biggest thing for people to remember about ERs is that the definition of an emergency varies from person to person, but we are always available. We would never turn anyone away. Columbia St. Mary's has just undergone a huge effort to stop having to divert ambulances…and the diversionary time has plunged to just about nothing."
- Howard Croft, M.D., Emergency Medicine, Columbia St. Mary's

Perhaps it's the expectations or the demands, but the holidays are the peak season for depression in this country. If you find yourself filled with the blues rather than holiday cheer, you aren't alone. According to the National Institute of Mental Health, depression affects over 18 million Americans, over 9% of the U.S. adult population.

The good news is that depression is a highly treatable disease, with 60 to 80% of sufferers responding to therapy or drugs or both. "Depression is clearly thought of as a chemical imbalance treatable with medications. That's why psychiatrists spend a great deal of their time finding the right medication for individual patients," said Howard Croft, M.D., an emergency medicine specialist with Columbia St. Mary's.

Depression and stress form a vicious cycle, with each contributing to the other. Most important, if depression suddenly worsens, get to a physician quickly. While victims of depression or their families first think in terms of a visit to a mental health professional, many of these are not reachable during the holidays. But an emergency room is, and they have the means to deal with depression.

"If someone is feeling suicidal or concerned they might hurt others, our recommendation is to seek help immediately," Dr. Croft said. "The ER is there twenty-four hours a day and we have the ability to care for those suffering from depression. In severe cases, we tend to hospitalize them and find they benefit from inpatient care."

Causes

There is no single cause of depression, though it tends to run in families. It is also a side effect of some drugs used to treat arthritis, high blood pressure and cancer. A single event can bring on depression, or it may develop over time or return when a sad memory surfaces.

The holidays are a time when we are all expected to be happy and cheerful as we shop, attend services or gather with family. It's no wonder, then, that a depressed person with little desire for social contact, will feel more worthless, more guilt.

Symptoms

Along with the common symptoms of stress, symptoms of depression usually include:
• A lack of interest or pleasure in ordinary activities, including sex.
• An ongoing sense that the future is grim.
• Feelings of guilt, helplessness or worthlessness.

Howard Jeffrey Croft, MD, Emergency Medicine Infinity Healthcare

Although men and women exhibit similar symptoms of depression, women report more atypical symptoms including anxiety, somatization (the physical expression of mental processes such as aches and pains with no physiological cause), increases in weight and appetite, oversleeping, and expressed anger and hostility. Read more about women and depression.

Combating mild depression

It may not be your favorite time of the year, but living up to other people's expectations of holiday cheer and good will can be stressful.

Here are a few tips on how to combat mild depression during this season.

1. Acknowledge feelings and share them with a trusted friend or physician.
2. It is vitally important that a significant other in your life knows what you are going through.
3. Be realistic about what the holidays can accomplish.
4. A dysfunctional family is not going to make up, and may not even "make nice" at their annual gathering. If the thought of spending the holiday with your family fills you with dread, invite over a few good friends to help you celebrate the holiday with less stress.
5. Practice healthy habits - exercise and get some fresh air and sunshine, every day. Perhaps it's the endorphins released during exercise, or the feeling that comes from knowing you are doing something good for yourself, but exercise helps mild depression.

If you can't shake the blues, see your doctor, said Dr. Croft. "Other disorders can mimic depression. The most prevalent is hypothyroidism."

Seasonal affective disorder (SAD) is a major cause of depression that shows up about the time we set our clocks back, and mysteriously disappears in spring. Read more from Dr. Croft about seasonal affective disorder.