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Caitlin Whyte (Host): While the holiday season can be a festive and joyous time for some, it can actually be a dark and lonely time for others. Joining us to talk about holiday depression and the blues are two of our psychiatrists, Dr. Frank Clark and Dr. Casey Berson.

This is Flourish. A podcast brought to you by PRISMA Health. I'm Caitlin Whyte. I'm so glad we're talking about this today. Dr. Berson, why do you think the holiday season is a difficult time of year?

Casey Berson M.D. (Guest): Yeah, that's a great question. I think a lot of us think of the holidays with this sepia inspired joy. We kind of look back and have great memories, but that's just not the case for a lot of people. And even if it is, that can make these holidays hard. So let me take a step back then. Family isn't always easy. And so when people get together, I think that can be a really tense situation. So, I work with children and adolescents and sometimes also home just isn't a safe space. So I think that in and of itself, increased time at home and with families can be one reason the holidays are hard. I think another reason too, is even if you look back and you had great holidays, if you've lost someone close to you recently, the remembrance of that, just brings up a lot of emotions that are difficult to deal with. Outside of that, there's stress around finances and finding and making things perfect.

And we tend to put a lot of pressure on ourselves this time of year in the midst of a colder season with less sun. I think there's a lot that goes around or happens at the holidays, that we should just really be mindful of. It's not always the perfect time of year and most wonderful time of year for everybody. And that's okay.

Host: Oh, I know for me, the lack of sunlight hits hard. That 4:30 sunset is killer.

Dr. Berson: Absolutely. Absolutely.

Host: So, Dr. Clark, what are some warning signs to look out for in yourself, if you are affected by that lack of sunlight or others that indicate that a person might be struggling during this time?

Frank Clark M.D. (Guest): That's a very good question. I want to piggyback off of my colleague nd friend, Dr. Berson, you know, I think we have to have realistic expectations and you know, she mentioned something that I would wholeheartedly agree with. It's not the most wonderful time of the year for everyone. And so when, when we think about warning signs that somebody may be struggling, I think it's important to first look at are we seeing a decline in terms of their function, they are changed from baseline. So if you have someone that is very extroverted and enjoys socialization. They're usually the one that is the life of the party, or they're going to parties. They're engaging with friends and family. And you notice that now they've become more isolated, for example, that would be a warning sign for me. I see this a lot in, in my patients that I provide care for. I'm an adult psychiatrist and oftentimes people will tell me they just don't have the motivation or the energy to want to even get up and interact with their family and friends. And, and to me that says that there has been a decline in their functioning and their quality of life.

So I would say if you've notice that there's an increase in isolation, people are withdrawing from the people that they normally would want to be around, I would be mindful of that. Other things that we think about, especially during this holiday season, but when we think about depression in general, if somebody may be feeling that around this season, especially as the days are getting shorter, you know, looking at their sleep and appetite patterns. Some people may say, you know, I'm usually somebody that eats three meals a day, but now if they're only eating one meal a day, then I think we have to look more into that and be curious in saying what is leading to that person's change in appetite, or if they're sleeping more or sleeping less.

The last thing I'll say in terms of warning signs, holidays evokes a lot of mixed emotions for people. And I kind of think about going back to my, one of my favorite authors, Charles Dickens, and A Tale of Two Cities, you know, "It was the best of times. It was the worst of times. There was spring of hope or winter of despair."

And so a lot of times around the, around the season, people are feeling despair and they may have thoughts that life is not worth living. If they are mentioning that, we want to delve more into tell me about how long that's been, you've been experiencing those thoughts. Do you have a plan? Have you talked to someone about this plan?

Have you researched ways if you are thinking about harming yourself? So, these are some signs that we can be mindful of and make sure that we pay close attention to and family members can also be mindful of that. And then making sure that we refer people to the resources that are going to help them live a good quality of life.

Host: And Dr. Berson, you are a child and adolescent psychiatrist. So, how are these emotions different or similar in children?

Dr. Berson: So, I'm going to echo what Dr. Clark had said in that changes of behavior is kind of a warning sign. Right? And we don't want to ignore our canaries, which is really what that is. And also just taking a step back, Dr. Clark, I love that you always have a quote or just some sort of reference to these areas. They're so thought provoking and I really appreciate it. I'm hoping we'll get a haiku through here. We'll see. I don't want to put you on the spot.

Dr. Clark: You will, you will.

Dr. Berson: So I think though, for children specifically, it's, we're still learning to deal with our emotions and emotions are really big, right, for little people, they can have big emotions and it's easier sometimes too, to be mad than sad. That's just an easier emotion to express. And so for children specifically, you can look for an increase in irritability or anger can also be warning signs, in addition to those changes in appetite changes in sleep, isolation that Dr. Clark was talking about as well. Those would be kind of specific warning signs for children. The other outlook, you know, we talked about, are we feeling down? Are we feeling upset? I would say, you know, we can do the self-reflection, but that doesn't mean we can always do our thinking for other people.

And so when we're talking about our kids, I think it's important to listen to them and to give them the open space to tell you how they're feeling and to not bring our own anxieties into the conversation. And that is easier said than done. And that's something that we all struggle with as parents or even as adults.

So, giving them that time on the drive to school, or, you know, on the way, home those couple of minutes to tell you how they're feeling and then taking your own fears and anxieties and worries, and voicing them to your significant other or your best friend or your therapist or, or somebody kind of outside of that situation too.

Host: So, the season is coming our way, regardless of how we feel about it. Dr. Clark, what are some things we can do when faced with a daunting holiday season that we might not be looking forward to?

Dr. Clark: That's another good question. I would say the first thing is to acknowledge how we are feeling. Again, the seasons bring about mixed emotions. One of the ingredients, I think for when facing daunting tasks or what the holidays are going to bring again, is to give ourselves permission to feel the way that we feel.

I think oftentimes, as Dr. Berson of mentioned, we, we put so much pressure on ourselves, well we should be feeling this way. And I think that word should can get us in trouble. We feel the way we feel. If you wake up on Christmas morning or Hanukah or Kwanzaa, whatever it may be that you're celebrating and you don't still joyful, that is okay. I think, you know, acknowledging that, you know, today's a rough day for me, you know, maybe you lost a grandmother or a grandpa or a mother or father around these years. And, and for that moment, for a couple of hours, you may not feel so joyful, but maybe as the day progresses, you are able to find ways to celebrate the life that they did have here and enjoy those moments.

But I think we have to give ourselves permission, to feel the way that we feel. No one should invalidate how a person is feeling. And I think that can be very frustrating for people when they say, well, you shouldn't feel this way as Christmas. You know, we shouldn't be all about humbug. Well, I would have to disagree with that.

You know, you don't know that person's experience. So I think people are experiencing these, this daunting tasks or these mixed emotions, surrounding themselves around a support system and that's going to look different for everyone. We talk about in, in mental health that there's tailor made treatment for the individual.

I would say the same thing applies to the holidays. Holidays are going to be, make the holidays about what's going to be authentic and what's going to be good for you. And it doesn't matter what other people say or think, you have to have the best holiday season that's going to fill you up and that's going to look different for everyone.

Dr. Berson: Yeah. So I, I agree. And I wholeheartedly think recognizing that you're maybe not in a great place, but then also know that it is okay to reach out and to ask for help. That's not a character flaw and that's, that's not something that's wrong and it doesn't, doesn't mean the end of the world, right. Or that you're going to be hospitalized, that you're going to be put on medication. It just means that maybe we need somebody to listen or to think about things differently.

Host: Well, Dr. Berson, that was actually my next question. When should you reach out for further help?

Dr. Berson: Sure. Sure. So I think if you're concerned, always reach out and help can, can look different ways. So that help can be, I need again, to just have coffee with my best friend, or I need to talk to my spouse to figure out how I can have five minutes to you go for a run or to, you know, read a book or to, to have a cup of coffee or just to go in my room and cry and to let something out. So I think help can look different ways. When you're looking to advance too and say, hey, I think, I think I'm a little bit farther beyond that. Dr. Clark mentioned one of the biggest ones, absolutely, if you're ever having thoughts that you don't want to be alive anymore, you're lost in despair and you're unable to care for yourself, or you notice those changes in the child as well.

Absolutely, you should reach out for help at that point, too. Kids also specifically, I know where some of them have breaks for school, but they can also go to the school systems and guidance counselors to reach out for help there too. So there are people kind of in your community that are available and able to help.

Host: And Dr. Clark, if like we've talked about, you think that medical intervention is necessary, where and how should you reach out for that further help?

Dr. Clark: Sure. So there are a plethora of resources available throughout the community. I want to put a plug in for a lot of our mental health organizations, our nonprofit organizations, such as NAMI, the National Alliance for Mental Illness, also Mental Health of America, that are both of those organizations are strong advocates for individuals who may be experiencing mental health conditions. The other things we have our suicide hotline, the crisis line, which is available and we encourage people to utilize those resources. And then we also have our emergency departments if you know, people are not able to reach out to family or they cannot, or they feel like the thoughts that they're experiencing are so distressful that they may act upon them; we encourage them to go to the emergency department. And then, you know, Dr. Berson and I, we work here at our clinic together. And, you know, if, if you're feeling like you need to seek help and you want to see a psychiatrist, whether it be an adult psychiatrist or child psychiatrist, geriatric psychiatrist, or if you want to see a psychologist an LPC, what have you; we have those resources available here at our clinic. A lot of times we get most of our referrals from our primary care colleagues. The referrals could be related to depression, anxiety, what have you. So, those are just some resources in the community that I think people should utilize early and often.

And as Dr. Berson said, there's so much stigma around mental health, unfortunately, that we do want people to know. And I want to reemphasize this point. It is okay to not be okay. And it is okay to reach out and being vulnerable is not a sign of weakness. It is a sign of strength and courage.

Host: Wonderful. Wholeheartedly agree. Dr. Clark, is there anything else?

Dr. Clark: Well, I did promise Dr. Berson that I would end with a haiku. And so...

Host: That is true. I was waiting. No, take it away. Dr. Clark please.

Dr. Clark: Sounds good. Alrighty. So the haiku goes as seasonal feelings, a holiday pendulum, mindfulness matters.

Host: Well, what a way to end this episode. Thank you so much doctors for reminding us that this season can be difficult for some and to check in on our friends and loved ones. For more information and other podcasts, just like this, head on over to Prismahealth.org/flourish. This has been Flourish, the podcast brought to you by PRISMA Health. I'm Caitlin Whyte. Stay well and happy holidays.