My Life and Times

November 28, 2004
High for the HolidaysBy WARREN ST. JOHN and ALEX WILLIAMS
N Tuesday afternoon Kelly Kreth, a 34-year-old marketing director from Manhattan, was in a meeting at work when she was overcome with the jitters, the familiar rumblings of what she feared would become a full-fledged panic attack. Ms. Kreth said she had no doubt about the cause: holiday stress.
"I have a lot of issues with the holidays," she said. "There's all this supposed holiday cheer, and I feel inadequate because I never get up to that level of cheer. It's Thanksgiving and Christmas and New Year's. You want to be left alone, but in the next month I'm going to be with so many people that I don't have the luxury of freaking out and locking myself in a room."
With no opportunity to let her panic attack play itself out in private, Ms. Kreth said she took a Valium, just one of a number of drugs she has at her disposal to fend off holiday angst, and in half an hour, she said, she was fine. Ms. Kreth said she takes antidepressants to keep her black dogs at bay, and Percocet, a prescription painkiller, to help her cope with the awkwardness of social situations. "If I have a major party to go to and I'm feeling sad, Percocet really takes the edge off," she said. "It makes me racy and highly social, which is not how I am normally."
When it comes to warding off the holiday blues, Ms. Kreth said, "you have your pill of choice."
It was not so long ago that the preferred method of self-medication for the holidays might be called the Cheever model: copious alcohol, delivered in highball glasses and cut if necessary with a creamy bolt of eggnog.
The age of psychopharmaceuticals has changed that. With a smorgasbord of antianxiety medications easily available — if not from a physician, then from Internet drug sellers or simply from friends — almost anyone so inclined can take a tablet for holiday stress. And to hear doctors tell it, many people are so inclined.
"It is clear that psychotropic medications are used more commonly than they were 10 years ago," said Joseph A. Himle, the associate director of the anxiety disorders program of the psychiatry department at the University of Michigan. "If that medicine is prescribed by a competent clinician and taken according to the prescription, it can be quite helpful in managing holiday stress."
Despite the best efforts of Hallmark and television channels rebroadcasting "It's a Wonderful Life," holidays have long been understood to represent an interpersonal minefield for some individuals and families, as much as a time for carols and warm reminiscences around a glowing hearth.
Those seeking to brighten their seasonal blues with medicine, doctors say, are likely to pursue a number of options. For those already on antidepressants doctors will sometimes increase the dosage in advance of anticipated difficult times. While most antidepressants take days or weeks to have an effect, another class of drugs — benzodiazepines, which include antianxiety medications like Klonopin, Xanax and Ativan — can be taken when the need arises, say, before getting on a plane home to Oklahoma for those with a fear of flying or before sitting down for an elaborate family dinner for those with what might unscientifically be called holiday stress disorder.
"If something is fairly acute, then benzodiazepines are certainly the medication of choice because they work like aspirin," said Dr. Rudolf Hoehn-Saric, the director of the anxiety disorders clinic at Johns Hopkins Medical School. "They start to work in 15 minutes, last for a few hours. Then the effect is gone."
Dr. Hoehn-Saric said antianxiety medications had at least one advantage over the more traditional method of self-medication through holiday stress. "You can't drink all day long to keep anxiety down," he said. "But if you take something like Klonopin, it lasts six to seven hours, you have a much smoother effect, and you don't get a hangover the next day, which sometimes makes things worse."
While all doctors interviewed insisted that pharmaceuticals should be used only under the strict care of a physician, some said that increasing the dosage, and perhaps adding new medications to a patient's treatment regimen temporarily, is a common course of treatment to fight holiday stress.
Some patients who treat their mild depression or anxiety during the year with low doses of antidepressants like Zoloft or Paxil (known as selective serotonin reuptake inhibitors) may benefit from a slight increase in the dose to get them from the kickoff of the Lions game on Thanksgiving through the booting out of the last guests on New Year's Eve.
But that requires planning, doctors said, because an increase in dosage in those drugs can take as much as six weeks to register in a patient's mood.
"If they felt like they needed more, they can talk to their doctor, and the doctor could consider increasing their dose," said Dr. Beth Salcedo, the medical director of the Ross Center for Anxiety and Related Disorders in Washington. "Or they might consider something like Klonopin or Xanax through the holidays and see how things go afterward."
Of course many, if not most, people find the parties, religious observances and family get-togethers at year's end a source of joy and personal renewal. There is no thought of narcotizing away any feelings of anxiety.
Among a certain group, however — addiction counselors and former addicts — it is an article of faith that the holidays represent a perilous time.
"It's a particular problem for drug addicts: here come the holidays, a time fraught with bad feelings, expectations unfulfilled, tremendous loneliness, even with a lot of people around," said Roberta Hollander, a television news producer in Los Angeles, who said she was a drug and alcohol abuser for decades but has been sober for 21 years. "The sight of people having a good time, but you don't know how to, so you stock up on drugs because you have three or four weeks where it's going to be really tough," she said. "Even when I got clean, I would spend holidays praying for January."
Dr. Marvin Seppala, the chief medical officer at the Hazelden Foundation, a recovery clinic in Minnesota, with branches in Chicago, New York, Florida and Oregon, told of a 25-year-old alcohol and drug abuser from Oregon who had kicked substance abuse at Hazelden for many months in 2003. Then the holidays came.
"He just found the holidays pushed him to the point where he wasn't so sure he wanted to change," Dr. Seppala said. "It wasn't that he didn't realize he was an alcoholic, but he started to question all of it. Ultimately he found himself in a workplace party. He hadn't really shared his recovery with people at work. Everybody else was drinking, and it seemed uncomfortable not to be. Suddenly he had a drink in his hand and, boom, he was off and running." It took four months and the loss of a job to clean up again.
Most of those who are tempted to medicate away the holiday blues never allow their impulses to reach such extremes of behavior. In fact many do not seek treatment at all, Dr. Hoehn-Saric said. The holidays are a time of giving, and that apparently extends to the contents of one's medicine cabinet.
"Oftentimes in a family, when the husband or wife is taking Klonoapin or Xanax and the spouse becomes anxious, they'll give the other person a pill," he explained. "It's not uncommon. People don't talk much about it. It generally comes up when people come for a refill for a prescription earlier than they should. `I gave my husband five of my Xanax.' "
Doctors highly caution against this practice.
Self-medication for the holidays, however, may even predate St. Nicholas, if the Roman taste for Tibers of wine at Saturnalia winter solstice festivals is any indication. Was it joy over the successful olive harvest that sent Dad back for a second pull from the amphora or the agitation over a villa full of screaming nephews in town for the week from Neapolis?
Regardless, some physicians caution against trying to blend certain older traditions — say, mulled wine — with newer ones like reliance on mood-altering medications.
It could be a ticket to an especially rotten holiday, said Dr. Alan Manevitz, a family psychiatrist at the New York Weill Cornell Medical Center. "If they're mixing antianxiety drugs and alcohol, they're really taking a risk," he said. "They're not compatible. It could backfire on you by shortening your fuse. You may get disinhibited and say the things you were trying to keep in check."
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