As we get older, holiday festivities may sometimes no longer seem so cheerful. What used to be joyous occasions can take on new meanings as life takes unexpected turns throughout our life.

There is the expectation we need to be exceptionally happy this time of the year, but that expectation can even cause people of any age to experience sadness or even depression. This is especially so among some older adults and/or their family caregivers.

Older individuals may experience holi­day blues or depression for various reasons. Older people may be more concerned at the passing of time, year after year. They might feel the absence of siblings, friends or even children who have died; loss of independence, mobility and autonomy; relocation to long-term care; loneliness and separation from family and friends; social exclusion and isolation.

Furthermore, due to these losses, certain traditions that were once observed may sometimes not be convenient or comfortable. As we can see, one thing builds on another, and it is understandable that some older persons and/or their family may develop depressive symptoms.

What is depression?

Depression is a common, but serious mood disorder. It causes severe symptoms that can influence how one feels, thinks and affects daily activities, such as sleeping, eating and work (including house chores). To be diagnosed with depression, the symptoms must be present for at least two weeks: this is usually called major depression or clinical depression.

There are other types of depression, some of which develop due to specific circumstances. These include seasonal affective disorder, which comes and goes with the change of seasons, sometimes also associated with the daylight-saving time, and typically starts in late autumn and early winter, and subsides during spring and summer.

Depressive disorder related to a medical condition is another type of depression that is related to a separate illness, like, for example, heart conditions or multiple sclerosis.

Depression can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease and Parkinson’s disease. These conditions are often worse when depression is present, and research suggests that people who have depression and another medical illness tend to have more severe symptoms of both illnesses.

Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A geriatrician or psychiatrist specialised in old age can help work out the best medical treatment strategy, taking into consideration the issue of polypharmacy in older people.

Depression disorder can also be persistent, typically lasting for at least two years. Other types include perinatal depression (antenatal and postnatal depression or depression during pregnancy, birth and postnatal period) and depression with psychosis (where one can experience delusions or hallucinations).

Individuals with bipolar disorder also experience depressive episodes, in which they feel sad, indifferent or hopeless, combined with a very low activity level. But a person with bipolar disorder also experiences manic episodes, or unusually elevated moods in which the individual might feel very happy or irritable with a marked increase in activity level.

Risk factors

Research suggests that genetic, biological, environmental and psychological factors play a role in depression. The following risk factors are normally related to depression but it does not mean that they will necessarily cause depression:

• Bereavement and various types of losses;

• Medical conditions, such as stroke or cancer;

• Genes – people who have a family history of depression may be at higher risk;

• Stress, including caregiver stress;

• Sleep problems;

• Lack of exercise or physical activity;

• Functional limitations that make engaging in activities of daily living difficult;

• Addiction and/or alcoholism –  included in Substance-Induced Depressive Disorder;

• Social isolation and loneliness.

Grieving, social isolation and loneliness are big risk factors for depression during Christmas and other holidays.

Does depression look different as you age?

Depression in older adults may be difficult to recognise because older people may have different experiences, and thus report different symptoms than younger people. For some older persons with depression, sadness is not the main symptom. Instead, they would report more feelings of numbness or lack of motivation in taking part in activities. In addition, older people might not be as willing as younger adults to open up and talk about their feelings or what they are going through.

The following is a list of common symptoms. Still, because people experience depression differently, there may be symptoms that are not on this list:

• Persistent sadness or feelings of emptiness;

• Loss of interest in once pleasurable activities, including sex;

• Feelings of guilt and hopelessness;

• Feelings of worthlessness or helplessness;

• Decreased energy or fatigue;

• Difficulty concentrating, remembering or making decisions;

• Difficulty sleeping, waking up too early in the morning or oversleeping;

• Eating more or less than usual, usually with unplanned weight gain or loss;

• Thoughts of death or suicide, or suicide attempts.

What if I’m going through grief during Christmas?

The most important thing is to ask for help. Services exist that can help you process the grief. If you are grieving someone, there are some ways to help overcome this period. Develop some traditions for this period:

• Place the person’s picture in a place of prominence at home and light a memorial candle;

• Organise a memory box or a photo album of previous holidays together to focus on positive memories;

• Set aside a time so that everyone who wants to can share a favourite memory or a funny story about the deceased;

• Have a toast to your loved one;

• Spirituality is important for support ‒ go to church, mosque or synagogue and engage with others;

• Volunteer to help those in need;

• Visit your loved one’s final resting place or a location where they enjoyed spending time.

If you have several of the signs and symptoms mentioned in this article, talk with your family doctor or GP. These could be signs of depression or another health condition. Don’t ignore the warning signs. It is important to remember that there are also helplines in Malta that are free of charge and available 24 hours a day, seven days a week: Richmond Foundation Helpline 1770; Supportline 179; Dementia helpline 1771.

Christian Borg Xuereb is head of the Department of Gerontology and Dementia Studies at the Faculty for Social Well-being, University of Malta. He is also a registered health academic and research psychologist with a special interest in geropsychology and is the PRO of the Maltese Association of Gerontology and Geriatrics (MAGG).