Holidays can be troublesome for individuals with an acute or chronic mental health condition or problems with alcohol, drug, or other substance abuse. Those with these problems are very vulnerable to anxiety, stress, depression, loneliness, and unresolved grief and loss.

Behavioral health crises interfere with normal functioning and usually require professional intervention. At worst, they may involve individuals who may become a danger to themselves through self-injury or suicide, or to others. Some may become agitated or aggressive, others may abuse their medications or alcohol. An awareness of what can trigger crises may help individuals and families avoid or better deal with them.

Holidays amplify many situations that can be difficult for individuals with anxiety disorders. Increased social contacts and demands can be challenging. Alterations in family, school, employment routines, or even household arrangements, can be anxiety producing and built up quickly.

The holidays can generate severe stress. Stress is a response to change. For most, holiday stress is a nominal and temporary problem, but for others it can lead to crisis. Maintaining personal routines may help. Sticking to customary exercise and eating habits is important.

Depression is not a normal effect of the holidays and is different and more serious than "the blues. Some signs of depression are feelings of hopelessness sadness, worthlessness, and helplessness. Those who are depressed may have trouble making decisions, concentrating, sleeping, may lack energy, and lose interest in things they enjoy.

Depression is often not recognized. It can overwhelm a sufferer very quickly. This is a particular problem among the elderly. Depression is now felt to have a physiological basis, which means that it can be treated with medications. It is important to seek medical help as soon as possible when any signs of depression are evident.

Loneliness can be critical during the holidays. Many people have a very unrealistic notion of how the holidays should be. They may be overtaken by loneliness regardless of how much social interaction they engage in. When this happens they may feel that there's "something wrong with me" because this is not how things are supposed to be.

Another common feeling during the holidays is grief or a sense of loss. The "family and friends" aspect of the holidays may cause us to be reminded of someone who is not there and whom we acutely miss. If possible, it may help to reach out to other family members or friends who endured the same loss.

There is the potential for one or more of these factors to lead to another. Anxiety, loneliness, stress, and depression may arise in any combination. Support systems may become disrupted over the holidays. Hospitalization may be needed if there is suicidal or self-injurious behavior, grossly reduced ability for self-care, and the need for medical assessment and stabilization. 12.00