The Woman Who Makes the Holidays Happen Is Not Okay

Midlife women are often the ones who plan, shop, cook and keep the peace every holiday season. For those living with depression, it can be the hardest stretch of the year.

Somebody has to buy the gifts, plan the meal, remember the allergies, host the cousins, and keep two sides of the family from arguing over the dinner table. In many families across St. Louis and beyond, that somebody is a woman in her forties or early fifties. From early November through New Year's Day, she runs the holidays like a second job.

If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.

For a woman who is already struggling with depression, that season can be brutal. The expectation of joy can make sadness feel even more out of place. The work can crowd out sleep and rest. And the gatherings themselves can stir up old family pain, recent losses, or the absence of someone who used to be at the table.

Why the season can deepen depression

Midlife women often carry several layers at once in the holidays. There may be an empty chair for a parent who has died, or a parent who now needs care during the visit. There may be a divorce that splits the calendar, or teenagers who would rather be elsewhere. There may be money pressure and a deep wish to make it all special anyway.

Shorter days and less sunlight can affect mood. Perimenopause can add sleepless nights and irritability. Alcohol is often everywhere. All of it lands on someone who may be the last person in the house to sit down.

For some women, this mix leads to thoughts of suicide. They may feel like a burden, or that the family would have a better holiday without them. Those thoughts are a sign that something needs care, and they deserve to be heard with kindness.

Warning signs during the holidays

Relatives often see each other more in this season, which makes it a good time to notice changes:

She seems withdrawn or flat during gatherings that used to bring her joy.
She says she is dreading everything, or that nothing matters this year.
She talks about being a burden, or about not wanting to be here.
She is drinking more than usual, or not sleeping.
She is giving away meaningful things, or saying goodbyes that feel heavier than the occasion.

If a relative seems off this season, find a moment away from the crowd and ask her directly whether she is having thoughts of suicide. A kitchen doorway or a walk around the block is enough. Asking does not introduce the idea, and it may be the kindest thing anyone does for her all holiday.

Making the season lighter

Share the hosting. Rotate who holds the main meal, or turn it into a potluck. Assign shopping, cleanup and travel planning to other adults.
Scale back on purpose. Fewer gifts, fewer events and simpler food can give a struggling woman room to breathe. Children adapt more easily than parents fear.
Protect quiet time. Build in a walk, a nap or an afternoon off. Treat it as part of the plan, not a luxury.
Keep the house safer. With guests coming and going, it is a sensible time to lock up medications and make sure firearms are stored securely.
Encourage a doctor's visit. Depression is treatable. Getting support before or during the season can make the year ahead feel more manageable.

If the holidays bring depression that does not lift

For women whose depression has not responded to earlier treatment, or who are having suicidal thoughts, a clinician may discuss Spravato. Spravato (esketamine) is a nasal spray the FDA has approved, taken along with an oral antidepressant, to treat depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. It is also approved for treatment-resistant depression. It is not a crisis treatment: it does not replace emergency care or a hospital stay when one is needed, and it has not been shown to prevent suicide or to reduce suicidal thoughts or behavior. It is given only in a certified clinic under a safety program called the Spravato REMS. The patient takes it there under supervision, stays at least two hours to be monitored, and does not drive until the next day after a full night of sleep. It is never dispensed for home use. Whether it fits is a clinician's decision after an evaluation.

If you are the one who makes the holidays happen and you are not okay, this can be the season you ask for something for yourself. Many clinics that offer this treatment start with a free first conversation, where you can ask whether an evaluation makes sense. You are welcome to bring a family member or a friend with you.