FOR SOME, CHRISTMAS is a depressing time. Numerous studies have shown that depression rates increase over the festive season. According to the Canadian Mental Health Association, the number and severity of calls to distress centres increases every year in November and December, through to the end of January. Since excessive stress is a risk factor for depression, it's not surprising that rates increase at Christmas time. The late Thomas H. Holmes, a former professor of psychiatry and behavioural sciences at the University of Washington School of Medicine, devised a scale to measure the relative stress induced by changes in a person's life. Studies by Holmes and his colleagues show that if you accumulate more than 200 units of negative or positive stress in a single year, your life has been disrupted enough to make you vulnerable to physical or emotional illness. At the top of their scale is the death of a spouse, which receives 100 stress units. Other examples include divorce (72), marriage (50), retirement (45), pregnancy (40), an outstanding personal achievement (28), and change in school (20). In all, 43 life events are ranked and Christmas receives 12 stress units. This suggests then that if you're already experiencing other stressful events in your life, Christmas can be an added strain that increases your vulnerability. So, how do we account for this increased stress over the holiday season? Single people are prone to feeling lonely over the festive period. Couples squabble about money and whose extended family they should spend Christmas Day with. Many of us agonise over buying presents for loved ones. Have we spent enough, or too much? Will it fit them, will they like it? Add to this the myriad other duties that the season entails, such as card sending, present wrapping, decorating, baking and entertaining and it's no wonder that we feel overwhelmed. If we approach this time with the aim of out-doing Martha Stewart, our stress levels are bound to escalate. The Sydney Morning Herald recently reported the latest by-product of Christmas pressure called checkout rage. According to the Australian National Retailers Association, the season causes many frustrated shoppers to take their stress out on retail staff. The newspaper cited a recent survey by eBay Australia that shows 96 per cent of Australians hate Christmas shopping, which is probably why they're on eBay. As if the pressures of getting through the season aren't enough, Christmas reminds some people of an impoverished childhood, when there were no presents and it was a disappointing time. One patient of mine recalls lying to her classmates about all the great gifts she received so as not to feel left out. Others, who learned at an early age not to expect much from life, either in the form of love or material things, often feel deep down that they're not worthy to receive good things or to be happy. Consequently, a mild depression, or melancholy, overtakes them when others are expectant or happy. Britain-based doctor Trisha McNair says on the BBC website that 'depression is a complicated problem, often hidden behind physical illness'. She says common symptoms (other than a depressed mood) are: a loss of interest in life, even in favourite hobbies or sports; loss of pleasure - getting no feelings of enjoyment, even from things most people would greatly enjoy; tiredness and fatigue; impaired concentration; suicidal thoughts; changes in appetite including either weight gain or loss; changes in sleeping patterns - most typical is waking unusually early and not being able to get back to sleep; and, finally, agitation, tetchiness or extreme placidity. So what can be done to avoid having a blue Christmas? First of all, try to put the holidays into perspective. While Christmas has a deeply religious meaning for some, for others it's merely a retail extravaganza. Identify what your feelings are about Christmas and work on approaching it with a positive attitude. Figure out whether your expectations and unrealistically high, self-imposed standards are causing you unnecessary stress. Limit the number of invitations you accept and try not to overextend yourself. Spend your time with people you want to be with. Use some of the extra time you have during the holidays to engage in some form of exercise - a guaranteed stress reliever. Try to cut back on the amount of fat and sugar you eat - too much of either can leave you sluggish and have a negative impact on your immune system. Take it easy on your caffeine and alcohol consumption; after all, alcohol is a depressant. Enjoy giving, but be realistic and only provide what you can afford. If you can give of your time, volunteer in a soup kitchen or a food bank and help those less fortunate. Christmas should be for reminiscing too, for revisiting a time when life was simpler and made more sense. As cliched as it may sound, try to see Christmas through the eyes of a child. Don't worry, be happy Slow down over Christmas, it's supposed to be a holiday. Try not to worry about things out of your control. Delegate, and stop striving for perfection, which is an illusion. Exercise, exercise, exercise. Try to aim for eating healthy 80 per cent of the time. Try to avoid excessive alcohol and stay hydrated. Rest.