The holiday season is here again and for many of us, it’s a time for celebration and for connecting with our loved ones. It can also be a stressful time, as the season is loaded with expectations.

Expectations often create stress and stress can be hard on everyone. For those who are the most vulnerable, the stresses of the season can result in a worsening of mood symptoms or even a relapse of addiction.

As a psychiatrist with a long-term psychotherapy practice, I’ve noticed how many of my patients start to feel sad this time of year, but the other day, one of my patients arrived for our weekly therapy group in a state of near-shock.

While on her way to my office for our weekly group therapy my patient had witnessed someone jumping off the subway platform onto the tracks. Luckily, a conductor was standing right next to her on the train. He pulled the emergency brake and the man was unhurt. We discussed the incident in group and many of my patients weren’t particularly surprised to hear about the jumper.

When December rolls around, there are parties and celebrations, gift-giving and lots of good food, but there’s a darker side to the holiday season. As much as it’s a time for fun, family and friends, the holiday season can be painful for some people.

Those of us who are healthy, financially stable and surrounded by loved ones might take it for granted that the season will be merry and bright, but not everyone is so fortunate.

In my psychotherapy practice, I’ve noticed an unfortunate trend of social isolation among my patients who suffered childhood trauma. Many of them have few friends. Many are estranged – for good reason – from their dysfunctional family of origin.

Early-life trauma has a destructive effect on a person’s ability to connect with others, even when they wish that they could connect. When the holidays come along, these people feel their loneliness more acutely.

Some of my patients choose to celebrate with their family, even when attending these gatherings means being rejected, criticized or made to feel crazy. These individuals prefer to spend time with their hurtful family members than be on their own over the holidays. Regardless of whichever choice they make, the stress piles on this time of year.

The expectations of the season can be overwhelming for those who are struggling financially. There’s pressure to buy presents that they can’t afford, and they’re caught between disappointing their loved ones and becoming overwhelmed by debt.

One of my patients rang up a huge credit card bill buying expensive presents for his entire family in the futile hope that this would make them all feel more connected.

For some people, their relationship problems come to a head over the holidays. With the expectations of deeper closeness, the ongoing conflicts with their partner become that much more obvious.

Some people are dealing with illness at this time of year. Ill health is isolating and over the holidays it can be especially painful if it means being alone and unwell while everyone else is out celebrating.

Some people struggle with depression, anxiety or addiction. All of these conditions are worsened by stress, and the stresses of the holiday season could make the symptoms worse.

One of my patients relapsed in their use of drugs when faced with spending extended periods of time with their family over one holiday season. Another patient had a recurrence of their panic attacks one year when organizing and preparing all the holiday dinners.

The glut of holiday movies depicting happy, perfect families and idealized romances can cause ordinary people to question their own personal lives. If their relationships don’t live up to the hype, they can become despondent.

Some people struggle with the holidays because this time of year is associated with a past loss or disappointment. This can negatively color all their future holiday seasons.

Some people who don’t celebrate Christmas feel left out of all the fun. While everyone else is out celebrating, they’re just waiting to get to the other side of Christmas.

For many people the holiday season is the best time of the year, but we shouldn’t assume that it’s the best for everyone. A lot of people are gritting their teeth this season, counting the days until it’s all over, and some might even be thinking of making a more drastic choice, like the subway jumper my patient encountered just the other day.

For those of you who are feeling down and extra stressed this time of year, there are resources you can turn to. The local helpline or crisis team is just a phone call away; your family doctor or clergy person, counselors and psychotherapists are all available in your community and they can help you get through the season.

Most importantly, try to enjoy the season to the best of your abilities, and a few words of advice: don’t expect too much of yourself or of others, and take really good care of yourself this time of year.  And if all else fails when dealing with the holiday season, remember the famous Bible verse: “This too, shall pass.”