Coming home to the blues

Medical Matters: No one has ever arrived into my consulting room and announced, "I'm suffering from the post-holiday blues."

Nor does the term exist in the International Classification of Diseases (ICD). And yet it is something we have all experienced in the days and weeks after our annual break away from it all.

Writing in this newspaper last month, Irish Times reporter Paddy Agnew described the "sting" of returning to Italy after nearly seven weeks on the road from Lisbon to Rome: "After travelling 3,000-odd kilometres from Lisbon to Rome, the first impression that modern Italy generates is one of a shoddy tiredness... Drive into Turin, not an insignificant Italian city, after crossing the border with France, and you are immediately overwhelmed by unkempt city streets, dirty footpaths, no flower beds, dust and, above all, omnipresent billboard advertising that uses naked or semi-naked women to advertise anything and everything from mobile phones to air conditioning."

As someone who returned from holiday in Italy just a few weeks earlier, I was initially taken aback by Paddy's description. For me, the stretch of coastline between Rome and Naples had provided three weeks of absolute bliss. In fact, the rejuvenated historic centre of the town we stayed in was clean and, if anything, more "kempt" than a year earlier. And while not for one minute defending the exploitation of women on billboards, it is different and a reminder that you are away from home.

But, then I realised that I too was disgruntled by the tired familiarity of Dublin Airport when we arrived back from Italy. The streets seemed even dirtier and the traffic even more migraine-inducing than before. And then there was the rain and the need to wear a sweater.

Probably the nearest "diagnosis" for the post-holiday blues is that of adjustment disorder.

Psychiatrists define adjustment disorder as a psychological disturbance which is closely related in time to a stressful event. It occurs generally within three months of the original stress and can continue until either the stressor is removed or a new level of adjustment is reached. The main symptoms in a person with an adjustment disorder are feelings of being dazed, followed by anxiety and even panic. An adjustment reaction can precipitate symptoms of depression: a change in appetite, sleep problems (either excessive sleep or difficulty sleeping) and difficulty concentrating. The difference is in the severity of the symptoms and in the length of time they last. An adjustment disorder is almost twice as common as depression.

Whatever about psychological classification, the post-holiday blues are a reality for many people. Tension headache and indigestion on the first few days back at work; difficulty concentrating with a tendency to look out the window and reminisce about moments of holiday pleasure are common features. And then there is the tendency to comfort eat in direct contrast to your holiday resolution to continue that lovely diet of fresh fruit.

Why do we find it so difficult to adjust to a normal routine after a holiday? Apart from the severe wrench of stressful work routines which are in marked contrast to the carefree bliss of beach, fun and sun, there are other things that we tend to do on holiday that make the transition on return home difficult.

For many people, alcohol consumption increases markedly while away. Alcohol is a natural depressant and may contribute to a temporary low mood when we return.

Most of us increase our exercise levels by virtue of having more time and energy. Exercise produces "feel-good" hormones called endorphins which contribute to the holiday good mood. Conversely, when we return to normality it can be difficult to maintain such a healthy routine. Without the endorphins buzzing around our blood stream, our mood can drop.

Many Irish people choose sunny destinations when booking a holiday. Spending a couple of weeks in a warmer, brighter climate increases the production of serotonin and other neurotransmitters in the brain, leading to an improvement in mood. Returning to the traditionally wet and windy Irish summer can lead to a dampening of spirits.

It may help to try to make time to continue some of the pleasurable holiday activities when you return. Daily exercise - even 30 minutes of brisk walking a day - will help to combat the return-to-home blues.

Try to build in reflection time into the day in the same way that the evening walk on the beach allowed you to reflect on anything or everything. It's best to avoid making unrealistic resolutions while on holiday; the inevitable failure to carry them through will contribute to feeling down and unfulfilled.

It is hard to argue with the old sage who said: "It is the day after the holiday when a holiday is most needed."

• Dr Muiris Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he cannot answer individual queries.