psychoanalyst dr. robert schwalbe knows that when the christmas carols start playing, the phone starts ringing.
the doctor, who specializes in treating men at his upper east side practice, said that much like a retailer, the holidays have become his busiest season.
"my practice booms at this time of year," he said, estimating that he typically sees a 25 percent spike peaking in january. and that's on top of the 50 percent increase he's already noticed since the economic crisis began.
if the greeting cards and christmas carols have it right, the holidays are supposed to be a time of merriment, laughter and cheer. but for many men, a darker reality hides behind the gift wrap.
while women are traditionally more prone to depression, psychologists say men can be especially vulnerable this time of year.
"men can feel very alone, they can feel very, very isolated," said schwalbe, who is also the author of sixty, sexy and successful: a guide for aging male baby boomers. "it's the sense of obligation that is part and parcel of the holidays."
women, he said, tend to be better at dealing with the social pressures of the holiday season. but many men are lost in the shuffle. some find themselves forced to socialize with relatives, co-workers and friends when they're really not up for it. others who don't have the same social networks are reminded again of the fact that they are left out.
there's also the issue of money. buying and receiving gifts has become an integral part of the holiday tradition. but that requires money, which is in especially short supply this year.
many of the men schwalbe treats, for instance, have lost anywhere from 25 to 55 percent of their net worth-which they often equate with self-worth-thanks to cutbacks and layoffs. plummeting incomes and dwindling savings have put marriages and other relationships on the rocks.
"it's very, very bad," schwalbe said. "it's a matter of pride that they cannot live the lifestyle they have been living. 'are they still the man they used to be,' many ask themselves," he said.
dr. vatsal thakkar is medical director of the graduate medical education wellness team at new york university and also runs a medium-sized clinical practice. he said that he is especially worried about men who are mourning the loss of loved ones this year.
"there's a unique confluence of events every holiday season that can sometimes magnify loss and suffering," he said.
this is also compounded by a simple fact of nature: while christmas lights may be shining, the sun is not.
according to dr. jonathan stewart, a research psychiatrist at the new york state psychiatric institute and professor of clinical psychology at columbia university's college of physicians and surgeons, the real culprit behind holiday depression is the lack of sunlight caused by shorter days, which severely disrupts biorhythms. dec. 21, the shortest day of the year, falls coincidentally just days before christmas, he noted.
but whatever the cause, because men express depression differently than women, thakkar said it is especially important to know which symptoms to look out for. men are more likely to withdraw or act out aggressively. some display self-doubt or a sense of worthlessness. others may exhibit self-destructive behavior, from drinking and drug use to seeking extra-marital affairs.
so what can men do to try to stave off the christmas blues?
schwalbe thinks it is crucial to adapt.
"just because you've done it this way all those many years doesn't mean you have to do it this way," he said.
that means being able to admit that you can't afford an annual family ski trip to aspen, or all those toys for the kids.
it's also important to try to minimize other pressures. try positive distraction, like playing ping pong or spending time outdoors with the kids.
and learn to say no. accept that it's okay to do less, whether it's declining an invitation, cooking fewer dishes at a holiday meal or telling out-of-town relatives that this year, it may be best to book a hotel.
"it's very, very important that we have the chance of saying, 'not this year, it's not for me,'" schwalbe said.
stewart adds that getting enough sunlight is crucial. interventions may be as simple as taking vitamin d tablets, getting a light therapy lamp or enjoying a walk in the morning.
"these other interventions can be pretty powerful when done correctly," thakkar said.