Depression at College

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Depression is not just about feeling sad. It is an illness that also affects the ability to think and reason and can cause insomnia, sexual dysfunction, and weight loss or gain. It is associated with other psychological problems, including anxiety disorders, eating dis­ orders, substance abuse, and suicide. It is a disease that affects every body system and many functions of the brain. And it is rampant on college campuses. The following story of Darrell's long fight with depression clearly illustrates how this problem affects so many aspects of a student's life:

By the time Darrell realized he was suffering from major depression, he had already left one university and transferred to another, only to find himself still discontented and lonely.

It all started back in his senior year of high school. ­ Darrell noticed that he felt unhappy, lethargic, and tired, but he put it off without complaining and looked forward to feeling better when he began college. However, after only a few weeks at college, he knew something was very wrong. "I was having difficulty making friends," he says, "and I felt so lonely. I spent most of my time secluded in my room feeling terrible that other people around me were having a good time and enjoying campus life, but I just couldn't. I figured it was the wrong college for me"just a bad fit"and so I started looking for another school where I wouldn't feel like this."

Darrell's parents had no idea he was so unhappy. Darrell made sure of that. "I pride myself on always appearing to be in control, and I didn't want my parents to think I couldn't handle school. In fact, my depression probably helped me academically because good grades were my anchor. I could focus on my schoolwork to distract me from my loneliness. So here I was at one of the nation's top twenty-five schools and getting excellent grades. How could I tell my parents that I wanted to leave because I wasn't having a good time?"

Darrell told his parents he wanted to transfer to an even better school for purely academic reasons. He applied and was accepted for admission the following year. While waiting to transfer, Darrell first visited a college counseling center at the school he was leaving. "I filled out a form that asked me to explain what was bothering me," remembers Darrell. "I wrote down that I needed help with stress management. Although the possibility of depression wasn't mentioned at that time, the counselors let me talk about all the stuff that was on my mind, and it felt really good. These were things I ­ couldn't say to family or friends (not that I had many) because I was still trying to hold up the image of being someone who had it all together and I didn't want to admit that there might be some cracks in that image."

After transferring, Darrell's hopes for a new beginning were quickly dashed. "I was unhappy right away," he says. "A new environment didn't change the way I was feeling at all. I still felt the disconnect between my internal and external world. A month later, I went to the mental health counseling center where I talked about the symptoms that had been plaguing me. I couldn't get out of bed in the morning. Every movement took so much effort. I didn't have the energy to walk across campus and then sit through an hour-long lecture. And when I did, I couldn't wait to get back into bed. I felt very unhappy all the time and spent far too much time thinking about death (although I never had a specific plan for suicide). I had this feeling of hopelessness and now realized that if I couldn't shake the feeling in either of these two very good schools, it probably wasn't the school that had the problem."

Darrell was diagnosed with major depression along with social anxiety, given a prescription for Prozac, and referred for regular counseling sessions with a therapist.

This helped Darrell, but did not suddenly turn him into a new man. "I'd say I felt less depressed, but I ­ wouldn't say I felt happy. I still didn't feel excited about being at such a good school, and I still didn't feel like making any effort to make friends. But I felt better, and that was something."

During his therapy sessions, Darrell learned more about depression and began to understand why he felt the way he did. Along the way, he also learned that it was not always necessary to hide his pain. After joining a mental health awareness advocacy group, Darrell met other students who were also struggling with mood and anxiety disorders. "This made me feel more comfortable in my own skin," he says with obvious relief. "And it helped me to realize I was not alone with this."

Feeling more comfortable with his mental health issues during his junior year, Darrell wrote a paper for school about his experience with depression. At that time, he also decided to tell his parents. "All along, we had had a good relationship. We talked for an hour at least two times a week, but I worked very hard to keep this problem from them. But then I realized that it was more of an effort to put on the show all the time than to tell the truth." So Darrell shared this paper with his parents. "I think they were surprised and rattled," he admits, "but ultimately it strengthened the bonds we have and it's become easier to talk with them about the issues that until now I had been hiding." That alone has helped Darrell move forward with greater confidence.

As Darrell's experience shows, just because our kids say, "I'm fine," doesn't mean they really are. We need to learn how to listen to the silence and be attentive to the signs of depression they may try to hide.

An Epidemic of Depression

Darrell's story is all too typical. A 2003 study conducted by re­ searchers at Kansas State University examined the kinds of problems counselors at its counseling center had addressed over thirteen years. Among other findings, the percentage of students seen with depression nearly doubled, and these findings reflect the increasing rates on most college campuses. The increase may in part be due to a greater willingness by students to admit their feelings of depression and to the increased academic, social, family, and financial pressures students feel today. But it is also due to advances in the pharmaceutical industry. The sale of antidepressant SRIs (serotonin reuptake inhibitors) has passed $10 billion. The public advertising has increased awareness, and more students with treated depression are able to get to college, where before, their depression would have made them nonfunctional. Now they are on our campuses and naturally increase the numbers seeking counseling.

Tips for Mental Health

Do not ignore symptoms of depression or delay treatment. The Centers for Disease Control reports that the vast majority of young adults aged eighteen and older who are diagnosed with depression do not receive appropriate or even any treatment at all.^* Minorities in America fare even worse. A report from the U.S. Public Health Service found that blacks, Hispanics, Native Americans, and Asian Americans face severe economic, cultural, linguistic, and physical barriers for treatment of mental illness, difficulties that prevent thousands from being properly treated.

This is a dangerous situation, especially given the fact that depression raises the risk of suicide and contributes directly to binge drinking, over- and undereating, and alcohol abuse, which are all often attempts at self-­ medication.

^*Centers for Disease Control, National Center for Chronic Disease and Health Promotion, "Youth Risk Surveillance: National College Health Risk Survey" (Atlanta, Ga.: Centers for Disease Control, 1995).

"Report: Minorities Lack Proper Mental Health Care," CNN.com/
Health, Aug. 27, 2001. [http://www.cnn.com/2001/HEALTH/08/26/
mental.health/].

The Symptoms of Depression

Major depression shows itself in a combination of symptoms that interfere with normal life functioning. They may appear once, twice, or many times over a lifetime. According to the Diagnostic and Statistical Manual of Mental Disorders, depression exists when five or more of the following symptoms (including one or both of the first two symptoms) are present over a two-week period:

• Depressed mood most of the day
• Markedly diminished interest or pleasure in all or almost all activities
• Significant weight loss when not dieting, weight gain, or decrease or increase in appetite
• Insomnia or increased sleeping
• Restlessness or slowing down of body movements
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Diminished ability to think or concentrate, or ­ indecisiveness
• Recurrent thoughts of death (not just fear of dying), recurrent thoughts of suicide, or a suicide attempt