Depression in College Students

Depression is a pretty common disorder. The APA reports that one in six people will experience depression at some point in their lives. According to the World Health Organization, more than 300 million people around the world live with depression. These numbers are all pre-pandemic. We can only imagine how many people are feeling depressed now. What is everyone worried about? Little things like paying the rent, putting food on the table, taking care of kids, home-schooling, will I have a job when this is all done, when will this be done, if you are single, will you ever be able to date again?

According to the National Alliance on Mental Illness (NAMI), one in five college students experiences a mental health condition during their university years. Young adults, many who will be away from home and their primary support systems for the first time, need to know how to identify signs and symptoms in themselves and their peers and how to access resources. Many students will find that they are coping with more than one mental health challenge at a time. This is normal. For example, many people who are struggling with addiction may also be depressed. Or, in some cases, having an untreated mental health condition can put you at higher risk for other mental health challenges. For example, people experiencing PTSD are at greater risk for other mental health conditions such as anxiety and depression, substance abuse, and eating disorders.

If you have been experiencing any of the following signs and symptoms nearly every day for at least two weeks, you may have major – sometimes called ‘clinical depression’ in college students:

Addiction

Alcohol and substance abuse.

Adjustment Disorder

Students are adjusting to college life, a new town, new friends, living in a new environment, and being away from home and family for the first time.

Anxiety

Anxiety is an “anticipation of a future threat.” 

Attention-Deficit/Hyperactivity Disorder (ADHD)

Inattention such as difficulty with paying close attention, difficulty holding attention: difficulty listening, difficulty following through on tasks; difficulty organizing; difficulty maintaining attention for extended periods; a tendency to lose things; and being easily distracted. Hyperactivity such as fidgeting, difficulty sitting still, feeling restless, talking excessively, or blurting things out; trouble with waiting your turn or constantly interrupting.

Bipolar

Manic Episode symptoms can include Elevated mood, increased energy; inflated self-esteem; decreased need for sleep, more talkative than usual; racing thoughts, distracted; increase in specific goal-directed activity, and involvement in high-risk activities. Depressive Episode symptoms can include: Depressed mood; decreased interest in activities; weight loss; disrupted sleep; noticeable restless or slowed behavior; loss of energy; feeling worthless or guilty; difficulty concentrating; and thoughts of death including feeling suicidal.

Depression

Depressed mood; decreased interest in activities; change in weight; difficulty sleeping; noticeable restless or slowed behavior; fatigue; feelings of worthlessness or guilt; difficulty concentrating; thoughts of death that may include feeling suicidal.

Eating Disorders

Lack of appetite or an increased need to eat, leading to either weight loss or gain:

• Anorexia: Restricting calories needed to maintain the minimal weight for age and height; fear of gaining weight or becoming fat, while underweight.

• Bulimia: Recurring episodes of binge eating; eating more in a window of time than what most people would eat in the same period of time; recurring and inappropriate behavior to prevent weight gain (vomiting, use of laxatives or other medications not as directed, fasting, or excessive exercise).

Panic Attacks and Panic Disorder

Accelerated heart rate; sweating; shaking; shortness of breath; feelings of choking; chest pain or discomfort; nausea or abdominal pain; feeling dizzy or lightheaded; feeling hot or cold; feelings of numbness or tingling; feelings of unreality; fear of losing control; and fear of dying.

Post-traumatic Stress Disorder (PTSD)

After experiencing sexual assault or witnessing a traumatic event: Distressing memories that are recurrent, involuntary, and intrusive; distressing dreams; flashbacks; distressing feelings or physiological reactions when exposed to things that remind the person of the traumatic event; irritability; reckless or self-destructive behavior; hypervigilance; easily startled; difficulty concentrating; difficulty with sleep. Veterans are a population that frequently experience symptoms of PTSD as well, and many veterans begin or return to college following their service.

Sleep Disorders

Trouble sleeping or sleeping too much. Insomnia or increased need for sleep. Dissatisfaction with sleep quantity or quality; difficulty falling asleep; difficulty staying asleep, waking up frequently; difficulty falling back asleep if woken up at night; waking up earlier than you would like; disturbed breathing at night, including snoring; feeling sleepy during the day.

Suicide

Thoughts of suicide or increased thoughts about death. Feelings of guilt or worthlessness.

Other Signs and Symptoms of Depression

Not everyone who is depressed experiences every symptom. Some people experience only a few; some have many. If any of these symptoms are interfering with your functioning – or if you are having thoughts that life is not worth living or ideas of harming yourself – you should seek help immediately; it is not necessary to wait two weeks. These symptoms are not as severe but are warning signs:

Decreased energy

Difficulty concentrating and making decisions

Diminished interest in activities that were once enjoyable

Feelings of profound sadness

Flexible scheduling

Learn from anywhere

Persistent headaches, stomachaches, or muscle pain

Poor self-image

Reduced interest in normally pleasurable activities

Restlessness, irritability, or lack of energy and fatigue

Severe changes in physical activity and movements, such as prolonged pacing or shaking one’s leg

Trouble concentrating and attending to usual tasks

Depression and Suicide in College Students – Warning Signs

Depression is a major risk factor for suicide. The following are some of the signs you might notice in yourself, or a friend, that may be a reason for concern:

Talking about wanting to die or to kill oneself

Looking for a way to kill oneself, such as searching online or buying a gun

Talking about feeling hopeless or having no reason to live

Talking about feeling trapped or in unbearable pain

Talking about being a burden to others and those others would be better off if one were gone

Increasing the use of alcohol or drugs

Acting anxious or agitated; behaving recklessly

Giving away prized possessions

Sleeping too little or too much

Withdrawing or feeling isolated

Showing rage or talking about seeking revenge

Displaying extreme mood swings

There are three main reasons:

Lack of Support and Mentoring

Undergraduate universities are usually nurturing environments for the first-time college student. But, on the other hand, some graduate schools can be rather competitive, or even cutthroat, because the stakes are so much higher. Online graduate universities may try to provide an encouraging atmosphere, but there is only so much they can do at a distance. Graduate students wind up having to fend for themselves more than they bargained for.

The Stigma of Mental Illness

Most university personnel are prepared to deal with younger, undergraduate students who may develop problems. On the other hand, they may be less sympathetic toward older graduate students. The students may also have the perception that they should be able to handle their complex situations and not have to rely on university resources.

Balancing Many Responsibilities

Most graduate students are older. Many will not only be responsible for themselves; they may have fulltime jobs, spouses, and children. Add the pressure of graduate-level courses, and you have a recipe perfect for developing depression.

Here is a sample of some of the non-medical strategies in my book:

Celebrate Small Victories :If you have an accomplishment, no matter how minor, feel free to feel good about it. It doesn’t matter if the source is internal or external. If it makes you feel good or brings a smile to your face, take it and run with it. Then, do something else that makes you feel good. Do this enough, and it becomes a habit. 

Find a Real Happy Place: Whether it is alone or with others, if there is someplace that brings a smile to your lips (or, at least, erases a frown), then go there as often as you can. Maybe a backyard with a view, a quiet rooftop, a park bench, a favorite niche in the library, or even your bed. Wherever you feel happy and content, go there whenever you can.

Have a Good Cry: Crying can release a cascade of emotions. You may not realize that anger, hurt, hate, are welling up inside you, but they can. You do not always have to suppress them. When you are alone, bring them to the surface. Allow yourself to be sad. Allow tears to fall from your eyes. Take that sadness and wash it away

Laugh More: Laughter is the best medicine. It is really hard to feel bad when you are laughing. Just by laughing and getting into a good mood, I was able to focus. It snapped me out of the down mood I was in and energized me to start doing stuff.

Listen to Music: It is said that “music has charms to soothe a savage breast.” Most people have some sounds that make them feel good. Create a playlist of your favorites, put on your headphones (not earbuds), crank up the volume (but not too loud), and listen with eyes closed.

Lists, Calendars, and Routines: Depression is bad enough. But, throw in the anxiety you feel when you are sure you forgot to do something but can’t remember what it is – that just exacerbates the situation. Making a list, writing appointments (or deadlines) on a calendar, and having a routine

Physical Activity / Exercise: Exercise has also been shown to have numerous mental health benefits, including reducing stress, anxiety, and depression. College students can also benefit from the impact that exercise has on the brain, including improved memory and thinking skills.

Sing: You can’t be unhappy when you are singing – it is a physical impossibility. Print out the lyrics to your favorite songs and sing out loud.

Sleep: For the depressed, sleep is a double-edged sword. You want to make sure that you have enough so that you have the energy to do things, but you don’t want to sleep so much that you lose the day. I love to take naps. Before a nap, I am dragging and don’t feel like doing anything. When I wake up, I am energized and feel like I can accomplish everything. 

Stop Watching the News: We live in a depressing world, and many college students feel like they need to be activists to help fix it all. That’s a lot of responsibility. Take a break from the news of the day. I know, you are already feeling anxious that you don’t know the latest faux pas made by a politician that you hate, or are aware of the latest atrocity on another continent. Turn off your phone, turn off your radio, turn off your TV, and do something fun.

For those experiencing a mental health challenge, the perceived stigma is often the biggest barrier to getting help. People often feel embarrassed or ashamed of their symptoms and are afraid to ask for help. You wouldn’t feel ashamed for seeking medical care for a physical health condition (think ear infection, broken leg, stomach pain), so there is no reason to feel embarrassed about seeking help for a mental health condition. Health is health. Everyone is entitled to good health care.

Mental health conditions are treatable. Help is available. Finding a good therapist, doctor, or support group can make all the difference. You do not need to do this alone. There are trained professionals available to help. With the appropriate support, you can and will feel better!

Like any health issue, left undiagnosed and untreated, mental health conditions can worsen. Symptoms can become increasingly intense, making it hard to cope with the daily routine of life. Students may find themselves becoming increasingly isolated, failing or dropping out of college, or in the worst case, attempting or committing suicide.

The stress that students experience in college can trigger a relapse in symptoms for a mental health condition that a student may have felt was under control. If you experience a relapse in symptoms, it doesn’t mean that you have failed; it simply means that it is a good time to reevaluate your current treatment. Maybe it is time to assess your current self-care (sleep, nutrition, workload), reconnect with a therapist, or reevaluate your medication with a doctor.

Sometimes confiding in others is a great way to relieve stress. Don’t forget that you have these resources:

Friends – Maybe they are feeling the same way you are. 

Trusted Teachers – They’ve been there before. If they are there for you now, then let them know what is going on.

University Counselors – That’s what they are paid for and what they are trained for.

Doctors – Some are more sympathetic than others, but they are trained professionals and can refer you to the best options.

Therapists – The perfect choice if they are available. 

Clergy – They are also trained to help in a more spiritual vein.

Parents and Relatives – Don’t forget Mom and Pop, Aunt Sue, or Cousin Bob. They know you and want to help.

Here are a few additional resources when the going gets tough:

• National Suicide Prevention Lifeline: 1-800-273-TALK: The National Suicide Prevention Lifeline offers free and confidential crisis support for suicide prevention 24/7.

• Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-HELP: The National Helpline offered by the Substance Abuse and Mental Health Services Administration (SAMHSA) is available 24/7. This confidential and free helpline offers information (in English and Spanish) for individuals and families seeking information on treatment options for mental health and substance use disorders.

• The National Institute of Mental Health (NIMH): http://www.nimh.nih.gov/health/topics/depression/index.shtml