Provided by the National Institute of Mental Health
When I took a part-time job and started living off-campus, my course work fell
apart. I couldn't concentrate or sleep, and I was always IRRITABLE and
angry.—Leah, sophomore year
After two years of straight A's, I couldn't finish assignments anymore. I felt
exhausted but couldn't sleep, and drank A LOT. I couldn't enjoy life like my
friends did anymore. —John, junior year
I've always been anxious and never had much confidence. College was harder than
I expected, and then my parents divorced, which was traumatic for me. After a
while, all I did was cry, sleep, and feel waves of panic. —Marta, freshman year
They are college students who got depressed...got treatment...and got better.
College offers new experiences and challenges. This can be exciting—it can also
be stressful and make you, or someone you know, feel sad. But when "the blues"
last for weeks, or interfere with academic or social functioning, it may be
clinical depression. Clinical depression is a common, frequently unrecognized
illness that can be effectively treated.
What is Clinical Depression?
Clinical depression can affect your body, mood, thoughts, and behavior. It can
change your eating habits, how you feel and think about things, your ability to
work and study, and how you interact with people.
Clinical depression is not a passing mood, a sign of personal weakness or a
condition that can be willed away. Clinically depressed people cannot "pull
themselves together" and get better.
Depression can be successfully treated by a mental health professional or
certain health care providers. With the right treatment, 80 percent of those who
seek help get better. And many people begin to feel better in just a few weeks.
Types of Depressive Illness
Depressive illnesses come in different forms. The following are general
descriptions of the three most prevalent, though for an individual, the number,
severity, and duration of symptoms will vary.
Major depression is manifested by a combination of symptoms that interfere with
your ability to work, sleep, eat, and enjoy once pleasurable activities. These
impairing episodes of depression can occur once, twice, or several times in a
lifetime.
Symptoms of Major Depression
Sadness, anxiety, or "empty" feelings
Decreased energy, fatigue, being "slowed down"
Loss of interest or pleasure in usual activities
Sleep disturbances (insomnia, oversleeping, or waking much earlier than usual)
Appetite and weight changes (either loss or gain)
Feelings of hopelessness, guilt, and worthlessness
Thoughts of death or suicide, or suicide attempts
Difficulty concentrating, making decisions, or remembering
Irritability or excessive crying
Chronic aches and pains not explained by another physical condition
A less intense type of depression, dysthymia, involves long-term, chronic
symptoms that are less severe, but keep you from functioning at your full
ability and from feeling well.
In bipolar illness (also known as manic-depressive illness), cycles of
depression alternate with cycles of elation and increased activity, known as
mania.
How to Recognize Depression
The first step in defeating depression is recognizing it. It's normal to have
some signs of depression some of the time. But five or more symptoms for 2 weeks
or longer, or noticeable changes in usual functioning, are all factors that
should be evaluated by a health or mental health professional. And remember,
people who are depressed may not be thinking clearly and may need help to get
help.
I kept asking myself, "How could I be depressed? I'd had a normal family life,
had been getting good grades, and hadn't experienced any big trauma—where did my
depression come from?"—John
What Causes Depression?
The causes of depression are complex. Very often a combination of genetic,
psychological and environmental factors is involved in the onset of clinical
depression. At times, however, depression occurs for no apparent reason.
Regardless of the cause, depression is almost always treatable.
Family History— Depression often runs in families, which usually means that
some, but not all, family members have a tendency to develop the illness. On the
other hand, sometimes people who have no family history also develop depression.
Stress— Psychological and environmental stressors can contribute to a depressive
episode, though individuals react differently to life events and experiences.
In coping with stress, some people find writing in a journal, exercising, or
talking with friends helpful. But in clinical depression you need some form of
treatment (usually medication and short-term psychotherapy) to start feeling
better soon.
I had a period of nearly constant turmoil when I wanted to "come out" to my
friends about being gay but didn't want to be treated like an outsider. A good
friend made jokes about homosexuals and I was afraid of what he'd say about me.
That stress played a big part in my becoming depressed.—Josh
My family wanted me home every other weekend and I didn't fit in there anymore.
I'd argue constantly with my father, who still treated me like a child. My
sister thought I was 'uppity.' Everyone was miserable and I felt guilty.—Kim
College and Stress
Common stressors in college life include:
Greater academic demands
Being on your own in a new environment
Changes in family relations
Financial responsibilities
Changes in your social life
Exposure to new people, ideas, and temptations
Awareness of your sexual identity and orientation
Preparing for life after graduation
Psychological make-up can also play a role in vulnerability to depression.
People who have low self-esteem, who consistently view themselves and the world
with pessimism, or are readily overwhelmed by stress may be especially prone to
depression.
For Marta, her feelings of being "not good enough" were worsened by the stress
of the academic demands of college and the emotional conflict caused by her
parents' divorce, which combined to trigger her episode of major depression.
Bipolar Disorder (Manic Depression)
As mentioned earlier, bipolar disorder is a type of depressive illness that
involves mood swings that go from periods of depression to periods of being
overly "up" and irritable. Sometimes the mood swings are dramatic or rapid, but
most often they occur gradually, over several weeks. The "up" or manic phase can
include increased energy and activity, insomnia, grandiose notions and impulsive
or reckless behavior, including sexual promiscuity.
Medication usually is effective in controlling manic symptoms and preventing the
recurrence of both manic and depressive episodes.
During a manic episode, I stayed awake for 5 days straight, but had a lot of
energy. I spent my tuition on a major shopping spree and long distance phone
calls. I also had sex with several guys that I hardly knew. At the time, I felt
so great that I couldn't see that there were serious problems with what I was
doing.—Teresa
Suicide
Thoughts of death or suicide are usually signs of severe depression. "If you're
feeling like you can't cope anymore, or that life isn't worth living, get
help<," advised Darrel, a student who tried to kill himself during his freshman
year. "Talking to a professional can get you past those intense feelings and
save your life."
Suicidal feelings, thoughts, impulses, or behaviors always should be taken
seriously. If you are thinking about hurting or killing yourself, SEEK HELP
IMMEDIATELY. Contact someone you trust to help you: a good friend, academic or
resident advisor, or:
Staff at the student health or counseling center
A professor, coach, or advisor
A local suicide or emergency hotline (get the phone number from the information
operator or directory)
A hospital emergency room
Call 911
If someone you know has thoughts about suicide, the best thing to do is help him
or her get professional help.
"I'm back from the edge," Darrel continued. "Now that I've gotten some
treatment, I know how to keep from being out there again."
Depression and Alcohol and Other Drugs
A lot of depressed people, especially teenagers, also have problems with alcohol
or other drugs. (Alcohol is a drug, too.) Sometimes the depression comes first
and people try drugs as a way to escape it. (In the long run, drugs or alcohol
just make things worse!) Other times, the alcohol or other drug use comes first,
and depression is caused by:
the drug itself, or
withdrawal from it, or
the problems that substance use causes.
And sometimes you can't tell which came first...the important point is that when
you have both of these problems, the sooner you get treatment, the better.
Getting Help—Treatment Works
If you think you might be depressed, discuss this with a qualified health care
or mental health professional who can evaluate your concerns. Bring along an
understanding friend for support if you are hesitant or anxious about the
appointment.
Several effective treatments for depression are available and can provide relief
from symptoms in just a few weeks. The most commonly used treatments are
psychotherapy, antidepressant medication, or a combination of the two. Which is
the best treatment for an individual depends on the nature and severity of the
depression.
Sharing your preferences and concerns with your treatment provider helps
determine the course of treatment. Certain types of psychotherapy, particularly
cognitive behavioral therapy, can help resolve the psychological or
interpersonal problems that contribute to, or result from, the illness.
Antidepressant medications relieve the physical and mood symptoms of depression
and are not habit-forming. In severe depression, medication is usually required.
Individuals respond differently to treatment. If you don't start feeling better
after several weeks, talk to the professional you are seeing about trying other
treatments or getting a second opinion.
Making a Decision
Don't let fear of what others might say or think stop you from doing what's best
for you. Parents and friends may understand more than you think they might, and
they certainly want you to feel better.
Taking the First Step
I knew I was depressed but thought I could pull out of it by myself.
Unfortunately, friends reinforced this attitude by telling me to just toughen
up. When that didn't work, I felt even worse because I had 'failed' again. When
a friend suggested I talk to his counselor, I resisted at first. In my mind,
professional help was for weak, messed up people. But then, I hit a bottom so
low that I was willing to try anything.—John
I decided to try treatment when my friends got fed up with me. They didn't want
to talk about my problems any more, but my problems were the major focus of my
life. I needed someone who could help me understand what was happening to me.
I'd seen ads for the counseling center and decided to give it a try.—Kim
When I began considering suicide, I knew I needed serious help. My resident
advisor helped me call a local hotline where I got some good referrals. It was
just a phone call, but it was the starting point that got me to the professional
help I needed.—Leah
Help Yourself: Be an Informed Consumer
Don't give in to negative thinking. Depression can make you feel exhausted,
worthless, helpless and hopeless, making some people want to give up. Remember,
these negative views are part of the depression, and will fade as treatment
takes effect.
Take an active role in getting better. Make the most of the help available by
being actively involved in your treatment and by working with a qualified
therapist or doctor. Once in treatment, don't hesitate to ask questions in order
to understand your illness and the way treatment works. And, if you don't start
feeling better in a few weeks, speak with the professional you are seeing about
new approaches.
Be good to yourself while you're getting well. Along with professional help,
there are some other simple things you can do to help yourself get better, for
example: participating in a support group, spending time with other people, or
taking part in activities, exercise, or hobbies. Just don't overdo it and don't
set big goals for yourself. The health care professional you are seeing may
suggest useful books to read and other self-help strategies.
Helping a Depressed Friend
The best thing you can do for a depressed friend is to help him or her get
treatment. This may involve encouraging the person to seek professional help or
to stay in treatment once it is begun. The next best thing is to offer emotional
support. This involves understanding, patience, affection, and encouragement.
Engage the depressed person in conversation or activities and be gently
insistent if you meet with resistance. Remind that person that with time and
help, he or she will feel better.
Helpful Resources
The professionals at a student health center or counseling service, the Resident
Advisor in your dorm, your family health care provider, and your clergy can be
helpful resources for getting treatment. You also might contact any of the
following organizations in your area for mental health services or referrals:
A community mental health agency
A hospital psychiatric outpatient department or clinic
A private or nonprofit counseling center
Your local Mental Health Association
The telephone directory or information operator at your school or in your
community, or a local hotline, should have telephone numbers for these and other
mental health services.
Finding Affordable Treatment
People are sometimes reluctant to seek help because they are concerned about the
cost of treatment. Services at college counseling centers are often low-cost or
free. Also city or county mental health services are often offered on a "sliding
scale" (the fee is based on your financial resources). Check out any health
insurance you may have and see if it pays for private mental health services.
Is It Worth It?..........Yes!!
Actually, while the depression was painful, working to get better has taught me
a lot about who I am and how to stay healthy.—Marta
Getting treatment definitely changed my life for the better and helped me avoid
flunking a semester.—John
For Additional Information About Depression
Please visit the following link for more information about organizations that
focus on depression.
For More Information About NIMH
The Office of Communications and Public Liaison carries out educational
activities and publishes and distributes research reports, press releases, fact
sheets, and publications intended for researchers, health care providers, and
the general public. A publications list may be obtained by contacting:
National Institute of Mental Health
Office of Communications
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll free
TTY: 301-443-8431
FAX: 301-443-4279
E-mail: nimhinfo@nih.gov
Web site: www.nimh.nih.gov
NIH Publication No. 97-4266
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