All About Depression at College

Today I’m talking about depression in college students. I’m going over what depression is and what it isn’t and what parents can do to help their struggling college student. I’m also going to give a brief overview of where diagnoses are listed. There's so much to cover when discussing depression so I think understanding the diagnostic context as well as the strategies parents can use are essential. It's not a single mental health challenge. Depression comes in all sorts of shapes and sizes. Hopefully this provides you with a solid basis from which to better understand what your college student is dealing with and what you can do about it. 

https://www.youtube.com/channel/motivatecounseling
https://robdanzman.com/

Transcript

In this podcast episode, Rob Danzman, a licensed clinical mental health counselor and national expert in college student mental health, discusses depression in college students,  how it manifests, and how parents can help for their college student navigate treatment without derailing their academic goals. 

All about depression at college

Today I’m talking about depression in college students. I’m going over what depression is and what it isn’t and what parents can do to help their struggling college student. I’m also going to give a brief overview of where diagnoses are listed. For a painfully long, detailed, and very opinionated look at where diagnoses come from, check out my blog post The DSM: 97 YRS of History and Controversy. Most of this episode is also pulled from my blog at robdanzman.com as well as my first book, Insider’s Guide to Parenting: How to Solve Messy Problems and Build a Great Family.

Depression is a generic name for a category of mental illness which is often poorly understood and poorly treated. To get started, I want to quickly go over the primary types of depression most often found in college students.

Types of depression include the following

Major Depressive Disorder. Severe symptoms that interfere with a student’s ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a student’s lifetime, but more often, students have multiple episodes. I won’t go into all of the criteria details for this one but the important thing with diagnosing is that the student has 5 or more criteria from a list of 9 and includes a few other symptoms. One important thing I also want to point out is that Major Depressive Disorder transcends nearly all life domains - it almost doesn’t matter how much someone used to like something or how stimulating an event is, this type of depression makes it nearly impossible to experience joy and satisfaction.

Persistent Depressive Disorder (Dysthymia). A depressed mood that lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years.

Psychotic Depression. This is a subtype of Major Depressive Disorder. It occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations). Psychotic depression requires immediate medical care and treatment. Treatment usually involves antidepressant and antipsychotic medicine after which therapy can be more effective. Your son or daughter may only need the antipsychotic medicine for a short period of time. Research has also found that Electroconvulsive therapy can help treat depression with psychotic symptoms.

Seasonal Affective Disorder (SAD). Is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy. If natural light from outside exposure is not an option, a light box can be effective. The advisability and timing of using a light box should be carefully reviewed since increasing exposure too fast or using the light box for too long each time may induce manic symptoms if the college student has bipolar disorder. I’ve put some info on light boxes in the show notes.

Bipolar Disorder. Bipolar (or BPD) is technically different from depression. The reason it’s included in this list is that I don’t have a separate episode for it and students with bipolar disorder often experience episodes of extreme low moods (depression). But a person with bipolar disorder also experiences extreme high moods (called “mania”). There are four types of Bipolar:

Bipolar I Disorder. This is most often seen with manic episodes that last at least a week, or with manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least two weeks. Episodes of depression with mixed features (like having depression and manic symptoms at the same time) are also possible.

Bipolar II Disorder. We see this showing up as a pattern of depressive episodes and hypomanic episodes (abnormally elevated mood, energy or activity level), but not the full-blown manic episodes as with Bipolar I.

Cyclothymic Disorder. This type of Bipolar is characterized by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years though less for teens. However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

Bipolar Disorder NOS (not otherwise specified) and Related Disorders. This category is more of an un-category. It’s the “We’re-not-really-sure-where-to-categorize-this label because the symptoms don't match the three categories listed above. It’s not used very often since it’s not very helpful from an intervention perspective.

Adjustment Disorder (aka Stress Response Syndrome). Although adjustment disorder is categorized in the DSM-IV under trauma- and stress-related disorders, I’m including in my list of depression diagnoses since there are so many similarities and a lot of interventions that are effective for both. Adjustment disorder is a short-term condition that happens when a college student has significant difficulty managing, or adjusting to, a specific stressor, such as a major life change, loss, or event. It’s defined by the development of emotional or behavioral symptoms in response to a specific stressor(s) occurring within 3 months of the onset of the stressor(s).These symptoms or behaviors are clinically significant, as evidenced by one or both of the following:

1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
2. Significant impairment in social, occupational, or other important areas of functioning.

In 2013, the name “adjustment disorder” was changed to "stress response syndrome." Because people with stress response syndrome often have some of the symptoms of clinical depression, such as tearfulness, feelings of hopelessness, and loss of interest in work or activities, adjustment disorder is sometimes informally called "situational depression." I still use the term adjustment disorder.

PTSD: This is another diagnosis that’s not categorized under Depressive Disorders but I still think it’s important to examine here since there’s a lot of symptomatology overlap. Some symptoms of depression and PTSD overlap. And you can have both conditions at the same time. Some, but not all, cases of depression can follow a traumatic event like an illness or even a really painful break-up. Some ways that the two conditions are similar include:

• Trouble sleeping 
• Keeping focused
• Lack of interest or pleasure in things they used to enjoy
• Irritability or bad temper
• Emotional detachment from other people

As you’ll hear next, the symptoms of PTSD have a lot in common with depression. Signs of PTSD might pop up a month or so after the event that sets it off. Or, even more diabolically, they might not come for years. PTSD symptoms fall into several groups:

• 
  

Unwanted memories. You might:

• Keep remembering what happened, even though that upsets you
• Have flashbacks, like you’re reliving it
• Have an emotional or physical reaction when something reminds you of it

Avoidance. You might:

• Try to keep from thinking or talking about what happened
• Stay away from people, places, or activities that remind you of it

Negative thoughts and moods. You may:

• Be down on yourself, other people, or the world
• Feel detached from other people, hopeless, or emotionally numb

Changes in emotional and physical reactions. You could:

• Be easily startled or frightened, or you might always be on guard for danger
• Do self-destructive things, like drinking too much alcohol or driving too fast
• Have trouble sleeping or concentrating

Misconceptions about Depression

Now let’s move away from the types of depression and talk about what depression isn’t. Depression is not when we feel sad because our pet died. Depression is not when we feel down because we got fired from a job or did really badly on a test.

By asking a few questions we can determine if someone’s feelings are more serious and likely meet criteria for a diagnosis. Is their emotional state affecting their school work, friendships, sports? Is it related to a specific event (e.g. getting dumped) or is it unattached and seems to come out of nowhere? Is it a part of their personality (negative outlook on things) or is it counter to how they normally are?

If their negative emotions last for more than a few months and are keeping them from an otherwise typical academic experience, social functioning and decent overall health, they probably have some form of depression. I look for a general sense of how long the student has had symptoms and what parts of life have been impacted.

Ok, So What Causes Depression?

There are ten factors that contribute to the onset or escalation of depression. They include  (1) genetics, (2) developmental, (3) lifestyle, (4) circadian rhythm, (5) addiction, (6) nutrition, (7) exposure to toxic substances, (8) social or complicated grief, (9) a medical condition, and/or (10) a frontal lobe issue.

Depression can also be caused by really bad events that happen to us and are never truly processed properly. Our brains use a sophisticated defense mechanism to protect us from perceived threats. When we experience a trauma (for example - a car accident, death of a loved-one) our brain sometimes creates an overcompensation of protection.

There’s no actual threat to us but psychologically we start building walls (or moats, or canons, you get the point). Most of us experience grief and loss in typical ways - we get sad when someone dies. We think about the good times, we feel regret for what we never talked about and we consider a future that doesn’t include that person. But over time, our brain slowly separates the feelings from our thoughts about the person - we can remember that loved one without crying. We still feel a bit sad, but it decreases over time.

When depression is triggered from events like a death, our brains don’t let go and don’t allow the separation of thoughts and feelings. The sadness doesn’t decrease. It starts negatively impacting other areas of our life, what therapists refer to as “life domains.” A life domain is a category of our life. Life domains include school, work, family, social, and self-wellness.

When to Worry

Some of these are obvious. Some are more clinical and not so obvious. Some are just plain contradictory. But that’s the nature of an illness we barely understand and have even less understanding of what causes it.
Sleeping More. Either sleeping a longer amount each night or a significant change in the pattern of how they sleep.

Staying Up Later. It’s not uncommon for those with depression to not be able to fall asleep as their mind races about the bad things in their life. It’s like they are mentally reliving one or more bad events.

Watching More TV/Gaming. It’s the entertainment junk food we reach for when the world is awful to us. It’s not unusual to find someone binging (more than usual of course) on tv series since it's a long, engaging and passive way to fill one’s time.

Eating More. When we feel depressed, all those good self-control mechanisms shut down. It’s pretty typical to see those with depression vacuum up anything easy and comforting like junk food. Plus, sugar and tasty but nasty foods release brain chemicals that make us feel good …for a bit. Refined sugar actually increases depression along with deleterious effects on metabolism and chronic health conditions

Eating Less. Here’s one of our contradictions - On the other hand, some students who experience depression have their stomachs turn off (or intentionally restrict eating) almost as a way to get control over something in their lives. Food seems to lose its flavor. Research has repeatedly found that depression alters our sense of smell and taste. 

Substance Use. I’m not just talking about your weed. I’m talking here about traditional drugs as much as I’m talking about things that can have subtle impacts like Nyquil, sleep meds, Benadryl. Some may go for chemical depressants while others reach for stimulants like caffeine, adderall, concerta, vyvanse, or illegal drugs like cocaine (which is more common at college than parents imagine).

What to Do

If your son or daughter is probably depressed based on the info I’ve provided today, here are some things that may help.

Talk with Them. Just like with suicide, talking about depression with someone that’s depressed will not make them more depressed. Validating how they feel and letting them know you see them hurting can often be a good starting position. Here are some ways to start a conversation about depression:

• “I have been feeling concerned about you lately.”
• “Recently, I have noticed some differences in you and wondered how you are doing.”
• “I wanted to check in with you because you haven’t seemed yourself lately.”

Questions you can ask:

• “When did you begin feeling like this?”
• “Did something happen that made you start feeling this way?”
• “How can I best support you right now?”
• “Have you thought about getting help?”

What you can say that helps:

•  “You are not alone in this. I’m here for you.”
• “You may not believe it now, but the way you’re feeling will change.”
• “I may not be able to understand exactly how you feel, but I care about you and want to help.”

Get Professional Help. Do everything in your power to get your depressed kid to the help he or she needs. You can help by encouraging them to see a therapist or counselor, get help finding a treatment facility, or take them to a doctor's appointment. Just like with many other issues we’ve discussed, I’ve had countless free consults where parents brought in their son or daughter and we talked through what’s going on and what we can all do to start a healing process. This is also the time to contact your son or daughter’s counseling and psychological services office (or CAPS). I have a whole episode on using CAPS earlier in this season so I won’t go into details but CAPS is another place to start trying to get help. Though you won’t be able to set up the appointments for your student, CAPS may be helpful in coaching you through how they can access CAPS quickly.

Follow-up on Treatment. If a doctor prescribes medication, make sure your kid takes it as directed. Be aware of possible side effects and be sure to notify the physician if they seem to be getting worse. It often takes 3 weeks or longer to antidepressants to start working. It also takes persistence to find the medication or therapy that’s right for a particular person.

Be Proactive. Those experiencing depression often don't believe they can be helped, so you may have to be more proactive at offering assistance. Saying, “Call me if you need anything” is too vague. Don’t wait for the person to call you or even to return your calls. Drop by, call again, invite the person out. Same as with those that have a history of suicidal thinking, it’s not uncommon for me to harass clients with depression. I’ll text, call and plan on meeting them for coffee out somewhere if I have to.

Cheerlead. Encourage positive lifestyle changes, such as a healthy diet, plenty of sleep, and getting out in the sun or into nature for at least 30 minutes each day. Exercise is also extremely important as it releases endorphins, relieves stress, and promotes emotional well-being.

Make a Safety Plan. If your kid talks about hurting themselves or you suspect they might, help him/her develop a set of steps they promise to follow during a suicidal crisis. Also include contact numbers for the person's doctor or therapist, as well as friends and family members who will help in an emergency. I have an upcoming episode on suicide coming up soon.

Long Term Support. Depression is not like a cold that folks just shake off in a week or two. Continue your support over the long haul. Even after the initial signs of depression have passed, check in regularly, periodically checking in. Just like someone recovering from drug addiction, a student recovering from depression may seem fine on the outside but be quietly struggling so don’t give in to a false sense of healthfulness.

If you suspect a loved one is depressed, get some professional guidance on how to proceed. This chapter is a broad overview and gives you strategies but it is certainly not a replacement for the stabilizing and long-term support needed.

In Summary

The most effective strategies for students with most types of depression include consistent, high quality sleep, nutrient-dense foods, outside exercise and exposure to sunlight, regular social contact, regular therapy and possibly the use of antidepressant medications. Depression is terrible for students and sometimes even worse for their parents who may be hundreds of miles are several time zones away but with the right combination of engaged supports, you son or daughter doesn’t have to suffer through the semester

Ok folks. Hope this helps you understand more about depression in college students. That’s it for this episode. For more information, check out my blog at motivatecounseling.com or my two books on amazon - just search my name Rob Danzman.