Editor’s note: This is the first in a two-part series evaluating depression among students on campus and how they seek help. This article analyzes how Duke students fit into the trend of increasing rates of depression at universities nationwide and why some students choose medication over other treatment options. In Part 2, The Chronicle assesses how the college environment makes students more susceptible to depression and explores alternative treatment options to medication.
Although he had been a diligent student throughout the majority of high school, something shifted for Advait Ghuge, now a senior, before he arrived at Duke. He began to lose his interest in academics and lost the ability to focus on anything. Finally, in college, he was diagnosed with depression.
“During my senior year of high school, typical senioritis came in around Christmas,” Ghuge said. “Between then and the end of the next two years, I have almost no memory, and that’s attributed to depression. I didn’t realize I had it.”
Ghuge’s story is just one example of a burgeoning phenomenon in the United States. Today, the number of students entering colleges and universities nationally who seek treatment for depression is higher than ever, said Gary Glass, assistant director for outreach and developmental programming at Counseling and Psychological Services.
Duke does not keep data on the number of students diagnosed with depression because the disorder is complex to diagnose and many students choose to receive treatment outside of the University. But 30 percent of students entering Duke in 2011 were already using medication to treat depression, said Donna Lisker, associate vice provost for undergraduate education.
In order to gauge the prevalence of depression on college campuses over time, CAPS draws information from reports written by the Center for Collegiate Mental Health, CAPS Director Kelly Crace wrote in an email Apr. 5. The pilot report was published in 2009, and statistics from Duke have been included in every annual report.
The 2009 report notes that depression is the most frequent problem experienced by students seeking psychological and psychiatric treatment. The current estimates also indicate an increase in the prevalence of depression compared to several decades ago. The average age of onset is also on the decline, making depression a “particularly salient problem area for college student populations.”
Although Ghuge had not yet identified what was wrong, he decided to take a semester off to spend at home.
When Ghuge returned home for the semester, he and his parents began to accept that Ghuge might have depression. With his family, Ghuge eventually decided to try medication.
“I still remember the first day I took my medicine,” he said. “It was as if a veil had been removed from in front of me.”
Deciding to medicate
Although CAPS offers a range of treatments for depression, Glass noted that sometimes medication is the best option to combat physiological manifestations of depression. There are several psychiatrists at CAPS who can prescribe anti-depressants to students for the first time or work with students already on anti-depressants to moderate dosage.
According to the Center for Collegiate Mental Health 2012 report, 13 percent of students surveyed nationwide started taking a prescription for mental health concerns after starting college, 8.7 percent reported having taken medications before coming to college and 10.1 percent took medications before starting college and continued to do so. The remaining 68.2 percent of respondents had never been medicated for mental health reasons.
“Nationally, more students come into college with medication, and this accounts for some of the rise in college students being depressed,” Glass said. “But it’s not necessarily an indication that college students are more depressed.”
An ‘elusive’ diagnosis
Despite the growing trend of students either identifying themselves as depressed or seeking help for symptoms of depression, the condition is still elusive, Glass said. It is hard to identify students as depressed because nearly all individuals go through periods of unhappiness or stress, he added.
“Our philosophical assumption is that students are going through such profound life experiences that it makes more sense to think of how students are developing than simply what diagnosis we would assign,” he said. “It’s often more helpful to recognize the symptoms of depression as indicating that help is needed.”
CAPS offers a range of counseling services and treatment options to students who show symptoms of depression but lack an actual diagnosis.
To diagnose depression is to diagnose a “constellation of symptoms,” Glass added, and is further complicated because individuals do not have to have all symptoms to be clinically considered depressed. Symptoms include impaired concentration, apathy and loss of interest, sad or numb moods, irritability and suicidal thoughts. Depression can be recurrent or single-episode, and each of those disorders has sub-categories of mild, moderate and severe.
Taking time off
Although Ghuge had not yet been diagnosed with depression when he decided to take time off, he said the disorder seriously affected his ability to function as a student.
“My grades had declined, and my motivation to study was gone, whereas before I was an extremely motivated student,” he said. “Depression takes whatever intellectual gift you have and makes you unable to use it. Easy things become things you’re unable to do.”
Senior Ahmad Jitan, who was diagnosed with depression his sophomore year, said the stresses of being at Duke made him feel as though his depression was affecting his life more significantly than it had in the past. This led Jitan, also a columnist for The Chronicle, to consider taking time off from school.
“The competitive environment brought more of it out,” he said.
In order to take time off from Duke, students are required to provide documentation from a medical provider that states their support for a leave of absence, which students then give to their academic dean, Amy Powell, associate dean of students and director of the case manager office, wrote in an email Tuesday.
During his time off, Jitan traveled to foreign countries and spent time at home.
“[I] gave myself time and space to heal [and] to process it and to find myself,” he said.
Getting back into life at Duke after his leave of absence was also difficult, he added.
“There was a process of realizing that I was taking a nontraditional path for my education and realizing there’s nothing wrong with going at my own pace,” Jitan said. “There was also a lot of forming new relationships because some of the people I came in with were graduating earlier [than I was].”
When students return to campus, the University provides outreach and support through the Office of Case Management, Powell said.
“A lot of it is relearning how to study or finish a task all the way through or disciplining yourself to get up in the morning,” Ghuge said. “It makes you highly introspective…. You have to learn about how different thought processes affect you and how to avoid falling into the pitfalls of those processes.”
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