Katie Cox recalls sitting in a geology class freshman year when she was suddenly overwhelmed with sadness. She started crying, and couldn’t stop, which was embarrassing for Cox, a St. Louis sophomore.

A few weeks before, Cox’s good friend from high school had committed suicide. Because she was from out-of-state and didn’t have close friends here and her boyfriend was at a different school, her adjustment from high school to college had been difficult. Her friend’s death was the tipping point.

Cox wasn’t motivated to do anything, didn’t feel like socializing, ate and slept poorly and cried so frequently she began wearing sunglasses to class to hide her tears.

Cox had joined an increasing number of college students who suffer from depression so severe that they can’t manage everyday tasks. According to the American College Health Association (ACHA), the percentage of college students diagnosed with depression has increased 56 percent in the last six years. That depression is often triggered by leaving a structured home life, high school friends and relationships for a college life where students have to make their own decisions. Psychological problems such as depression often first surface during early adulthood and late adolescence. In addition, the college social scene is centered on the powerful depressant alcohol, which can make these feelings even worse.

Depression can manifest itself in different ways. Students may feel like they never want to get out of bed or don’t want to shower, and they begin to isolate themselves from friends. However, students like Cox can reach out to get the help they need, whether it’s therapy, anti-depressant drugs or natural mood-boosters, and the University of Kansas has made these options available for students.

Defining depression

Students often feel sad and homesick when they leave for college freshman year, but depression goes beyond these feelings, Stephen Ilardi, associate professor of psychology at the University, said. He said there was more public misunderstanding of depression than of any other illness.

“Everyone has sadness,” Ilardi said. “Depression is not just moodiness and sadness. It profoundly impairs your ability to function, ability to stay asleep, quality of sleep, robs you of energy and the ability to concentrate.”

Melissa Farr, Leavenworth senior, has suffered from depression periodically since freshman year. Farr had a tough time settling in with roommates, broke up with her boyfriend of three years and was experiencing hormone problems. She began to withdraw from friends, and her grades plummetted. She turned to alcohol for to escape it all, not realizing it was a depressant that would only worsen her condition.

“For the longest time I was just kind of naïve and sugarcoating everything and not wanting to say ‘Look, cut the crap; there’s something wrong,’” Farr said.

Farr had to force herself to care about school or even shower. She didn’t care whether she ate, and she lived for weekend nights. Instead of attending class, Farr spent her time lying alone in bed, in the darkness and silence of her dorm room, while her roommate was in class or socializing.

“If I was asleep all the time, that was less time awake to experience reality and having to deal with things,” Farr said. “My bed was a safe place to be.”

Hara Morano, editor at large of Psychology Today, has extensively studied depression in college students and said a lack of engagement was the main cause of depression.

“That’s how you define it. Kids who are not engaged intellectually have no flow, no real deep meaningful exchange. They think about themselves all the time. When you are engaged with something on the outside, you grow and are forced to reflect on that experience,” Morano said.

Ilardi called depression a neurological runaway stress response in the brain with a set of physical reactions to it, similar to the flu.

“They have no energy, feel like they just want to crawl in a hole and don’t want any interaction,” Ilardi said.

Ilardi said depression could negatively impact memory and appetite and make those who suffer from it lethargic. Depression stimulates the parts of the brain that register physical pain, and some people say depression can hurt worse than natural childbirth or a kidney stone, he said.

Marcia Epstein, director of Headquarters Counseling Center in Lawrence, said depression could look like anger and aggression, not just like tears and withdrawal. She said feelings of depression didn’t necessarily diminish over time regardless of support and self-care. She said that if people could just decide to feel better, they would, but that “it’s just not that easy.”

This often causes depressed students to drop out of school, and those who don’t drop out have to force themselves to keep at it.

Morano said, “They can perform sort of like robots, going through the motions of current and extracurricular life, but there’s no soul there. It is really hard to study if your mind has been hijacked by stress or anxiety.”

Farr said she struggled to carry on.

“It was almost like I was forcing myself. There was a part of me that knew I had to get up and shower and eat and stuff like that, but I didn’t care,” she said.

Cox said she didn’t feel like herself.

“I was just kind of flat,” Cox said. “I felt like I was alone trying to handle this by myself. A lot hit me all at once.”

Extent of the problem

According to an ACHA survey of 23,863 students from 34 colleges, including the University, 35 percent said they felt so depressed it was difficult to function one to 10 times in the past year. If that percentage held true for the 28,000 KU students, almost 10,000 of them would have felt depressed in the past year.

Ilardi called depression on college campuses an “epidemic.” He estimated that around one in five of the 600 students in his classes were currently depressed or had taken antidepressants. Ilardi said that because he taught classes such as abnormal psychology, the percentage of depressed students in his classes may be higher than the total number at the University because students who suffered from psychological problems were more interested in the subject.

“The proportion of students who have told me directly about their own experience with depression is really pretty staggering,” Ilardi said.

Morano, a Psychology Today editor, said the increasing rates of depression were “astronomically high on college campuses these days, no matter what sources you look at.”

Morano said depression was common in young people because of the stress that college can cause, their lack of coping skills to effectively deal with internal pain and because their parents hovered over them and prevented them from developing a healthy sense of self.

Before students went off to college, they had structure in their homes, Morano said. They wake up at the same time each day, go to school and have parents who make them meals and tell them what to do.

“Then you get to college on your own and have to decide when you go to sleep, when to get up and when to study. There’s more room to not be self-organized and fall apart,” Morano said.

Alcohol and Depression

The college atmosphere can be detrimental to someone dealing with depression because social life revolves around “keggers”, parties and going to bars. Because alcohol is a depressant, it only deepens the depression and hides its symptoms.

When Farr first became depressed, she spent her weekends drinking. That’s all she would think about. When Sunday evenings came around and the weekend was over, it would depress her even more.

“When I was out getting drunk, it was the best thing there was,” Farr said. “I thought if I can still go out and have a good time, then I can’t be depressed.”

However, it only masked her problems and worsened them. She used alcohol to cover up against suspicions her friends had about her depression.

According to a study done in 2003 by the National Center on Addiction and Substance Abuse at Columbia University, alcohol-dependent individuals are almost 4 times more likely to have a major depressive disorder than those who are not dependent. The study also found that alcohol abuse was more common among students who had been diagnosed with depression than among those who had not.

Ilardi said that alcohol could seem desirable for those who are depressed, because of the substance’s anti-anxiety effect.

“Ultimately, though, it is a disastrous choice for someone fighting depression, as it tends to make depressive symptoms worse,” he said.

Farr said that only after she had stopped drinking and isolated herself from her friends was she able to understand her depression and seek help.

“The alcohol was masking everything all along, and once I stopped partying and stopped drinking, it was a huge slap in the face, that wow there is a problem,” Farr said. “You definitely can’t drink and be depressed. I’ve learned that now.”

Treatment of depression

In March of Farr’s freshman year, after an extremely difficult start for her, Farr realized she was close to rock bottom. She was sitting in her dorm room looking out her window that overlooked campus, which had always been a source of strength for her. It was a beautiful Sunday, and Farr finally picked up the phone and called her mom to ask for help.

“I can’t do this on my own anymore,” Farr told her. “It was definitely a huge weight off my chest; I could finally take a deep breath,” she said of the phone call.

Farr began seeing a therapist and started taking Lexapro, an antidepressant. Her depression began to lift. Unlike others who take antidepressants, she suffered no side effects, and slowly built herself back up. She was eventually able to stop taking the drugs and going to therapy.

Over the summer before her senior year, she began to relapse. She was irritated frequently and again withdrawn from others. She started to give up on school. She went back on Lexapro, but this time suffered side effects such as insomnia and headaches.

“If anything, I felt worse,” Farr said. “I wish I wouldn’t have even gotten back on the medication, because it was terrible, but now I’m over that hurdle and don’t really have any of the side effects.”

Medication is a controversial treatment for depression among younger people. Not all psychologists and psychiatrists agree that antidepressants are effective or the best answer for college-age patients. Some studies suggested younger depression patients who took drugs were more likely to consider suicide.

Also, medications such as Xanax, Lexapro and Effexor that psychiatrists commonly prescribe for depression, can cause sleep problems, nausea, fatigue and decreased libido.

“There’s a bizarre irony for antidepressants,” said Ilardi, the associate professor of psychology. He said that the use of such drugs “has increased exponentially over the last couple of decades and despite this, the rate of depression just keeps going up and up and up. It’s not like we have a widely effective treatment.”

Morano said she didn’t think antidepressants alone were the answer.

“You don’t learn the coping skills, and I personally don’t think it is all that effective,” Morano said.

Cox treated her depression with Lexapro, and she said she felt better within two weeks. After about four months she stopped taking the medication.

John Wade, outreach coordinator of KU Clinical and Psychological Services (CAPS), said that at times medicine was very helpful, but that treatment had to be decided on a student-by-student basis. He said working with a therapist always helped people make progress more quickly.

“It’s like trying to become a better tennis player without a coach,” Wade said about taking antidepressants without seeing a therapist.

Epstein, of Headquarters Counseling Center, said that whatever the treatment, it was most important for people to seek it.

“We need to feel just as comfortable getting help for a mental health problem as we do for physical health problems,” Epstein said.

Ilardi said depression left untreated could lead to brain damage and shrinkage of key areas in the brain.

Other than drugs and therapy, treatments for depression include exercise, sunlight and Omega-3 supplements. Avoiding caffeine, alcohol and nicotine helps, and Epstein said that expressing yourself through art, journals or simple conversation with others could ease the pain of depression.

Psychology Today’s Morano said, “Just doing things that are pleasurable helps. Working out, sex, being with other people, doing something for other people are all mood boosters and take pressure off of yourself and are all important.”

Morano said universities needed to take a larger role in helping students deal with such a common problem.

“Even if the universities didn’t cause the problem, I think they have a job to help solve it, because they’re part of the business, and part of the job is making people whole socially, emotionally and cognitively,” Morano said.

CAPS, Watkins Memorial Health Center and the Headquarters Counseling Center all offer therapy and other services for students with depression. CAPS offers individual counseling and group therapy and has a psychiatrist to prescribe medications. They also have a free online screening for depression, anxiety and alcohol use that students can use to determine whether they need help and how severe their problems are.

Cox is grateful she received help for her depression. She said she thought about how her friend who committed suicide not have done so had he gotten help. Farr still battles depression and worries she will suffer relapses for the rest of her life. She is currently in a two-year-long relationship and rarely drinks anymore, but said her medication made her emotionally numb.

“I definitely have my good days and bad days,” Farr said. “I mean you just have to carry on. You have to find it somewhere in you, no matter how bad you are, to just carry on.”

—Edited by Chris Beattie