Lessons from College

Although colleges are now reaping the Prozac payoff, college being what it is, they must also deal with Prozac rebellion. It triggers many a depressive episode.

A significant proportion of students go off their medication once they get to college, figuring that now that they are out of the house, where problems first arose, their troubles should be over. Observes Rosemarie Rothmeier, Ph.D., director of student counseling at Austin College in Sherman, Texas: "They say, 'my parents were the problem.' Or 'I had no friends before, but now I do.' They go off their medication, and indeed, they don't feel bad immediately. It takes some time."

Others seek to escape the possibility that they may have to be on medication for the rest of their life. They think, "I want to be like everyone else." Still, David Mednick, Psy.D., co-director of counseling at Fairleigh Dickinson University in New Jersey, reports that his "biggest concern is the number of depressed patients needing medication who have not yet not followed through filling a prescription. They share the public prejudice against needing medication to feel well."

Still others slip back into depression surreptitiously. They fall prey to a more disorganized lifestyle and experience the return of symptoms because of disrupted dosing schedules. And then there is that stark fact of campus social life. Many students stop antidepressants to start drinking.

The notoriously erratic sleep patterns of students can dramatically disregulate body systems and precipitate depression in those with no prior history of it. Many schools attempt to educate incoming students. "We point out that if you don't sleep regularly, it will not only interfere with your academic performance but put you at risk for depression," says Harvard's Dr. Kadison. And sleep deprivation can be the trigger that sets off a manic episode.

A World of Difference

Students today do live in a more complex world than their parents did. That alone can set the stage for depression.

Most of today's college students have faced competitive pressures from birth and are carrying a cumulative burden of stress. Says Dartmouth's Dr. Reed: "These students experienced competition to get into kindergarten. They develop 'areas of excellence,' and have portfolios to get into the best prep school. Most of their self-esteem comes from a few areas of excellence. They fail to develop an internal system to sustain them in all environments. They've sunk under the weight of obligation at an early age."

For those students not at a first-tier college, the pressure, ironically, may be especially intense. "They really suffer a crisis in confidence about their future," observes Michael Doyle, Ph.D., head of student psychological services at Loyola Marymount University in Los Angeles. "They feel like they lost out already. So, many feel more pressure to succeed."

In previous generations, troubled students disappeared from campus. "Now we're seeing the opposite end of the spectrum," says Austin's Dr. Rothmeier. "Parents have too much of an investment. They don't want students taking off time to get stabilized first."

Time of Challenge

Despite frat parties, spring break and grade inflation, the college years are a challenging time of life. "Everyone underestimates the amount of change normally required to leave home and adapt," offers Linda K. Hellmich, Ph.D., associate director of counseling at Carleton College in Northfield, Minnesota. "It's a huge stress."

Young people are learning to regulate themselves in a hyperstimulating world. They're living on their own for the first time, having left their primary support system behind, and trying to figure out what to do with their lives. That's not even counting the academic demands of college. Or the urge to begin exploring their own sexuality.

The big issue for most students is how to separate out successfully from their family, moving from dependence to independence. That's a challenge under the best of conditions. It's especially difficult for the many who never got what they needed at home, or who got abuse or neglect. Dr. Hellmich is surprised at how many students come from "amazingly disruptive backgrounds," like the girl who spent seven years of homelessness with her divorced mother.

Nil on Skills

With their hothouse childhoods, many students today come to college lacking the very skills that would help them cope most effectively with whatever challenges they encounter—social skills and emotion-regulation skills.