The Gateway
Feature
volume ci number 40
Dealing with
Depression
The Gateway’s mental health series
Today • Battling depression
Thursday, March 24 • The bigger problems with addiction
Thursday, March 31 • Suicide and students
Written by Alix Kemp Illustrated by Anthony Goertz
A
ll students experience times of hardship and stress, periods where they feel tired, listless, or sad. For most, these feelings pass relatively quickly, the product of too much homework or a string of bad days. But for others, it’s a part of their everyday lives, a persistent state of gloom that can feel insurmountable.
Severe clinical depression can make even the most basic tasks seem nearly impossible. Those with depression may experience a broad range of symptoms, from a general sense of sadness, feelings of worthlessness or guilt, anxiety, to a loss of interest in activities they once loved, and even suicidal thoughts. Psychological symptoms are often accompanied by a host of other problems: headaches, insomnia, lack of sex drive, and weight loss. What’s becoming increasingly concerning, though, is the number of students who demonstrate depressive symptoms. A recent study from researchers at the University of British Columbia (UBC), published in the American Journal of Orthopsychiatry, found that a large percentage of students who accessed campus health centres for a variety of ailments showed significant signs of
depression. Students on five university campuses in Canada and the United States were screened for symptoms of depression; one in four of respondents were potentially depressed. Dr. Elizabeth Saewyc, the Applied Public Health Chair in youth health at UBC was one of the study’s co-authors. “University students are often under a lot of stress, and depression is one of the most common mental health challenges of adolescents and young adults,” Saewyc said. “It’s far more common than the other kinds of mental health challenges that you hear about, but a lot of people don’t necessarily know that’s what they’re struggling with, [or that it’s] something they can get help for.” That’s one of the largest problems with depression
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among students — it frequently goes undiagnosed. Simply exhibiting symptoms doesn’t mean that someone has clinical depression; everyone feels sad or hopeless occasionally, according to Saewyc. But, there may be a lot of students who would qualify for a diagnosis of depression who are unaware of the problem, and therefore unable to get assistance. “There were a lot of young people out there who were distressed, seriously distressed, and were not getting help for that,” Saewyc said. Of the students who indicated high levels of depressive symptoms in the study, one third of them had never done anything about it. Also troubling was that, of the students who showed symptoms of depression, one third of them reported suicidal thoughts, though they said they would not act on them. Saewyc said it’s not necessarily the case that university students have higher rates of depression than the general population. However, students do face a lot of unique challenges that may contribute to depression. “Part of what may be happening is that for the first time in their lives, they have moved away from their key support systems. So if you think about it, a lot of university students have moved to a different province, or sometimes even a different country,” Saewyc suggested. “Then there are all those expectations, because you have to do well, you have to be able to succeed and graduate, and your future career is riding on that. Young people put a lot of pressure on themselves to do well [...] They’re also doing it with fewer of their supportive networks around them. They feel more isolated and alone, and have a hard time coping.” There are a lot of situational causes for depression, including stress or trauma. However, the exact balance between genetic, biochemical, and psychological factors isn’t entirely understood. While it was once thought that depression was caused solely by external factors, to researchers and doctors it’s been increasingly clear that biology plays a significant role. Evidence strongly suggests a genetic factor in depression — those with a history of depression in their families are at an increased risk to experience depression at some point in their own lives. However, it’s unclear how large the role of genetics is, and to what extent they may be overridden by hormonal or environmental factors. In fact, depression is closely related to the limbic system of the brain, which includes the hippocampus, amygdala, and hypothalamus. Together, these structures affect emotion, memory, and sleep patterns. The hypothalamus in particular is responsible for regulating hormone production and release in the brain, and may play a significant role in depression. On a biochemical level, doctors know that depression is linked to a number of hormones in the brain, including noradrenaline and serotonin. Serotonin is linked to mood, emotional behaviour, and sleep, while noradrenaline is linked to responsiveness. Low levels of both likely contribute to depressed mood, lethargy, and feelings of sadness. Many anti-depressants, such as selective serotonin re-uptake inhibitors (SSRIs) work by elevating levels of serotonin. Another class of anti-depressants, serotonin-norepinephrine uptake inhibitors (SNRIs) increase levels of both serotonin and noradrenaline. Approximately six per cent of Canadians take anti-depressant drugs to manage symptoms of depression. However, anti-depressants are only one way that people deal with depression. At the University of Alberta, there are a number of resources available on campus that students can access in order to help manage their depression. The University Health Centre operates as a first line of defence for helping students who show symptoms of depression. As Saewyc’s study illustrates, it’s important for physicians to screen patients for depression, since many students may not recognize when they’re experiencing symptoms. But after a diagnosis, students can then be pointed towards other support services. One of those support services is the University Health Centre’s Psychiatry and Student Counselling Services. After a recent increase in staff, SCS employs seven registered
thursday, march 17, 2011
psychologists, three pre-doctoral student interns, two registering interns, and two parttime practicum students completing their masters’ degrees, providing free therapy sessions to students in need. Currently, there is approximately one psychologist per 3,000 full-time students. There are another six available psychiatrists. Together, these counsellors and doctors serve the entire student population. The centre also runs a number of group sessions, including a program called “Eight Weeks to Wellness,” which is tailored to students dealing with depression and stress. According to Dr. Steve Knish, a psychologist and team leader at SCS, “depression is one of the big three [issues] that we see students for.” Between September 1 and December 31 of last year, counselling services completed 593 initial consultations with students. Of those, 37 per cent said that depression was their primary difficulty, 16 per cent reported suicidal ideation, and 21 per cent were already taking psychotropic medications. Other issues that were common among students accessing SCS were anxiety and relationship issues. Individual therapy allows counsellors at the department to tailor their counselling to the needs of the student. “Depression can be different for everyone. Although there are some of these common sort of signs or symptoms of depression, everyone can have a bit of a different experience with it,” Knish said. Students begin with an initial consultation, after which point they can be matched with a counsellor. “Essentially, we will try to match the treatment to the student, so it’s very individual,” Knish said. “Sometimes we’ll work with negative thinking or critical thinking, [...] depending on what’s happening for the student [...] Sometimes [it could] be grief or loss of a relationship that’s bringing on the depression, so that’s something we could look at. The depression could have many sources, so we have to individually sit down with a person and work with wherever they’re at, and whatever approach is going to fit for them.” Depending on the needs of the student, student counselling may also connect them with other resources on campus. “If [a student is] spiritual, we will work with the chaplains, or use them as a resource,” explained Knish. “We could surely send someone for academic support, we would work with the chaplains, [and] the Student Success Centre is a place that we would send students to with respect to financial issues. These are all things that we would potentially use as well.” Whether it’s going to a family doctor or heading to the University Health Centre on the second floor of SUB, dealing with depression should be taken seriously. With an increasing student population facing mental health problems, getting help quickly is key to dealing with problems before they balloon into larger issues. However, with the help of increased students services, more people affected by depression are getting the help they need.
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“Young people put a lot of pressure on themselves to do well [...] They’re also doing it with fewer of their supportive networks around them. They feel more isolated and alone, and have a hard time coping.” - Dr. Elizabeth Saewyc