Students Confront Clinical Despair

"I called it my existential crisis," said a sophomore English concentrator, remembering the fall of last year. "Everything felt completely empty. I had no motivation to do anything, even to move. I just wanted to stay in my bed and lie there. When I tried visualizing things it was just dark and I was this little thing in the middle. There was no point to anything."

Unbeknownst to her, this Harvard student was suffering from clinical depression. "I just never thought of myself as a depressed person," she says.

And it was not until this fall that she decided to seek help. "It was kind of a relief to have it diagnosed as a real illness instead of something I was struggling with," she says.

She is not alone.

According to Dr. Randolph Catlin, head of the Mental Health Service at University Health Services (UHS),12 to 15 percent of undergraduates are seen by mental health services at least once during their college careers.

Of these, Catlin says it is fair to say that one third, or about 300 under-graduates at Harvard, have some form of depression.

At MIT, the story is the same. Dr. Peter Reich '52, chief of psychiatry at the MIT medical department, says about eight percent of MIT under-graduates are seen each year for mental health concerns. "In at least one half of the students, depression is an important component of their presentation or complaint," he says.

According to the National Institute of Mental Health, 25 percent of all women and 10 percent of all men will suffer from at least one episode of depression at some point in their lives.

Yet even these figures may underestimate theprevalence of depression, as the disorder isfrequently undiagnosed or even misdiagnosed.

Many depressed students do not seek help atUniversity Health Services. And since depressionmay occur with symptoms other than sadness, suchas a loss of vitality and energy, people may noteven realize that they are suffering fromdepression.

Professor of Psychology Jill M. Hooley saysunderdiagnosis is a real concern, since at least80 percent of all patients suffering from clinicaldepression are responsive to treatment.

"Depression awareness is something that's notvery high in most of the population," says Dr.Joseph J. Schildkraut '55, a professor ofpsychiatry at Harvard Medical School. "Oftenpeople will write this off saying, 'I've been toobusy at work,' or, 'I just got over the flu."

The English concentrator says she experiencedsymptoms of depression for about a year beforeacademic concerns prompted her to seek help at theBureau of Study Counsel.

But when the focus of the counselling suddenlyshifted to personal issues, the student decided tostop therapy.

"I guess I started to get really really scared,afraid to get into anything personal," she says."I didn't want to open things up and I though Icould just go on and live a normal life."

According to Schildkraut, most people sufferingfrom depression wait until the situation becomesunbearable before seeking help.

The clinically depressed sophomore recounts oneSunday night when "things got really reallyawful."

"First there was this enormous anger that Ifelt and it was kind of ungovernable. I put on myboxing gloves and started punching the wall," shesays. "I didn't know what to do. It was suchcomplete emptiness."

The sophomore says minutes and hours felt"really heavy and long," and she began askingherself questions such as "How am I going to getthrough this hour?" and "What's the point?"

It was at this point that she consideredcommitting suicide for the first time.

"I couldn't imagine the night finishing andthought that all of the hours of the next daywould be awful," she says.

According to Dr. Steven E. Hyman, associateprofessor of psychiatry and neuroscience at theMedical School, about 15 percent of people withrecurrent mood disorders actually die of suicide.

Schildkraut says such suicides are especiallytragic since depression is so treatable.

"It's like someone dying of pneumonia todaybecause they weren't treated with the rightantibiotics," he says.

Types and Causes of Depression

There are tow major forms of depression:unipolar and bipolar.

People suffering from unipolar depression mayexperience symptoms such as feelings of sadness,irritability or guilt for no apparent reason;changes in weight and sleep patterns; and aninability to concentrate or make decisions(please see graphic above).

Bipolar, or manic, depression is characterizedby cyclic fluctations between depressed states andstates of mania, or hyperactivity.

Symptoms of mania include increased energy anddecreased need for sleep, inappropriate excitementor irritability and impulsive behavior and poorjudgment.

Manic depression occurs more rarely thanunipolar depression but is believed to have astronger genetic component. Thus, manicdepressives often have a family history of theailment.

When it comes to identifying the specificcauses of depression, researchers still have nodefinite answers.

"All depression is usually related to someextent, if it isn't purely chemical, to aperceived loss of what someone values," Catlinsays. "Thus depression may follow the loss of arelationship, loved one, values, even one'sself-esteem."

According to Catlin, depression among studentsmay result from an inability to find replacementsin college for previously important elements ofone's life, such as family, friends and hobbies.

The sophomore English concentrator says herloss of faith in religion last year may havecontributed to her condition. "I felt thateverything was kind of hollow if there's no divinebeing," she says.

Dr. Anthony J. Rothschild, associate professorof psychiatry at the Medical School, says thatentering first-years may find college particularlystressful if they are unable to form new types ofsupport systems.

A realization that one has not lived up toexpectations may also lead to depression. Thesophomore says that she found trying to choose aconcentration especially difficult. "It was likeeveryone else in the world had everything set andI was just drifting along," she says.

Another source of depression, especially atHarvard, may be judging one's sense of worth on aspecific ability or talent, Catlin says.

"People may fall short here because they findother people who do the same thing as them andoften better," he says.

While coming to Harvard can be a humblingexperience, it can also threaten the confidenceand self-esteem that students possessed in theirold environment, Rothschild says.

Subsequently, UHS attempts to treat depressionby broadening the base of a patient's self-esteem.

The UHS staff uses three major techniques totreat depression: psychodynamic therapy, an inightbased approach; inter-personal therapy, whichfocuses on personal relationships; andcognitive-behavioral therapy, which attempts tochange negative thinking and behavior.

Short-term psychotherapy is usually highlyeffective in treating Harvard students, since mostdepressed undergraduates come to UHS because ofspecific events in their lives, Catlin says.

"What we do in psychotherapy is help peoplelook at what their loss may be, how it changedtheir life and how to compensate in a way thatdoes not make them feel guilty," says Catlin.

An Illness, Not a Weakness

Hyman and most other mental health expertsinsist that depression is a brain disease ratherthan a sign of personal or moral weakness.

According to Rothschild, all people will sinkinto depression given enough stress, some justmore readily than others. "After a while, abiological process kicks in, and after that itdoesn't matter if you remove the stressfulsituation," he says.

Psychotherapy and anti-depressant medicationsare generally used to treat depression, withcombination treatment strongly recommended forpeople suffering from major or manic depression.

Catlin says UHS does prescribe antidepressantssuch as Zoloft, Prozac and Paxil when they aredeemed necessary by consulting psychiatrists.

Though the drugs are non-addictive, sideeffects do exist.

The clinically depressed sophomore said shesuffered from nausea and headaches the first weekshe took Zoloft and still feels a loss of appetitefrom the medication.

Anti-depressants may also cause insomnia,stomach problems and decreased sexual desire. ButRothschild points out that only about five percentof people experience sideeffects, which usuallycease after a few weeks.

For those suffering from mild forms ofdepression, psychotherapy and medication can beequally effective. And Schildkraut says that incertain discrete episodes of depression,medication alone can be effective.

Mental health experts strongly advise therapyin addition to medication for more severe cases ofmajor or manic depression.

"Drugs are helpful but it's also important fora person to feel supported during depression,"Hooley says. "Drugs won't help you get your lifeback on track."

Resources at Harvard

The three main Harvard resources for depressedstudents are UHS, the Bureau of Study Council andRoom 13.

Students who make appointments at UHS canchoose to see a male or female psychiatrist,psychologist or psychiatric social worker. Forthose who cannot wait to schedule an appointment,UHS runs three one-hour urgent care periods daily(please see graphic below).

The Bureau of Study Counsel possesses fewerclinicians than UHS and cannot prescribemedication, but its staff can administerpsychotherapy in a less medical environment.

Students can also talk to a peer counselor atRoom 13, a student-run group located in thebasement of Gray's Hall.

"We do a lot of listening," says a Room 13staffer who did not wish to be identified. "We tryto help someone understand what they're feelingand that it's okay."

But not everyone is satisfied with Harvard'sresources.

"I think in both the Bureau of Study Counciland UHS there's a lack of psychologists who willsee students on a regular basis," the depressedsophomore says. "That's why I went to a privatepsychologist."

Catlin says that UHS cannot guarantee regulartherapy. Students, he says, usually sign up forthe next available appointment, which can beanywhere from 10 days to two weeks away.

But the chief of mental health services saysthat the short-term seems to work well for moststudents, who are depressed over specific eventsin their lives rather than for pathologicalreason.

If students require more frequent and extensivetherapy, UHS refers theme to privatepractitioners. UHS refers those who cannot affordprivate therapy to one of Harvard's nearbyteaching hospitals, where they are seen byresidents or staff outpatient services.

In contrast to Harvard's system, Yale's mentalhealth services are able to provide long-termtherapy for their students without making privatereferrals.

Catlin says that Yale's health services canprovide long-term therapy because they only treatstudents, whereas Harvard's UHS must also handlefaculty and staff.

"Depression is perhaps the most treatabledisorder that we have in psychiatry," Schildkrautsays. "For most people the goal of treatment isnot solely helping people to get better, but torestore people back to their previous level offunction."

Treatment has allowed another sophomorediagnosed as clinically depressed to restore hisquality of life. Overcoming his depression hasalso fostered a deeper under-standing of himself.

"I'm definitely a stronger person because of mydepression," he says. "In the long-run, I'm gladit happened. I feel like everything I should havelearned about life growing up was thrown into thisone year. Although it sucked that it happened allat once, my life is so much better now."You Know You're Depressed When...

Symptoms of Depression

. Feelings of sadness and/or irritability.

. Loss of interest or pleasure in activitiesonce enjoyed.

. Changes in weight or appetite.

. Changes in sleeping pattern.

. Feeling guilty, hopeless or worthless.

. Inability to concentrate, remember things ormake decisions

. Fatigue or loss of energy.

. Restlessness or decreased activity noticed byothers.

. Thoughts of suicide or death.

The persistence of five or more of thesesymptoms over two weeks may indicate signs ofclinical depression.

Source: National Mental Health Association

Resources for Further Help

On CampusBureau of Study Council  5-2581Room 13  5-4969UHS Emergency Room (emergency psychiatriccare)  5-5711UHS Mental Health  5-2042

Off CampusDepression Support Group  855-2795National Alliance for the MentallyIII  1-800-950-NAMINational Mental HealthAssociation  1-800-969-NMHASamaritans Suicide Hotline  247-0220

Source: National Mental Health AssociationCrimsonEugene Y. Chang

Yet even these figures may underestimate theprevalence of depression, as the disorder isfrequently undiagnosed or even misdiagnosed.

Many depressed students do not seek help atUniversity Health Services. And since depressionmay occur with symptoms other than sadness, suchas a loss of vitality and energy, people may noteven realize that they are suffering fromdepression.

Professor of Psychology Jill M. Hooley saysunderdiagnosis is a real concern, since at least80 percent of all patients suffering from clinicaldepression are responsive to treatment.

"Depression awareness is something that's notvery high in most of the population," says Dr.Joseph J. Schildkraut '55, a professor ofpsychiatry at Harvard Medical School. "Oftenpeople will write this off saying, 'I've been toobusy at work,' or, 'I just got over the flu."

The English concentrator says she experiencedsymptoms of depression for about a year beforeacademic concerns prompted her to seek help at theBureau of Study Counsel.

But when the focus of the counselling suddenlyshifted to personal issues, the student decided tostop therapy.

"I guess I started to get really really scared,afraid to get into anything personal," she says."I didn't want to open things up and I though Icould just go on and live a normal life."

According to Schildkraut, most people sufferingfrom depression wait until the situation becomesunbearable before seeking help.

The clinically depressed sophomore recounts oneSunday night when "things got really reallyawful."

"First there was this enormous anger that Ifelt and it was kind of ungovernable. I put on myboxing gloves and started punching the wall," shesays. "I didn't know what to do. It was suchcomplete emptiness."

The sophomore says minutes and hours felt"really heavy and long," and she began askingherself questions such as "How am I going to getthrough this hour?" and "What's the point?"

It was at this point that she consideredcommitting suicide for the first time.

"I couldn't imagine the night finishing andthought that all of the hours of the next daywould be awful," she says.

According to Dr. Steven E. Hyman, associateprofessor of psychiatry and neuroscience at theMedical School, about 15 percent of people withrecurrent mood disorders actually die of suicide.

Schildkraut says such suicides are especiallytragic since depression is so treatable.

"It's like someone dying of pneumonia todaybecause they weren't treated with the rightantibiotics," he says.

Types and Causes of Depression

There are tow major forms of depression:unipolar and bipolar.

People suffering from unipolar depression mayexperience symptoms such as feelings of sadness,irritability or guilt for no apparent reason;changes in weight and sleep patterns; and aninability to concentrate or make decisions(please see graphic above).

Bipolar, or manic, depression is characterizedby cyclic fluctations between depressed states andstates of mania, or hyperactivity.

Symptoms of mania include increased energy anddecreased need for sleep, inappropriate excitementor irritability and impulsive behavior and poorjudgment.

Manic depression occurs more rarely thanunipolar depression but is believed to have astronger genetic component. Thus, manicdepressives often have a family history of theailment.

When it comes to identifying the specificcauses of depression, researchers still have nodefinite answers.

"All depression is usually related to someextent, if it isn't purely chemical, to aperceived loss of what someone values," Catlinsays. "Thus depression may follow the loss of arelationship, loved one, values, even one'sself-esteem."

According to Catlin, depression among studentsmay result from an inability to find replacementsin college for previously important elements ofone's life, such as family, friends and hobbies.

The sophomore English concentrator says herloss of faith in religion last year may havecontributed to her condition. "I felt thateverything was kind of hollow if there's no divinebeing," she says.

Dr. Anthony J. Rothschild, associate professorof psychiatry at the Medical School, says thatentering first-years may find college particularlystressful if they are unable to form new types ofsupport systems.

A realization that one has not lived up toexpectations may also lead to depression. Thesophomore says that she found trying to choose aconcentration especially difficult. "It was likeeveryone else in the world had everything set andI was just drifting along," she says.

Another source of depression, especially atHarvard, may be judging one's sense of worth on aspecific ability or talent, Catlin says.

"People may fall short here because they findother people who do the same thing as them andoften better," he says.

While coming to Harvard can be a humblingexperience, it can also threaten the confidenceand self-esteem that students possessed in theirold environment, Rothschild says.

Subsequently, UHS attempts to treat depressionby broadening the base of a patient's self-esteem.

The UHS staff uses three major techniques totreat depression: psychodynamic therapy, an inightbased approach; inter-personal therapy, whichfocuses on personal relationships; andcognitive-behavioral therapy, which attempts tochange negative thinking and behavior.

Short-term psychotherapy is usually highlyeffective in treating Harvard students, since mostdepressed undergraduates come to UHS because ofspecific events in their lives, Catlin says.

"What we do in psychotherapy is help peoplelook at what their loss may be, how it changedtheir life and how to compensate in a way thatdoes not make them feel guilty," says Catlin.

An Illness, Not a Weakness

Hyman and most other mental health expertsinsist that depression is a brain disease ratherthan a sign of personal or moral weakness.

According to Rothschild, all people will sinkinto depression given enough stress, some justmore readily than others. "After a while, abiological process kicks in, and after that itdoesn't matter if you remove the stressfulsituation," he says.

Psychotherapy and anti-depressant medicationsare generally used to treat depression, withcombination treatment strongly recommended forpeople suffering from major or manic depression.

Catlin says UHS does prescribe antidepressantssuch as Zoloft, Prozac and Paxil when they aredeemed necessary by consulting psychiatrists.

Though the drugs are non-addictive, sideeffects do exist.

The clinically depressed sophomore said shesuffered from nausea and headaches the first weekshe took Zoloft and still feels a loss of appetitefrom the medication.

Anti-depressants may also cause insomnia,stomach problems and decreased sexual desire. ButRothschild points out that only about five percentof people experience sideeffects, which usuallycease after a few weeks.

For those suffering from mild forms ofdepression, psychotherapy and medication can beequally effective. And Schildkraut says that incertain discrete episodes of depression,medication alone can be effective.

Mental health experts strongly advise therapyin addition to medication for more severe cases ofmajor or manic depression.

"Drugs are helpful but it's also important fora person to feel supported during depression,"Hooley says. "Drugs won't help you get your lifeback on track."

Resources at Harvard

The three main Harvard resources for depressedstudents are UHS, the Bureau of Study Council andRoom 13.

Students who make appointments at UHS canchoose to see a male or female psychiatrist,psychologist or psychiatric social worker. Forthose who cannot wait to schedule an appointment,UHS runs three one-hour urgent care periods daily(please see graphic below).

The Bureau of Study Counsel possesses fewerclinicians than UHS and cannot prescribemedication, but its staff can administerpsychotherapy in a less medical environment.

Students can also talk to a peer counselor atRoom 13, a student-run group located in thebasement of Gray's Hall.

"We do a lot of listening," says a Room 13staffer who did not wish to be identified. "We tryto help someone understand what they're feelingand that it's okay."

But not everyone is satisfied with Harvard'sresources.

"I think in both the Bureau of Study Counciland UHS there's a lack of psychologists who willsee students on a regular basis," the depressedsophomore says. "That's why I went to a privatepsychologist."

Catlin says that UHS cannot guarantee regulartherapy. Students, he says, usually sign up forthe next available appointment, which can beanywhere from 10 days to two weeks away.

But the chief of mental health services saysthat the short-term seems to work well for moststudents, who are depressed over specific eventsin their lives rather than for pathologicalreason.

If students require more frequent and extensivetherapy, UHS refers theme to privatepractitioners. UHS refers those who cannot affordprivate therapy to one of Harvard's nearbyteaching hospitals, where they are seen byresidents or staff outpatient services.

In contrast to Harvard's system, Yale's mentalhealth services are able to provide long-termtherapy for their students without making privatereferrals.

Catlin says that Yale's health services canprovide long-term therapy because they only treatstudents, whereas Harvard's UHS must also handlefaculty and staff.

"Depression is perhaps the most treatabledisorder that we have in psychiatry," Schildkrautsays. "For most people the goal of treatment isnot solely helping people to get better, but torestore people back to their previous level offunction."

Treatment has allowed another sophomorediagnosed as clinically depressed to restore hisquality of life. Overcoming his depression hasalso fostered a deeper under-standing of himself.

"I'm definitely a stronger person because of mydepression," he says. "In the long-run, I'm gladit happened. I feel like everything I should havelearned about life growing up was thrown into thisone year. Although it sucked that it happened allat once, my life is so much better now."You Know You're Depressed When...

Symptoms of Depression

. Feelings of sadness and/or irritability.

. Loss of interest or pleasure in activitiesonce enjoyed.

. Changes in weight or appetite.

. Changes in sleeping pattern.

. Feeling guilty, hopeless or worthless.

. Inability to concentrate, remember things ormake decisions

. Fatigue or loss of energy.

. Restlessness or decreased activity noticed byothers.

. Thoughts of suicide or death.

The persistence of five or more of thesesymptoms over two weeks may indicate signs ofclinical depression.

Source: National Mental Health Association

Resources for Further Help

On CampusBureau of Study Council  5-2581Room 13  5-4969UHS Emergency Room (emergency psychiatriccare)  5-5711UHS Mental Health  5-2042

Off CampusDepression Support Group  855-2795National Alliance for the MentallyIII  1-800-950-NAMINational Mental HealthAssociation  1-800-969-NMHASamaritans Suicide Hotline  247-0220

Source: National Mental Health AssociationCrimsonEugene Y. Chang