Transcripts From Above Article (Depression among college students rising)

College students are the focus of negative headlines about everything from binge drinking to campus crime. Now a new concern may dwarf the earlier crises: an alarming increase in cases of mental illness on college campuses.

Two new studies shed light on the phenomenon — an overview in a special report from the publishers of Psychology Today and the latest research presented Tuesday at the Philadelphia conference of the American Psychiatric Association (APA).

“Mental illness is absolutely going off the charts on college campuses,” says Hara Marano, who prepared the report for a May newsletter published in association with Psychology Today. “College counseling centers used to be the backwaters of the mental health care system. Now they are the front line.”

A March report in Psychiatric News from the American Psychiatric Association reported similar concerns.

Psychiatrist Shamsah Sonawalla of Massachusetts General Hospital says “there is not just an increase in prevalence” of psychological problems in college students, but “an identification of problems earlier. That we recognize it more is a good thing. But we have opened up Pandora’s box.”

Sonawalla found that 14% of 701 students who filled out a survey at a college in the Boston area showed significant depressive symptoms, and half of them could qualify as having major depression. The psychiatrist presented her research Tuesday to the APA.

North America’s college counseling centers report an increase in troubled students, according to psychologist Robert Gallagher of the University of Pittsburgh. His 2001 survey of counseling centers shows that 85% of colleges report an increase during the past five years in students with severe psychological problems.

About 30% report at least one suicide in the previous year. Such incidents include the much-publicized case of a girl who killed herself two years ago in a fire in her dorm room at the Massachusetts Institute of Technology.

Other sources document an alarming trend. A study from the American College Health Association in 2000 said 10% of college students have been diagnosed with depression. And the National Mental Health Association quotes a study saying 30% of college freshmen report feeling overwhelmed a great deal of the time; 38% of college women do.

The National Institute of Mental Health (NIMH) pays special attention to college students and mental illness on its Web site, The site highlights the common stressors that are part of normal college life, including greater academic demands; new financial responsibilities; changes in social life; exposure to new people, ideas and temptations; greater awareness of sexual identity issues; and anxiety about life after graduation.

Marano, whose study appears in the May issue of Blues Buster, a lengthy newsletter about depression, says the college population is not suddenly losing its moorings. For the deeply troubled, problems began before bags were ever packed for that first trip to school.

Many students show up already on antidepressants, thanks to earlier diagnoses in the young. “I call it the Prozac payoff,” Marano says.

“We find that students arrive at our doors with these severe problems, rather than developing them while on campus,” Gallagher says.

Students may run into trouble, Marano says, if they attempt to go off their medication. “They think once they are out of the house that made them go crazy, they will be fine.” Or, she says, they stop their pills in favor of alcohol or drugs, both of which can be associated with depression.

In the past, unmedicated students with dramatic problems would not have made it into college or could not have stayed there, Gallagher notes.

Other factors experts say are increasingly at play:

Family dysfunction at home. “Parental drug and alcohol use and the reduced presence of adults in the home” contribute, Gallagher says. Sexual and physical abuse “definitely predisposes the likelihood of depression,” Marano says. Students also may lack the social and emotional skills that a supportive family base provides. A college population that now parallels the general population. “College is no longer an elite place,” Marano says. “College populations are more like real life.” A group vulnerable to mental illnesses from depression to anxiety disorders. The ages of 18-25 are the prime time for serious conditions to emerge, Gallagher says. An increasingly complex and competitive world. “In the very high-pressure schools, there seem to be more student suicides,” says Gallagher, although they are still quite rare.

The increasing availability of psychiatric services at colleges. Counseling may be free. “It is a good place to get diagnosed and treated,” Marano says, and the stigma against mental illness, while still strong, is weakening a bit.

Marano notes that going home for the summer can be another traumatic time for students. They return to the place they perceive to be causing them problems. Often before leaving school they will have stopped for a tune-up. “They will first go to a counseling center to get taken care of.”

On a Roller Coaster : Bipolar Mood Disorder

As a psychiatry intern at a Mumbai hospital, I evaluated a middle-aged man who wore a red hat, Hawaiian print shirt and gold chains. Armed with enthusiasm, curiosity and a little theoretical knowledge of the subject, I sat down for what was to become one of the most interesting interviews of my training.

He greeted me cheerfully and talked about his appointment with the Prime Minister, his successful business ventures and the half-done film he was directing. He said he had a scheme to discuss with the PM that would end poverty and corruption in our country . He said he had been granted special powers by the universe for this mission. He also said that he did not need much sleep, was feeling very energetic and had many ideas to improve the world.

On speaking with his wife, I found following a setback in business, he had become irritable and then euphoric. He hardly slept but continued feeling very energetic, took up new projects, but did not complete them. He became more irritable, angry and even abusive , as ‘people did not believe him’ and started neglecting his family, work and health; this was interspersed with periods of euphoria and a sense of extreme well-being . This is when he was brought to the hospital.

Even to my relatively untrained mind, it was not very difficult to make a diagnosis: bipolar mood disorder (previously known as ‘manic depression’ ), in which a person goes through cyclical periods of feeling euphoric, energetic, grandiose, expansive or irritable (read manic episode) with periods of sadness of mood, low energy, lack of enthusiasm and low self-esteem (read depressive episode). It is like being on a thrilling high and then in a state of extreme gloom.

Bipolar disorder is characterised by a distinct period of abnormal mood, which could be either euphoric, expansive or irritable, accompanied by symptoms such as easy distractibility , inflated self-esteem , grandiose ideas, excessive talkativeness, racing thoughts, need for less sleep than usual and increase in goal-directed activity. For example , taking on too many projects at the same time; poor judgement leading to reckless behavior, such as spending sprees, reckless driving or promiscuity and denial that anything is wrong. When this lasts for at least a week and affects the person’s day to day functioning, it is called a manic episode.

What causes bipolar disorder ? Why is it that some individuals suffer these extreme ups and downs during their lives? We are far from having all the answers.

Research suggests that bipolar disorder can be inherited . Excessively high or low levels of neurotransmitters (chemicals produced by brain cells or neurons) such as serotonin , norepinephrine and dopamine , an imbalance in neurotransmitter levels, or a change in the sensitivity of receptors on the nerve cells can cause bipolar disorder.

Acommon misconception is that stress or environmental factors cause the illness. Stressful life events (such as a death in the family, loss of a job, relationship difficulties , child birth, etc.) can certainly trigger the onset of bipolar disorder. But once the illness begins, it is the underlying biological and psychological processes which keep it active and are the cause of the illness.My first patient with bipolar disorder responded well to medication and counselling sessions. Over time, he developed awareness regarding his illness (often absent during the ‘high’ phase). He visited the clinic every fortnight with afamily member for follow-up sessions and did progressively better over the following year. He later resumed running his business, which continued to be fairly successful . A fascinating aspect about bipolar disorder is its association with creativity.

Research has shown that individuals with bipolar are as likely to be creative and function exceptionally well, as they are likely to be dysfunctional . News channel CNN founder Ted Turner, psychologist Kay Jamison and actress Catherine Zeta Jones have talked openly about being bipolar. Picasso’s ‘pink’ and ‘blue’ periods are well known. While one should refrain from romanticizing an illness that involves immense suffering, it is evident that some individuals with bipolar disorder can lead extraordinarily productive and creative (if trying) lives.

If you are reading this and wondering if you have bipolar disorder, please note that (thankfully) not everyone who is energetic, creative and takes up many projects is bipolar ! Bipolar disorder spans a wide range of symptoms and needs a thorough assessment for a diagnosis.

I find it heartening to see family members often bring printed information on the subject with a set of questions to be answered. Research on mood disorders across various cultures shows that a supportive family environment significantly improves the outcome in bipolar disorder.

(Dr Shamsah B Sonawalla is a consultant psychiatrist and a former faculty of Harvard Medical School, US)

Sleeping pills: The hidden addiction

It was on the advice of close friends that she took `a sleeping pill’ to overcome in somnia. Over time, this mid dle-aged, successful professional was taking over 30 pills of alprazolam daily! But her insomnia persisted and she became increasingly anxious and agitated. So she combined alprazolams with alcohol. She would drive out to get them when her chemist was prevented from delivering them home. On several occasions, she had been found passed out in her car by passers-by or her family . One such episode scared her into seeking treatment. That was when we realized that insomnia wasn’t the primary problem. It was masking severe depression, untreated for years. She was selfmedicating to feel better.

Admitted to the hospital for a month-long detoxification, she was gradually weaned off the pills and treated with antidepressants and psychotherapy . Her treatment continued postdischarge, and she now leads a contented life.

Most people are not so fortunate.

We often don’t realize when the innocuous-looking sleeping pill becomes integral to our survival, and takes us down the road to addiction, which is more com mon than we realize, though rare ly talked about. According to a Na tional Sleep Foundation, USA, re port, “one out of three America women use sleep medication a few times in a week“. Closer home, a elderly patient told me she wa married to the sleeping pill for 3 years! Another patient from th Far East told me that benzodiaze pines from India“were sold at ove 150 times their cost in his coun try!“ This is clearly a public healt problem that has reached epidem ic proportions.

Sleeping pills include benzo diazepines ­ diazepam, alprazo lam, lorazepam, nitrazepam, tria zolam, clonazepam, temazepam chlordiazepoxide, etc. ­and non benzodiazepines such as zolpidem, eszopiclone, zaleplon, antihistaminergic medications, etc.These are consumed as a quick fix to insomnia, which is often symptomatic of an underlying condition, such as a depressive or anxiety disorder, which require com pletely different, supervised physician-prescribed medication.These are antidepressants, moodstabilizers, antipsychotics etc. They are not sleeping pills; they treat the cause of insomnia and may actually lead to excessive sleepiness as a side-effect.

What makes benzodiazepines dangerous are the desirable initial results. They increase the activity of gamma amino butyric acid (GABA) ­ an inhibitory brain chemical that has a calming effect.After the initial `positive’ effects of lowered anxiety and a good night’s sleep, the GABA receptors get down-regulated within a few weeks or even days, becoming less responsive to benzodiazepines due to compensatory changes in the brain. With `benzos’, people who grow accustomed to its effects increase their intake, or take it with pain medication or alcohol, perpetuating a vicious cycle of psychological and physical dependence, making de-addiction proportionately more difficult.

Non-benzodiazepine sleeping pills are equally hazardous. Zolpidem is known to make people do things while asleep that they don’t recall when awake ­ such as sleep walking, sleep eating, sleep texting, sleep tweeting and even sleep driving! Fatal car crashes have also been reported, since they slow down one’s reflexes. Indeed, all of us are at a risk due to misuse of sleeping pills.

Does this mean that such pills are all bad? Not if administered under strict supervision of the prescribing physician, in the lowest possible dose. In fact, shortterm usage can be extremely effective in treating certain medical conditions, including epileptic seizures, or providing immediate relief in case the primary medication is for the longer term such as for a severe anxiety disorder. If used correctly , short-term, judicious use under the guidance of a physician is usually associated with lower risk of addiction. It is imperative, however, that they are not used indiscriminately and for long durations.

Recovery from sleeping pill addiction, although slow, is possible.The first step towards this must come from the individual a realization that he or she has got used to them and may already be dependent. Then comes supervised treatment. For mild addictions, gradual dosage reduction and treating the underlying cause are helpful. For severe, long-term cases, the patient may need to be hospitalized. Stopping medication on one’s own, especially in higher doses, may cause withdrawal symptoms anxiety , insomnia and convulsions and increase the risk of relapse.

If sleep is a problem, try some lifestyle changes for starters ­ regular exercise, a healthy diet, lowering stress. Or go to a physician you trust and figure out if there is another reason for insomnia and stress. If you are already on prescription sleeping pills and feel like you are losing control over its use, discuss with your physician.

But the most important thing you need to do is be unafraid to seek the justify kind of help. Over and above all of that, you need to believe in yourself and know that you will find a way to tap into your inner resources, trust your physician, harness the support you need from your loved ones, and overcome any problem you’re facing. And when you do find the solution, it is likely to have a definite, positive and long-lasting effect.


Magnetic pulse used to beat depression

MUMBAI: For 20 times over four weeks, Stuti (name changed) sat in a special chair and had a magnetic coil placed over her scalp for 30 minutes. Diagnosed with major depression, the 27-year-old had quit her job, contemplated suicide and was on the verge of divorcing her husband of three years.

“Undergoing repetitive transcranial magnetic stimulation (rTMS) was the last-ditch attempt to save my marriage and sanity,” says Stuti, who was initially ecstatic about moving to Mumbai from Bangalore. A dress designer, she was confident work would be stimulating here. But four months into an arranged marriage with a businessman, the cracks showed.

Depression, the most common psychological disorder, affects one in every 10 Indians. “When Stuti came to me, she had major depression that would have needed a high dose of pills and intense counselling,” said psychiatrist Shamsah Sonawalla from Trans Mag Well-Being Clinic. Reluctant to take medication, she chose rTMS, usually reserved for treatment-resistant depression. Stuti is among the growing number of depressive patients who are trying out alternatives: Yoga, meditation, angel therapy and post-life regression, along with psychological treatment.

It is believed rTMS produces changes in neuronal activity in area of the brain that control mood. “After the sessions, we went on a European vacation and I started my boutique,” Stuti said. Now, a year after the treatment, she is pregnant.

Dr Sonawalla, who picked up rTMS at Harvard Medical School where she was a faculty, said western research has shown that the rates of remission are higher in patients undergoing a combination of rTMS and antidepressant treatment than those on antidepressants alone.

Her study of 185 people with major depression (83 with treatment-resistant depression & 102 with moderate to severe major depression) showed a high degree of remission. “While 59% of 83 patients with treatment-resistant forms responded, 41% are now in remission,” said Dr Sonawalla. Remission is a period with no residual symptoms. “Usually, 30% patients respond to other treatments.”

Psychiatrist Dr Harish Shetty said, “The milder varieties respond to exercise, yoga, counselling, while others may need medication, psychotherapy and non-pharmacological help.” The key to end depression is early identification, he said.