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It can be difficult to absorb detailed information at the time you meet with a doctor. Therefore, Counseling Center Staff have created this informational guide for your use. This guide is intended for college students coping with symptoms of depression who are interested in knowing more about depression and options for treatment. In particular, it is intended as a resource for students who are considering taking anti-depressant medication. We hope it is useful to you. As always, please don't hesitate to contact the Counseling Center if you have any questions.
Nathan P. Somers, M.D.
Depression: You are not alone
Depression is a common illness that occurs in about ten to fifteen percent of people the world over. College students are no exception. Fortunately, treatment for depression is very effective. Psychotherapy is the mainstay of treatment, providing an opportunity for you to discover and develop personal knowledge and skills that reduce depressive symptoms. Anti-depressant medication is another treatment resource that can lead to relief of symptoms and help you feel like yourself again.
What is depression?
Depression is a pervasive low mood that lasts for at least several weeks, and may be accompanied by changes in sleep, motivation, concentration, appetite, and energy levels. It may begin after a significant loss, or it may seem to come "out of the blue." Unlike ordinary sadness or grief, depression is longer lasting, is more pervasive, and is accompanied by feeling excessively negative about oneself.
Are there different kinds of depression?
Depression follows several different patterns:
A relatively mild depression that lasts for only a few weeks or months may occur after a significant loss or disappointment. This kind of depression often responds well to talking with friends, family or a counselor, and drawing on your skills of taking care of yourself during difficult times.
Another kind of depression is called major depression, which is characterized by at least two weeks of depressed mood, irritability or loss of pleasure, and most of the following symptoms:
Typically, major depression lasts for several months, and makes it hard to meet ones' responsibilities at school, at work, and with family and friends.
A third kind of depression, known as dysthymia, is characterized by depressed mood and feeling negative about oneself that lasts for two years or more. Dysthymia may also include:
Both major depression and dysthymia can be effectively treated with psychotherapy, antidepressant medication, or both.
What causes depression?
Depression appears to stem from biological, psychological and social factors. We know that depression has a genetic component and can run in families like other illnesses, such as heart disease. Depression can be caused by biological factors alone. Experiences of significant loss, such as death of a loved one, ending an important relationship, a career or educational setback, an assault, or an irresolvable personal conflict, may contribute to depression. Social oppression such as racism, sexism, classism, or homophobia may also promote depression. In many cases, a combination of causes appears to be responsible for the depression. Irrespective of its cause, depression is associated with chemical changes in the brain, which return to normal when the depression is resolved, whether that occurs without treatment, or with the help of psychotherapy and/or medication.
Is depression treatable?
Yes. In almost all instances, depression improves dramatically with treatment. Psychotherapy is effective in treating depression, and helps to prevent future episodes of depression. Anti-depressant medication is also effective. Psychotherapy in combination with medication can be the most effective.
The Use of Anti-Depressants:
What do anti-depressant medications have in common?
All currently approved anti-depressant medications are equally effective in that they will lead to substantial improvement in the symptoms of depression in 60-70% of the people who take them. For example, anti-depressants will improve energy levels and concentration, normalize sleep and appetite, reduce feelings of hopelessness and thoughts of death, and restore motivation and the capacity for pleasure, decrease unwarranted feelings of guilt, and eliminate depressed mood. One anti-depressant may be more effective or better tolerated than another for any given person. Most anti-depressants take from four to eight weeks to start working, and must be taken regularly to maintain their benefits. It is generally recommended that if an anti-depressant is effective, it should be taken for a minimum of six months, because there is a high likelihood that depression will recur if it is stopped sooner. Anti-depressants are not addictive, and they usually maintain their effectiveness over time.
Will I become a different person if I take medication?
On the contrary, most people who take medication for depression report that they "feel like themselves again." Although anti-depressants relieve symptoms of depression they do not cause euphoria. A person taking anti-depressants will experience the range of feelings that accompany day-to-day life, including both joy and sadness.
Is it a sign of weakness to take medication?
No. As with any serious illness, coping with depression takes great personal strength. Nonetheless, you may be exposed to negative attitudes about anti-depressant medications, which vary among individuals and cultures. Many students have found it helpful to take the perspective that medication is one form of treatment for depression, just as medication may be used to treat asthma, allergies, infections, or diabetes. Although no one welcomes the presence of illness in their life, treatment such as medication can serve to limit or eliminate the impact of illness, freeing you to direct your energy more fully toward your personal goals.
Is taking an anti-depressant just running away from my problems?
No. Anti-depressants relieve the symptoms of depression, which makes it easier to face your problems and take appropriate action. Many people find that they can work more productively in psychotherapy when they are free of depressive symptoms. If you are coping with the loss of a loved one, using an anti-depressant will not interfere with the grieving process. You can still feel the full range of emotions related to the loss.
How do anti-depressants work?
All anti-depressant medications work by influencing the activity of neurotransmitters in the brain. Neurotransmitters are the chemicals that cross the space between one brain cell (neuron) and the next to enable communication between them. Common neurotransmitters that are influenced by antidepressant medications include serotonin, norepinephrine, and dopamine. During an episode of depression, brain levels of these neurotransmitters are lower than usual. Antidepressant medications work by slowing the breakdown of neurotransmitters and enhancing the sensitivity of receptors on the receiving neurons. Basic science research has been focused on more accurately identifying which receptors are linked to the beneficial effects of anti-depressant medications, so that new medicines can be more specific and have fewer side effects.
Can anti-depressant medications cause suicidal thoughts and urges?
In very rare instances, suicidal thoughts and urges emerge in the first weeks of using anti-depressant medication. It is not always clear if the anti-depressant is causing these thoughts or urges, but to prevent risk, your doctor should be contacted immediately if you experience new or worsened suicidal thoughts when starting an anti-depressant.
When should I be especially cautious about using anti-depressants?
If you are or think you may be pregnant, if you are planning on getting pregnant in the near future, or if you are nursing a baby, it is important to discuss this with your health care provider. Anti-depressants have not been shown to be completely safe for the developing fetus or infant, though in some circumstances an individual may choose to take them during pregnancy or nursing; your doctor can help you make this decision. In addition, several prescription or over-the-counter medications and herbal preparations have interactions with anti-depressants which can be dangerous, so it is important to discuss any medications or herbal supplements you are taking with your provider. Any medical problems that you have, especially a history of seizures, head injury or eating disorders, should also be mentioned to your provider, because it may influence which anti-depressants would be safest for you to use. It is recommended to minimize your alcohol intake when taking anti-depressants because alcohol is itself a depressant, and because anti-depressants may increase the intoxicating effects of alcohol. As always, do not consider this written information to be sufficient to constitute complete medical advice, so please discuss any questions or concerns you may have with your health care provider.