ANN ARBOR, MI - Right about now, hundreds of thousands of college students across the country are packing their sweatshirts and their extra-long sheets, getting ready for another semester of studying, rooting for their school teams, and partying.

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But there's another common college experience that one in seven of them may face: depression. Brought on by a combination of students' vulnerable age and the stress and demands of college life, depression and related conditions can strike for the first time in college, or come back to haunt those who had first battled it in high school.

Many students don't know that what's happening to them has a name, a biological cause, or a range of treatments. And without proper help, depressed students may fall behind in class, withdraw from friends and activities - or try to kill themselves.

That's why it's so important for students, parents, professors and college officials to be aware of depression's symptoms, and to know how to get help for those affected by it, says a top depression expert at the University of Michigan Health System.

"Depression is a huge problem in the college student population," says John Greden, M.D., executive director of the U-M Depression Center. "The age of onset for depressive illnesses tends to peak during the ages of 15 to 19. That's when it starts to appear, and the estimates are that probably 15 percent of the college student population may be struggling with depressive illnesses."

Greden and his colleagues at the U-M center - the nation's first comprehensive center for research, treatment and education on depression and related disorders - are working to increase awareness and find effective methods for spotting and treating depression on campus. Last spring, they held the nation's first conference on the issue, drawing hundreds of educators, college leaders and health professionals.

But conquering college depression must start with a general public awareness of what depression is, and isn't, Greden emphasizes.

"It's absolutely essential to recognize that depression is an illness and that people don't just routinely adjust, adapt and 'get over it'," he says. "Without that recognition, a person can begin a lifetime course of depression that tends to get worse. That's when you start seeing risk of suicide, chronic illness, loss of jobs and hospitalization. We've got to start addressing this in those early stages, so it's essential that we not just attribute students' symptoms to just 'emotional stress'."

Greden, who is the Rachel Upjohn Professor of Psychiatry and Clinical Neurosciences and the chair of the Department of Psychiatry at the U-M Medical School, notes that scientists at U-M and elsewhere are learning more and more about what depression really is, and how it starts.

"Depression is both a physical disorder, rooted in brain chemistry and our genes, and an emotional and environmental disorder, meaning that it's accentuated by stressful life events," he explains.

Genetics research has even found that people can inherit a tendency to be vulnerable to the brain chemistry changes related to depression, and that this vulnerability can be triggered by stressful experiences. The hormonal changes of the teen years can also affect brain chemistry - and the result is a susceptibility to depression throughout high school and college.

"When you think of what happens when you go off to college, the age of onset collides with a very unique set of stresses," he notes. "You're leaving home, you have financial worries, you have to meet new friends and keep up with the study demands, and your sleep schedule changes. There's probably greater exposure to drugs and alcohol, and greater freedom to use them. You put all of these together and all of a sudden, the combination is not good."

The impact can be especially great on the 10 percent of college students that the American College Health Association estimates arrive on campus with a prior diagnosis of depression or other mental illness. But even students with no history can start feeling depression's impact.

College students with depression experience most of the same symptoms as the other 18.8 million American adults that the National Institute of Mental Health estimates have depression.

"What you tend to see are mood and pleasure problems, a sensation that 'I'm no longer enjoying things', and there may be some withdrawal from friends or activities," says Greden. "Grades may drop, they have trouble concentrating, the reading materials suddenly become very overwhelming, and their appetite may change."

Another key component is sleep. Depressed college students may find themselves unable to sleep - and although burning the midnight oil with an "all-nighter" is a longstanding college tradition, a consistent disruption to sleep may be both a symptom of and a trigger of depression.

Often, it's a student's roommate, friend or residence hall advisor who is the first to notice that something has changed - and the first to alert the depressed student. "The person with depression is often the last to recognize they've got something going on," says Greden. Parents may be far away, and hesitant to ask too many questions about their son's or daughter's mental well-being. So it's often up to friends to raise the subject of seeking help.

More and more, colleges and universities are making mental-health resources available to students, both at the traditional campus clinics and in non-traditional settings. The U-M, for example, is educating residence hall advisors about the signs of depression, and equipping them to help steer students toward treatment.

That treatment can include psychotherapy, a term that describes several kinds of specialized one-on-one or group counseling or "talk therapy" with a trained specialist, and medications.

Often, a combination of the two is what it takes to help a person with depression. The psychotherapy helps give patients strategies for dealing with events, conflicts and relationships in their lives, which can often set off an episode of depression. The medications can balance the levels of brain chemicals, or neurotransmitters, that are disturbed in depressed people.

The key to helping someone with depression, or helping yourself, is acting early, Greden says.

"If depression isn't caught in the earliest stages, it tends to worsen in its severity. As a person enters the second, third, or fourth episodes it tends to get a little deeper each time," he explains. "It also tends to get a little closer together in time, so instead of a gap of seven or eight years, you end up having episodes two years or even one year apart. As this happens, the condition becomes harder to treat, and doesn't respond to treatment as well. For all of these reasons, catching depression in its early stages is absolutely vital."

Greden sees hope in the growing awareness, and availability of help, on college campuses. Recent studies have shown that campus counseling centers are seeing far more students with depression, suggesting both that more students are arriving on campus with a previous diagnosis and a knowledge of their own vulnerability, and that newly depressed students are turning to increasingly busy campus mental health resources.

But campuses across the country have also seen an increase in suicide attempts and suicides among students - indicating that many students are not getting enough help. That's why the U-M Depression Center is working to spread the word to colleges nationwide about proven programs and the need for more on-campus resources. In fact, a second annual "Depression on College Campuses" conference is being planned at Michigan for March 9 and 10, 2004.

But parents and students must also help in the effort to combat the effects of depression. Those students with a history of depression who are getting ready to head to campus should plan now to prevent a recurrence, by sticking to a schedule that won't leave them worn out and tired, a budget that will keep their financial worries at bay, a plan for regular communications with family members and friends, and a strategy for avoiding excessive alcohol use or drugs.

And those with no history should remember that depression could still happen to them or to their friends. "The important message is, it's an illness, and it's very treatable," says Greden. "Go get some help - it works, and it works especially well if you intervene early and treat it effectively. If that's done, it should not interfere with the goals of your life."

Information on depression and college students:

• Depression is a real disease based in brain chemistry, genes and emotions. Hormone and brain changes in teens and young adults can increase the risk of developing it.
  
• Symptoms of depression include sadness; anxiety; decreased energy or fatigue; loss of interest or pleasure in usual activities; sleep disturbances; appetite and weight changes; feelings of hopelessness, guilt, and worthlessness; thoughts of death or suicide, or suicide attempts; difficulty concentrating, making decisions, or remembering; irritability or excessive crying; and chronic aches and pains not explained by another physical condition.
  
• Stressful events and experiences, or lifestyle changes, can trigger episodes of depression.
  
• As many as 15 percent of college students may have symptoms of depression, and about 10 percent of college students arrive on campus with a history of depression.
  
• More than 18 million American adults have depression, and many of them first experienced symptoms in their teen or young-adult years.
  
• Untreated depression is one of the most disabling conditions, according to the World Health Organization, interfering with a person's ability to learn, work, socialize and enjoy life.
  
• Depression treatments include psychotherapy with a trained professional (also known as "talk therapy" and "counseling"), and medications to balance brain chemistry. Early detection and treatment can prevent depression from worsening over a person's lifetime.

Learn more on the World Wide Web at:

U-M Depression Center:
www.depressioncenter.org

National Institutes of Mental Health, college depression: www.nimh.nih.gov/publicat/students.cfm

Written by Kara Gavin

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