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Depression

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What is depression? Low moods are a normal part of life but usually they are brief episodes that don't interfere with our full participation in life. By contrast, depression is more severe or prolonged than the usual range of sadness which most people experience. It's a condition which, when untreated, makes many of its sufferers find facing life very difficult. They can't "snap out of it" any more than a diabetic can regulate his or her blood sugar using willpower alone.

College students, depression and sleep: As many as one in three college students experience depression severe enough to impair function during the undergraduate years. Most college students who commit suicide are depressed, and suicide is the second leading cause of death among college students. As many as 10-20% of college students threaten or attempt suicide during their college years.

In college students, depression is two times more common than in the general population, affecting approximately 20% of students. Researchers believe that lack of sleep contributes to this high rate of depression in college students. Attending college increases the incidence of both sleep problems and depression.

Sleep disturbance for more than two weeks is a risk factor for developing depression. More than 80% of individuals who suffer from depression also have sleep abnormalities, and if sleep problems persist after depression has subsided, the risk of relapse and even suicide increases. For more information, see Sleep: Snooze or Lose.

Depression around the World About one in five people around the world experiences depression that impairs normal function. Most cases of depression are diagnosed in people 20-50 years of age but depression in adolescents and the elderly is on the rise. The World Health Organization reports that depression is the second most serious cause of disability and shortened life in industrialized countries. Only heart disease is more damaging to Americans' overall health and productivity.

Causes Most depression may be attributed to more than one cause. In some situations, no source may be identified. Some causes include:

  • Family history of depression or alcoholism
  • Genetic predisposition (genes yet to be identified)
  • Life stressors (e.g., job loss or other financial setbacks, death of a family member, poverty)
  • Alcohol and other drug use or abuse (including prescription medications)
  • Medical problems such as hypothyroidism or congestive heart failure
  • Environmental factors such as seasonal changes in light levels
  • Sleep deprivation or upsetting the circadian rhythm (the 24-hour biological clock that regulates body/mind processes) — see Sleep: Snooze or Lose.

Symptoms Depression is not just one disorder. Clinicians classify depressive disorders depending on factors such as severity, duration, the presence of other medical problems and association with life-stress events. However, all depressive disorders are identified by the presence of some combination of the following symptoms that represent a change from a person's usual mood or behavior:

  • Depressed or irritable mood most days for the majority of each day
  • Total or very noticeable loss of pleasure or interests most of the time
  • Significant change in appetite, weight or both
  • Sleep disorders (insomnia or excessive sleepiness) nearly every night
  • Feelings of agitation or a sense of intense slowness
  • Loss of energy and an overwhelming feeling of tiredness
  • Sense of guilt and worthlessness nearly all the time
  • Feelings of hopelessness and helplessness
  • Inability to concentrate nearly every day
  • Recurrent thoughts of death or suicide

If you suffer from any of these symptoms—even for a week—please consider getting help. You don't have to "go it alone!" See For More Information.

Types of Depressive Disorders Professional assessment is essential for accurate diagnosis. Before assuming that you have one of these conditions, remember that depressive symptoms can also be caused by other mental disorders, medical conditions or alcohol or other drug use.

Major depressive disorder (MDD), a common form of depression, is diagnosed if a person experiences five or more of the symptoms of depression for a period of two weeks or more. MDD also requires that symptoms include either depressed mood or loss of pleasure.

Dysthymic disorder (DD) is essentially chronic, low-intensity (two or more symptoms) depression that continues for more than two years.

Seasonal affective disorder (SAD) has many of the same characteristics as MDD but occurs in a cyclic pattern associated with changes in the seasons. Most sufferers of SAD usually experience depressive symptoms in the winter months associated with reduced sunlight. For more information, see Seasonal Affective Disorder.

Premenstrual dysphoric disorder (PDD) affects 3-8% of reproductive-age women. To be diagnosed with PDD, a woman must experience at least five of the symptoms listed, during most of her menstrual cycles, starting about one week before and tapering off towards the end of her menstrual periods.

Bipolar disorders are a group of mood disorders that are related to depression but which differ from the depressive disorders in some important ways. People with bipolar disorder cycle between depressive episodes and manic episodes in which mood is extremely, even dangerously, elevated. Moods cycle between these two "poles", hence the term "bi-polar".

Adjustment disorders are fairly common among younger adults. They are diagnosed when identifiable life stressors cause a person to become depressed for up to six months. Family problems, relationship problems, living away from home for the first time, academic problems and many other issues could cause a person to experience an adjustment disorder.

Some people suffer depression in ways that don't fall precisely into these categories. Such people can still be helped by mental health professionals. The sooner you get help, the sooner you can start a course of treatment to help you feel better.

Treatment Fortunately, depression is treatable using a variety of approaches, including medications, psychotherapy and light therapy (for seasonal affective disorder).

The psychotherapeutic and pharmaceutical treatments currently available are up to 80% effective at reducing or eliminating depressive symptoms. Consultation with a clinician is important because he or she can help you to decide what treatment option will be best for you and screen for other relevant medical conditions. Depending on individual preferences and the severity of the disorder, a clinician can prescribe medication and/or refer to a psychotherapist or psychiatrist for further evaluation and treatment. See For More Information for resources.

Self-care is an important part of managing depression. Exercising, eating well, avoiding the use of alcohol and other drugs and sleeping enough all aid recovery and may prevent recurrences. Exercise alone has been shown to decrease depression.

Frequently Asked Questions

How can I help a friend who is depressed?
See Helping a Friend for suggestions for talking to a friend about depression or other concerns.

What place do medication and psychotherapy have in the treatment of depression? 
Several forms of psychotherapy and interpersonal therapy are as effective as medication for treatment of mild to moderate depression. People with severe depression tend to respond best to either medication or a combination of medication and psychotherapy.

How long will I need to take medication before I feel better? 
Some medications may show effects within two weeks but full effects aren't usually expected for up to eight weeks. Also, be sure to ask your clinician about side effects.

Can I stop taking medication once I feel better? 
There isn't a standard and short course of treatment for managing depression. If you have never experienced a depressive episode before, your clinician may find it appropriate for you to stop taking medication after 6-12 months. The more depressive episodes you have experienced, the more likely it is that you will experience another episode. Current guidelines suggest that if you have had three or more episodes, you are better off not stopping your medication regimen.

Will I be on medication for the rest of my life?
While it may be uncomfortable to consider taking medication indefinitely, many people feel it's a better option than repeated bouts of depression. Also, psychotherapeutic treatments can be almost as effective as medication. Antidepressants can help depressed people the way that eyeglasses can help nearsighted people. Both are tools to help people function more effectively.

How effective is St. John's wort as treatment for depression?
St. John's wort contains a chemical similar to antidepressants called selective-serotonin re-uptake inhibitors (SSRIs). Because St. John's wort is considered a nutritional supplement, its production is not regulated by the US Food and Drug Administration. If you take preparations of St. John's wort, you have no way to know what dosage of anti-depressant you are taking, or whether the dosage in one bottle will be the same dosage as in the next bottle. Be careful if you are taking oral contraceptive pills or HIV medications because St. John's wort may make them less effective. In addition, it makes some people hypersensitive to sunlight. St. John's wort should not be taken with prescription antidepressants. Please consult your doctor regarding medication effects and interactions.

Can alcohol or other drugs take the edge off my depression?
Many people experience an initial sense of relief in response to ingestion of alcohol or other drugs, but these feelings are very short-term responses. Actually the use of alcohol and other drugs may make depression more severe. Withdrawal from cocaine and amphetamines, as well as some other drugs, often includes lengthy depressive symptoms.

For more information:

MI Talk is a website for UM students with mental health resources such as online screenings for depression and anxiety, skill-building tools, and recorded workshops, lectures and relaxation exercises.

UM Counseling and Psychological Services is students' primary campus resource for mental health services. Use their online screening tool for depression (link to Common Concerns, then Online Screening)

UM University Health Service provides medication management of common mental health issues. 734-764-8320

CampusMindWorks supports UM students who have been diagnosed with an ongoing mental health disorder. This site provides information and resources to help students manage their illness and get the most out of their college experience.

UM Psychological Clinic provides "affordable, confidential assessment, counseling, and treatment with specialty services for anxiety, couples' therapy, and adult ADHD and Learning Disabilities." Accepts some insurance plans including Premier Care and GradCare, offers sliding-fee scale.

UM Mental Health Resources links to campus and local resources.

Resources for Stress and Mental Health lists additional campus, local and national resources.

UM Depression Center
734-936-4400
Education, treatment and prevention for clinical depression. Treatment available on a fee-for-services basis (accepts some insurance plans). Produces Beyond Sadness, a brochure on depression in 12 languages. Also offers free workshops and support groups.

National Institute of Mental Health 301-443-4513 or 866-615-6464 (toll-free).

Mental Health America 800-969-6642 offers a Factsheet on Depression in College.