Defeating Depression in College Students During COVID

In September, your son Avery, a college freshman, calls you. “I don’t know if I want to stay on campus. I’m having trouble making friends. Most of the classes are online, and the clubs meet by Zoom.”

In October, he tells you, “I made a friend in the dorm, but he was exposed to someone with COVID, and now he’s in quarantine. I’m having trouble learning chemistry in an online class. Maybe I should drop out.”

In November, he comes home for Thanksgiving, where he will remain until January. You’ve never seen him look so unhappy. He is sleeping all day and playing video games at night. When you ask him about his courses, he is vague and you’re guessing school is not going well. You think he is depressed.

What should you do?

A. Invite him to exercise with you every morning.

B. Recommend he follow a regular sleep schedule.

C. Urge him to speak with a therapist.

D. All of the above.

These are terrible times for everyone, especially college students. As I write this, the United States is experiencing new peaks of COVID cases, hospitalizations, and deaths. The college students I see as a campus psychiatrist are facing challenges that surpass what I witnessed during the Great Recession of 2008. While families again struggle financially and students face employment uncertainty, they now fear losing their loved ones to COVID. They contend with an epidemic of loneliness, having fewer face-to-face interactions with other students due to social distancing measures. Some freshmen find they are not forming the friendships that will support them through their college years.

How is the mental health of college students in light of these COVID-related stressors? A recent study showed that nearly half of young adults aged 18-24 were experiencing symptoms consistent with at least moderate depression, which is higher than historical norms. College and non-college students were similarly affected. Young adults were surveyed between May and October of 2020 using a screening tool called the PHQ-9. This study is limited by the fact that no structured clinical interview was conducted to confirm a diagnosis of depression. However, it highlights the distress young adults are experiencing during the pandemic.

How would a mental health professional diagnose a student with depression? They would do a clinical evaluation using criteria from the DSM-V diagnostic manual. According to the DSM-V, a depressive episode involves at least a two-week period of feeling down or losing enjoyment in activities and includes at least four of the following symptoms: weight loss or weight gain, too much or too little sleep, poor concentration, fatigue, feeling slowed down or agitated, low self-esteem, and suicidal thoughts. Symptoms cross over to a clinical disorder if they cause significant distress or impairment in daily social or academic functioning.

Avery has both symptoms of depression and difficulty functioning in school. What should Avery’s father do in response to the multiple-choice question posed earlier? D — All of the above. He can encourage Avery to exercise; 180 minutes (thirty minutes six days per week) of exercise reduces depressive symptoms. Following a regular sleep schedule is also important for recovery from depression. Seeing a therapist is critical to assess the level of depression and what Avery’s needs are.

Here is what Avery’s father can say:

“Avery, I’ve noticed you look very sad lately. I wanted to ask you how you’ve been feeling.”

“I feel awful, but isn’t that normal, given all that’s going on?”

“I think it’s normal to feel lousy right now, but this feels stronger to me, like it is hard for you to get out of bed and get work done.”

“Yeah, I’m having trouble getting up. And I didn’t tell you, but I had to drop chemistry. I just couldn’t focus. I’ll pass the other classes, but I’m doing much worse in school than I expected.”

“I’m sorry you’re having such a rough time. I really want you to talk to a therapist at your school to figure out what’s going on. I heard many counseling centers are offering services online. Maybe you’re depressed and talking will help.”

“I don’t know Dad. It’s after Thanksgiving and our counseling center says there’s a waitlist for therapy.”

“That’s not a problem, Avery. We’ll see which therapists on our insurance plan are taking new patients. I just feel the sooner you get help, the better.”

Avery’s father is right; putting off treatment of depression could lead to him feeling much worse. Anyone who is experiencing several depressive symptoms should be evaluated by a mental health professional. Here are four steps Avery can take to defeat depression.

Depression Essential Reads

When the Brain Has Difficulty Listening to the Heart

Understanding Depression and Managing It Effectively

1. Lifestyle: Exercise is an underused resource for treatment of depressive symptoms. Take advantage of the many online exercise resources and if weather permits, ride your bike or walk outside. Exercise, both strength and endurance training, increases brain chemicals that improve mood. Eating the Mediterranean diet (fruits, vegetables, whole grains, legumes, olive oil, fish, and lean meats) can reduce symptoms of depression in college students. Having a regular sleep schedule is also important in the treatment of depression.
2. Medical evaluation: Consider a medical evaluation by your primary care provider or pediatrician if you have not had a recent physical exam. Sometimes a medical illness can manifest itself in the form of fatigue or a down mood. Although most young adults are healthy, I’ve had several patients over the years whose symptoms were caused or exacerbated by medical problems.
3. Therapy: Cognitive behavioral therapy has the most evidence for treating depression, followed by interpersonal and psychodynamic therapy. All can be helpful. One of the most important factors is therapist-patient fit, so if you are not comfortable with your first therapist, you should meet with someone else.
4. Medication: An antidepressant can be considered if depression levels are moderate. Moderate depression can also be treated by therapy alone. Your primary care provider or psychiatric provider will help you decide if therapy, medication, or both would be beneficial. Severe depression is best treated by a combination of therapy and medication.

Even if one doesn’t have clinical depression, talking with a therapist during this difficult time can help. While there are concerns about a dark winter, the promise of vaccines offers glimmers of hope. If we or our children are struggling, we can find help to bridge us to better times ahead.

©2020 Marcia Morris, all rights reserved.
Details have been altered to protect patient privacy.