Under pressure

Suicide is currently the second leading cause of death among college students. And for many people, that's a scary statistic.

While there are many factors that may lead a person to take his own life, the most dominant one is mental illness -- two-thirds of all people who commit suicide are depressed.

"It's definitely a real-life thing," Engineering freshman Nick Gianos said after the suicide of a classmate. "People do commit suicide."

For one student, who will be referred to as "Sarah," coping with mental illness has been an ongoing battle, a battle that began with the ability to recognize her own condition. Despite inquiries from concerned family and friends, it took a steep escalation in the severity of her disease for her to come to grips with the depression.

"It wasn't until several months and many sleepless nights and nights of just sobbing uncontrollably that I was finally able to see it," she said.

Coping with the suicide of a peer is a difficult process as well, regardless of one's relationship with the victim. A range of normal emotions follow such a tragic event; some may express feelings through anger, while others may take time to ponder the profound loss. And still others may choose to carry on as normal.

"At this point, the community's really in shock because you don't expect someone to do this," said Ilene Rosenstein, director of the Office of Counseling and Psychological Services.

"People get very fearful. They don't want this happening again," she added, sitting in a seminar room in Hamilton College House Saturday afternoon. Rosenstein, along with two other CAPS staff members, waited calmly in the small room to comfort students in need of someone to talk to in the aftermath of Joseph's suicide.

CAPS staff members upped their availability in recent days to help students cope with the loss of a fellow student.

"These things you don't have to deal with alone," CAPS social worker Marilyn Silberberg said. "It is a big University community and there are a lot of people on campus who are trained, interested and willing to help people out."

While coping with a recent suicide should not plant the idea in the minds of most people, it can be enough to drive someone already contemplating suicide to follow through with an attempt.

"Obviously it's a shock to every young person around," said Ellen Frank, professor of psychiatry at the University of Pittsburgh. "But the only young people vulnerable to imitation are the people who are already depressed and vulnerable themselves."

For students coping with depression, peer support can be invaluable in providing the knowledge that you can lean on others and have a sympathetic and nonjudgmental ear there to listen.

Gianos knows this firsthand. While growing up, one of his best friends was diagnosed with depression. Gianos said that he began noticing a change in his friend's mood, and became concerned when he began hurting himself with scissors and keys.

Depression is a disease that more and more college students are reporting. A recent survey noted that 10 percent of college students are diagnosed with depression, which strikes more than 17 million Americans each year.

Since depression is both biological and psychological in nature, many factors can contribute to its onset. A genetic predisposition, along with academic pressures, troubled relationships, drug and alcohol use and a society that preaches an entitlement to happiness have all been cited as factors that can push students over the edge, though experts still debate the validity of each.

"Almost any change in your life, good things or bad things, but mostly bad things, can trigger" depression, said Neal Ryan, a University of Pittsburgh psychiatry professor.

For many students, college brings additional stresses and pressures. Being away from home for the first time, along with the responsibility of forming new friendships, can be a lot for students to deal with. Students no longer have their best friends to eat lunch with everyday, and some are forced to sit by themselves in class for the first time.

"Just being on your own and having to deal with everything; it's more like a real-life situation than being home under your parents' protection all the time," Gianos said.

Rosenstein said that college life introduces decision-making on a daily basis. Simple things like what to have for dinner or coping with not getting the classes you want can sometimes be the straw that breaks the camel's back.

Sarah explained she only acknowledged her problem once she entered college and was forced to experience things alone for the first time.

"I am someone who has had mild depression probably for three years, but I had a support structure in place," she said. "So if I was feeling sad or like I had no future, it didn't matter... someone was always there to make me smile somehow."

"When you go to college for the first time, no one is accounting for your every minute, and there is that time spent alone just thinking," she added.

Along with an adjustment to college life comes a more realistic evaluation of oneself. It's hard for some students to come to grips with the fact that they can no longer be star athletes, editors of the newspaper and still maintain perfect 4.0 GPAs.

"People come to Penn who are stars in their high schools, and suddenly they're not stars here," said Jacques Barber, associate professor of psychology in the Department of Psychiatry.

The CAPS office is tucked on the second floor of the Mellon building on Walnut Street. The facility is dimly lit, with a spacious waiting room with two blue spotted couches. Next to one of the couches is a small table piled with magazines for students to read -- In Style, The New Yorker and Newsweek, to name a few.

Each year, 10 percent of the student population will seek help from this office, a substantial increase from a decade ago.

"Emily," who sought help from CAPS for an eating disorder and was subsequently diagnosed with depression, said that her experience with the University's counseling service has been extremely positive.

"I think if anything, people should take advantage of it," she said. "I thought it was such a great resource."

In a time when students are striving to create a sense of autonomy, the confidentiality that CAPS assures its patients is often an important factor in a student's decision to seek help.

"I wanted to get psychological help, but I didn't want to go to my parents," Emily said.

Last year, depression was the third most common reason for students to seek services at CAPS, with anxiety -- often related to depression -- being the most common. While more and more students are feeling comfortable taking advantage of the services CAPS offers, many are still not getting the help that they need.

In the general population, two-thirds of those who suffer from depression do not get help. Some suspect that those numbers may be even higher among college students. Many students are afraid to admit that they are depressed, or feel that they are not entitled to be depressed.

People "think, 'Here I am at this wonderful school, how could I be depressed? I don't have a right to feel depressed,'" said Dana Crowley Jack, a professor at Western Washington University.

Sarah, for example, has often questioned the validity of her disease.

"Really when you're having a depressive episode, you're wondering if this is really a disease or is this just me," she said. "The whole thought is 'I've made up this whole nonsense of having depression.'"

Many students also fear the potentially awkward moment of being discovered by a classmate, date or even a friend in the CAPS waiting room. In a University where students generally appear to be in control both mentally and physically, it's hard for students to let others know that they're not.

"I was really paranoid that people would ask me what I was doing and where I was going," Emily said. "I remember hoping that I didn't run into anyone I knew."

And still, other students delude themselves into thinking that their depression will simply go away, attempting to self-medicate, thinking that if they pay more attention to their diet and sleep patterns, feelings of isolation and despair will somehow magically disappear.

But many do seek help. Once students make this initial decision, they have an introductory meeting at CAPS with a counselor to explain their situation. In most cases, they are paired with a more permanent counselor and may be referred to a downtown facility. CAPS is also equipped to offer students prescriptions for anti-depressant medications.

There are two different major approaches to treating depression -- psychotherapy and medication. Researchers are still trying to determine which method is the most effective.

Sarah said that her treatment with medication instilled in her a sense of uneasiness.

"I think that fear is kind of a constant for someone who is on medication for a long time because there is always the chance that it is going to stop working," she said.

Though she lauds her current therapist, Sarah had a poor experience with CAPS when, in the height of a depressive episode, a former therapist didn't return several phone calls in one week.

"As hard as I thought I was trying, I thought that nobody was listening."

Even though the most effective treatment for depression is not clear, what is clear is that the disease is treatable. More than 80 percent of those treated for clinical depression significantly improve their lives.

"It's a very common disorder, it's very treatable and it's often part of a major life transition," Jack said. "And that's what happens at college."

Despite effective treatments, depression is a recurring disease, and most depressed people will experience more than one period of depression.

"Ninety-five to 98 percent of individuals who have a first episode of depression will ultimately have a second one and a third one and a fourth," Frank said.

And that's why she stressed the importance of monitoring the disease.

"If we have asthma or high blood pressure... even if we have it under control, we keep going back to check in and I think depression is the same phenomenon," she said.

Editor's note: Like all stories that appear in The Daily Pennsylvanian's Perspective section, this week's piece on depression was planned several weeks prior to publication. In light of the recent suicide at Penn this past weekend, the decision was made to stay with the original topic in an effort to raise awareness and provide members of the University community with information on the various resources available.

CAPS can be reached by phone at (215) 898-7021 or online at http://dolphin.upenn.edu/~caps.

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