For Taylor, anxiety and depression have always been unwanted companions. The two forcibly linked arms with her when she was a young child, refusing to leave her side ever since.
Early on in middle school, as Taylor, who asked that her real name not be used, was balancing schoolwork and a passion for the bass guitar with being the victim of bullying. The unwanted pair reinforced themselves, infecting her mind with “extremely morbid and suicidal thoughts,” she said. They followed Taylor into high school, making her feel “trapped” and “overwhelmed”.
At 15, Taylor was sent to the therapist who would provide a path to relief. Almost three years of consultations followed before Taylor was referred by this therapist to another who prescribed her a series of medications at age 17. Some made things worse and, finally, some made things better.
Now a psychology major at Central Connecticut State University, Taylor is a quiet student. She does well with all but her participation grades. She rarely raises her hand and speaks primarily only when spoken to—a symptom of the severe social anxiety that has plagued her since childhood, though treatment has improved how she’s able to deal with it, and her depression.
Taylor starts and ends her days with medication: one Xanax pill in the morning before class to alleviate her anxiety and two Cymbalta pills before she goes to bed for her depression. (If she takes Cymbalta in the morning, Taylor will get too drowsy to stay awake during school; she’s fallen asleep multiple times in class because of it before, she said.) She continues frequenting both therapists, receiving counseling sessions weekly to arrange strategies for dominating her demons—like joining school clubs and meeting friends—and an occasional prescription check-in.
“I think if I didn’t start going to therapy I would have no idea how to deal with my depression and anxiety,” Taylor said. “My medication is also important in aiding me in approving my moods and easing my anxiety. I don’t think I could really have one without the other. I think anyone who takes any sort of medication should also regularly see a therapist because although medication can be extremely helpful for people dealing with all types of mental health problems, at the end of the day, there’s no magic pill that can solve all of your problems.”
“Completely Saturated”
Anxiety is the most common mental health illness in the United States. The U.S. Department of Health and Human Services details anxiety as “characterized by feelings of excessive uneasiness, worry, and fear.” Victims “respond to certain objects or situations with fear and dread.” Examples include social anxiety disorder and phobias.
Forty million adults 18 and older are affected by some form of anxiety every year, with only 36.9 percent of them receiving treatment, according to the National Institute of Mental Health.
According to an annual survey conducted by the Association for University and College Counseling Center Directors, anxiety has overtaken depression as the main reason why students seek counseling services, jumping to 50.6 percent in 2016 from 36.8 percent in 2009. Additionally, the American College Health Association’s Fall 2016 Executive Summary reported that 61.9 percent of college students surveyed “felt overwhelming anxiety” at one point in time. The same executive summary saw 39.1 percent of students surveyed as having “felt so depressed that it was difficult to function.”
Some who suffer from untreated depression experience a recurring sadness so incapacitating that it can flip an otherwise normal life on its head. Those affected might turn away from activities they used to enjoy, they might lose days and days of sleep, and some are plagued with thoughts of and the desire for death. Depression left untreated can be a life threatening condition
Depression is classified as the “leading cause of disability worldwide” by the World Health Organization, estimating that more than 350 million people are suffering globally, with the U.S. Department of Health and Human Services stating more than 20 million are currently fighting it in the country.
Photo by Ryan Callinan
These numbers come as no surprise to individuals like Marisol Cruz Meléndez, associate director of the Health Services division of CCSU’s Student Wellness Services and a nurse practitioner. She has witnessed the rising number of students coming in for assistance firsthand.
“What we have seen, historically, every year, is that there seems to be an increase in the amount of students seeking services from us,” Meléndez said in an interview, her gentle voice and optimistic demeanor befitting of her profession. “I’ve been here eight years and every single year we’re seeing more and more students. I suspect that a lot of it has to do with the additional responsibilities that students carry nowadays. Granted, students are much more forward about talking about mental health and behavior health [than before].”
The soar in demand for services and in the number of students affected by anxiety and depression can’t be pinpointed to a single origin. Meléndez suggested potential culprits such as overflowing plates of tasks being overwhelming. She also believes sometimes students make the mistake of relying on technology to solve problems, rather than taking a more active role in problem solving.
However, it’s also true that depression and anxiety are natural reactions to triggering situations and can also be attributed to multitudes of other factors, according to Sarah Amenta, an advanced practice registered nurse with a speciality in psychiatry at Hartford Hospital’s The Institute of Living.
“Genetic and environmental factors can increase the chances of depression and anxiety including past abuse, certain medications, conflicts and disputes, death or loss, serious illnesses, and substance abuse,” Amenta wrote in an email interview. “Everyone will experience times when their mood is lower. Mood symptoms that become more constant, more chronic, disturb your social life, interfere with your work or classes, or cause more distress might be an indicator of a disorder. I’ve had patients say they questioned: ‘Is what I am feeling normal?’ ‘Do other people feel and think this way?’”
Meléndez encourages students to continue coming in for help, but the influx is emblematic of a bigger problem—her colleagues have told her their workdays are “completely saturated with appointments and students coming in to schedule appointments,” indicating a stalemate in supply as the demand for help inflates exponentially year-to-year.
“It is no secret that we have quite a few students on campus that do require medications that help them with their quality of life,” Meléndez noted. “I don’t think anyone on campus is free from behavior health [problems]. I think that, for some of us, it’s harder to be able to control some of those symptoms without the addition of a medication.”
The most common medications prescribed to CCSU’s students, according to Meléndez, are Zoloft, Lexapro, and Celexa—Zoloft is the most popular, as it is aimed toward college students and adolescents.
“It is really important that they not be just on medication,” Meléndez emphasized. “We strongly encourage that they see a therapist. With any type of behavior health condition, you need the dual therapy.”
Amenta agreed, stating that the inclusion of psychotherapy, exercise, nutrition, and sleep are important and effective in treatment.
“Medication can be helpful in the treatment of both depression and anxiety to help to regulate chemical imbalances in the brain. I am a firm believer in assisting patients with making lifestyle changes along with the use of certain medications to treat depression and anxiety,” she detailed.
“Adequate Treatment”
Dr. Jonathan A. Pohl, coordinator of CCSU’s Office of Wellness Education, is helping students battle their anxiety and depression as a one-man show; he is the only permanent person in his department.
Photo by Ryan Callinan
His office itself is disproportionately small in relation to the number of clients who flood in and out of it and is stuffed with resources overflowing from boxes and shelving. The office across the hall—where students come in to schedule appointments—is even more cramped, shared by two desks and the two assistants inside that work there.
However, like Meléndez, Pohl recognizes the significance of his department’s existence, no matter how limited: it provides easy access of treatment and medication for students on campus. The Office of Wellness Education, a branch of Student Wellness Services, is a toll-free bridge for students to cross to seek relief.
“[Students] need to have access,” Pohl said in an interview. “It’s extremely important for people who are suffering from any mental health issue to have access to adequate treatment.”
“Adequate”, in Pohl’s opinion, would include an on-campus provider to fill prescriptions, a psychiatrist to write prescriptions, and more counselors and staff. As of now, students are referred to off-site evaluators, either at The Hospital of Central Connecticut or the University of Connecticut Health Center.
Dr. Lawrence Haber, director of the Ambulatory and Young Adult Services programs at The Institute of Living, said that The Institute of Living has a “collegial and referral relationship” with CCSU where students can receive the services the university is not able to provide.
The medication students acquire through this process is vital. According to Pohl, it “creates a balance in the neurotransmitters in the brain” so that those suffering feel an equilibrium of their emotions as one without anxiety and depression would feel, putting them in a position to benefit from psychotherapy.
Amenta further explained that these medications are designed and used to treat “target” symptoms: a specific symptom of an illness that should respond to a specific medication.
The university offers students who refuse prescription medication alternative treatment options. Pohl noted that these afflicted students must strive to “create structure in their lives.” Health Services and Wellness Education will work with such students to develop a plan to succeed in that goal. Anything that allows victims to “gently push themselves out of the depression or away from the anxiety,” such as exercising regularly or following through on a small, daily to-do list, can be helpful, and is encouraged.
“It has to be a gentle process, though,” Pohl said of these substitutes. “There’s no ‘snap’ and everything’s fine.”
At this time, students are not able to access both medication and therapy through on-campus resources at CCSU. According to Meléndez, many students already have some form of off-campus support and having them transition to any kind of new dual therapy would “dissect” their current plans and disrupt their progress. Yet, both Health Services and the Office of Wellness Education are in a position to help students get the help they need, even though resources are limited.
In the case of students like Taylor, these treatments are necessities. Even those students who do not struggle with anxiety or depression on a day-to-day basis may need treatment and support on occasions, particularly during times of high stress.
“If you can’t admit you’re having some problems, it’s hard to get the help you need,” Haber said. “All of these kinds of issues don’t have to last. They’re all problems that can be extensively treated.”