From the issue dated February 14, 2003
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Prozac CampusMore students seek counseling and take psychiatric medicationBy JEFFREY R. YOUNG It's almost trendy to have psychological problems, says Eve Kidd. The first-year
"In high school, my friends would compare whether they were on Zoloft or Paxil or Prozac," Ms. Kidd says. "One of my friends had a key chain that said 'Smile if you took your Prozac today.'" Recent studies and surveys confirm a sharp rise in the number of college students taking psychiatric medication, with an increasing number of students already diagnosed with depression and other psychological problems coming to campuses. And more students than ever are using campus mental-health services, leading some colleges to hire more counselors over the past few years. College officials are also reporting a rise in more severe mental-health problems, such as bipolar disorder. Hoping to identify students who need help but might not seek it themselves, some colleges are training professors and resident assistants to identify signs of psychological disorders, and they are coordinating efforts of various student services to help keep students from slipping through the cracks. Some see the rise in reported mental-health problems as a sign that college has become more stressful, as more students juggle work, academics, extracurricular activities, and complicated family issues. But others worry that some students are popping pills unnecessarily, or that they are taking drugs without also seeking therapy to work through underlying problems. "We want quick fixes to things, and we don't want to take the time to develop long-term relationships with people," says Gertrude C. Carter, director of psychological services for students at Bennington College. "We work against having medication used in the Olympics," she says, so why should medication be allowed to "increase performance in school"? Seeking Help A study published this month in Professional Psychology: Research and Practice highlights the changes that college counseling centers have faced in the past decade. For the study, which is one of the largest of its kind, campus mental-health officials at Kansas State University carefully tracked the types of cases they saw from 1989 to 2001. During that period, the number of students with depression doubled, and the proportion of students taking psychiatric medication rose from 10 percent to 25 percent. The number of suicidal students tripled. "A big part of it is that students just are experiencing more stress, more anxiety, more depression than they were a decade ago," says Sherry A. Benton, assistant director for training at Kansas State's counseling center, who led the study. "Over the years, college has come to feel more competitive, and it's a bigger struggle financially to get through college. I think those are probably big factors." In a national survey of counseling directors at 283 colleges, 95 percent reported seeing more students on psychiatric medication than in previous years. Most colleges reported that about 18 to 20 percent of those who sought counseling were already on medication. Elite colleges report a greater share of students on psychiatric drugs than other institutions, says Robert P. Gallagher, who led the survey of counseling directors. Mr. Gallagher was the director of the University of Pittsburgh's counseling center for 25 years, and continues as a psychologist at the center. He points out that elite colleges offer a broader range of mental-health services, which could account for the difference. Of the 2,000 students who sought counseling at Harvard University last year, for instance, more than 1,000 received a prescription for an antidepressant, according to a report in the May 2002 issue of Psychology Today. "There is definitely a rise in the instances of mental-health problems," says David S. Rosenthal, the director of Harvard University's health services. Like many other colleges, Harvard has increased its staff to deal with the demand, adding five full-time positions to its counseling center in the past four years, bringing the number to about 23, Dr. Rosenthal says. Cultural Shifts One reason for the increases is a greater willingness by family physicians and other doctors to prescribe psychiatric drugs to students in secondary school. One large health-maintenance organization shows more than a threefold increase in prescriptions for psychiatric medication for people under 20 years old between 1987 and 1996, rising from 18.6 people out of every 1,000 to 59.1 out of every 1,000, according to a study by Julie Magno Zito, associate professor of pharmacy and medicine at the University of Maryland at Baltimore. "It used to be that we were much more careful and wary about prescribing drugs to kids, but that's just not true anymore," says Jeffrey Winseman, medical director of health and psychological services at Bennington College, where around 40 percent of students who seek counseling are already taking some kind of psychiatric medication. And taking Prozac or other medications is far more socially acceptable than it used to be, according to college students. "Everybody knows somebody who's taking something," says Ree-chik Chatterjee, a senior at Duke University, who knows several people on antidepressants, though he does not take them himself. "As a result, it's become pretty much the norm, and it's not looked down upon." Ms. Kidd, of the University of Missouri, heard so much talk of depression around her that she wrote a column about it in The Maneater, the student newspaper. "It's just weird, the way this once-stigmatized condition is becoming sort of a trend, like slap bracelets or Capri pants," she wrote. Ms. Kidd has never taken Prozac or any similar medication, but she says she sought therapy when she arrived at college, at the recommendation of her parents, who thought that it would help her adjust to life away from home. She attended a one-hour therapy session every other week for 10 weeks, and she says it helped. Some worry that as demand for mental-health services increases, colleges short on staff members will only further the trend toward more medication and less therapy. Though many counseling centers require therapy along with medication, others simply refer students to area doctors after initial visits. "There's a lot of discomfort about what to do" about the increases in medication on campuses, says Leighton C. Whitaker, editor of the Journal of College Student Psychotherapy, and an adjunct clinical professor of psychology at Widener University. "It's a touchy issue." This past September, mental-health officials from nine colleges in the Northeast gathered to voice concerns and share strategies during a conference called "The Escalating Use of Medications by College Students: What Are They Telling Us, What Are We Telling Them?" At the conference, Dr. Winseman and Ms. Carter of Bennington, which co-sponsored the conference with a therapy center in Stockbridge, Mass., argued that college counselors should think more carefully before prescribing medication. "We do not accept that our students are 'sicker' because they arrive with diagnostic labels and medications in hand," they wrote. And some physicians may be diagnosing students as depressed or hyperactive when they simply show signs of adolescent development, such as rebelliousness, they added. "I would hope that colleges would really take every means possible to really require psychiatric evaluations and not just simply renew the medications," says Dr. Winseman. "Growing up involves a lot of regression off and on, and the ability to collapse and fall apart," says Ms. Carter. "You want time out, and you want people to come and comfort you, and you want to be young. Students are not allowed to do that anymore." Other college health officials, however, see the popularity of psychiatric medications as largely positive. "The advent of psychotropic medication over the last 20 years has made it possible for students with those types of problems to come to school, where in the past they would not have been able to come to school," says Gregory Snodgrass, assistant vice president for student affairs and director of the counseling center at Southwest Texas State University, which has also seen increases of students seeking help. "The medications now are so good that we can treat depression Ö and it doesn't have that many side effects." Peter D. Kramer, a clinical professor of psychiatry at Brown University and the author of the bestselling book Listening to Prozac, says he is less worried about prescribing antidepressants to students than he once was. "Within the profession, these medicines are looking rather better," he says. "Treating depression early and vigorously is just looking like a good strategy." Even so, Dr. Kramer says that colleges should make sure therapy remains part of the treatment picture. "Adolescence is confusing enough, and with the transitions students encounter then, it's almost the ideal moment for psychotherapy." Side Effects At some colleges, the rise in mental-health problems also means changes in other areas of student affairs. "It affects a wide range of places where students interact with the institutions" says Kevin Kruger, associate executive director of the National Association of Student Personnel Administrators. Among them are dormitories, fraternities, and student affairs. "You really need to have a more-coordinated approach to mental health than just waiting for students to show up at the counseling center." Mr. Kruger points to Bentley College, in Waltham, Mass., as a model of such coordination. Each Monday morning, officials from student affairs, the counseling center, health services, residential life, the multicultural center, campus police, and student judicial affairs meet for a "safety net" meeting to talk about events of the weekend. Early Detection "There may be a student who's been coming to the health service for stress-related issues or who may be unable to sleep," says Geraldine Taylor, director of student health services at Bentley. "And at the meeting they bring up that [the same student] has been involved in an incident where they've had a lot of alcohol and they've been taken to the emergency room." Ms. Taylor says that officials would then call the student to recommend counseling or other support. Students who seek counseling or other medical services are asked to grant the institution permission to trade information about them with other campus offices, and most students oblige, says Ms. Taylor. "We try to get on top of problems before they become larger problems," she adds. Some college officials have also started to think about counseling services and medication issues for their study-abroad programs, after noticing an increasing demand for such services. "We identify capable physicians and counselors in the host cities where we send students," says David C. Larsen, vice president of Arcadia University and director for its center for education abroad, who adds that officials also work with students to make sure they have enough medications for their stay or know how to get more. "We weren't doing this 15 years ago." Some colleges are also working on raising awareness of their mental-health services. At Harvard University, where students can get free massages in their dorms, officials run a series of health workshops each spring called "Caring for the Harvard Community," which focuses on reducing student stress. Mr. Snodgrass, of Southwest Texas State University, says he hopes to start a "wellness" program that emphasizes similar themes. "Part of our mission ought to be to share that information with students," he says. "We ought to be helping students live happier, healthier lives ... and not spend almost all their time figuring out how can they secure their material wealth." 
http://chronicle.com Section: Students Volume 49, Issue 23, Page A37
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Copyright © 2003 by The Chronicle of Higher Education