Andrew graduated high school near the top of his class and with an excellent academic record. He was also on drugs for most of it.
“I just did all sorts of shit that fucked up my brain,” he said before proceeding to give a long list of illegal drugs he has taken. “Even last semester I drank every day.”
But Andrew’s problem isn’t just drug abuse—he was also recently diagnosed with bipolar disorder after spending several months in counseling. Andrew, CC’12, who asked that his name be changed in order to avoid future ramifications for his career, is one of many Columbia students taking medication for mental illnesses, including major depressive disorder, bipolar disorder, and social anxiety disorder.
An American College Health Association survey conducted in 2004 on 47,202 students at 74 campuses across the country reports that the number of students diagnosed with depression increased from 10.3 percent in 2000 to 14.9 percent. Another American College Health Association study reports that in 2008, 43 percent of students had at some point in the previous year felt so depressed it was difficult to function and nine percent had thoughts of suicide.
Despite increasingly widespread use of prescription for mental illness, the decision to medicate is often difficult for many students due to social stigmas, spiritual beliefs, and sometimes serious side effects. Those that do go on medication must also choose whether it will serve as a short-term fix or as a lifelong treatment.
INITIAL DOSE
Andrew sought help from Counseling and Psychological Services (CPS) in September after feeling depressed during the first few weeks of school. Andrew recalls periods of being depressed in high school, but as he puts it, “I was too messed up to do anything about it.” But when faced with a more challenging workload and the pressures of a new environment, Andrew decided that he would need to seek help in college.
According to officials, CPS and Furman Counseling Center at Barnard are designed to be temporary resources that can provide students with rapid access to care. Often students like Andrew who have diagnosed conditions and need continual treatment are generally referred to off campus providers after immediate needs are met.
Andrew was referred to an outside psychiatrist for substance abuse treatment after several months of meeting with a CPS counselor, but his outside treatment is covered under the Columbia health insurance program, which all students are enrolled in when they pay the Health Services fee each semester. It wasn’t until December, after a very lengthy counseling period, that Andrew was diagnosed with bipolar disorder—the specific type of bipolar is still being narrowed down—and put on medication.
Mary Commerford, director of Furman, said she has seen an increase in medicated students over time. But despite what some students fear, it’s not a first option.
“We don’t typically rush to medicate at all because often psychotherapy is very effective,” she said. “It’s a clinical decision. There are certain signs, for example, in depression, when you think about meds, and that is when you see the mood state starting to affect the body’s functioning. When someone is depressed to the point where they have a sleep or appetite disturbance, that is an indicator that you may want to think about medication.”
SIDE EFFECTS
Andrew’s medication, which includes a mood stabilizer and a sedative, has so far caused him only minor side effects, and he said he takes it on schedule. Yet for many patients, psychiatric drugs can cause debilitating side effects, which cause some to quit taking their medication altogether.
Mariana, CC’09, whose name has been changed because she said she’s currently interviewing for jobs and worried about employers finding this story, took a series of anti-depressants and mood stabilizers to deal with her depression and later diagnosed bipolar disorder until the side effects proved too much to bear.
“The side effects were terrible. It ranged from sleeping all the time during the day, having no sex drive, to the worst—suicidal thoughts. These medications are supposed to make me stop thinking about suicide, right? That’s when I knew something was wrong.”
Even before she quit her medication, Mariana often didn’t take it on schedule. “It’s so difficult to adjust to these meds while fulfilling your obligations as a college student, which is why I often didn’t, “ she noted. “When I needed to stay up late to work on a paper, I’d skip a dose of one of my SSRIs [selective serotonin uptake inhibitors], which would make me sleepy. I would adjust to fit my schedule, which isn’t how these pills are designed to work.”
According to the National Institute of Mental Health Web site, many side effects of psychiatric medications are mild and many weaken or disappear after the first few weeks of treatment. Sometimes anti-depressants can increase suicidal ideation, according to the FDA-mandated black box label, and patients should be monitored regularly when first starting out.
OFF-LABEL USES
While some students may not take their medications exactly as prescribed, prescription abuse still concerns providers. But many psychiatric medications belong to a class of drugs called selective serotonin uptake inhibitors (SSRIs), which are hard to abuse. “You can’t get high from them, and you can’t really overdose on them. So they’re the ideal from that standpoint in psychiatric medication,” Richard Eichler, the director of CPS, said. “They treat symptoms, they don’t treat illnesses. Because they have such wide use, they can be used for a great number of problems students bring in.” he added.
Still, another class of medication, called psycho-stimulants, present more of a concern. These are drugs such as Adderall—which is often prescribed for ADHD but is being used more and more recreationally.
“We’re very cautious about stimulants, period,” Commerford said.
Students who come in with ADHD or similar diagnoses are generally referred out immediately, and people who are curious are carefully tested. “ADHD doesn’t just hit you at this age—you have to have a history of it—so stimulants aren’t so easily prescribed.”
The policy is as stringent at CPS, according to Calvin Chin, associate director for outreach and community clinical initiatives.
“With every student who comes in that says something about having an attention deficit disorder, we look carefully at their early history, school records, and standardized assessments to make sure the diagnosis is current,” Chin said. “It makes sure that students are diagnosed correctly, and it also limits a student coming in just because they want medication.”
“It’s a happy convergence between monitoring for off label uses and providing the best care,” Eichler added. “Students with past history of attention deficit might find the process a bit cumbersome.”
Tyler, SEAS ‘09, who did not wish to give his last name for fear of academic repercussions, said he often takes Adderall to stay up at night to write papers and read hundreds of pages. He said that he was given a prescription at CPS without a major hassle.
“Actually, I started buying from a kid who had ADD or whatever, and I decided to cut the middle man,” he said. “It’s probably impossible to regulate how people use their pills.”
LONG-TERM OPTIONS
Since Mariana quit taking medication over a year ago, she said she has not felt the need to go back on, even when she’s going through a depressive episode.
Instead, she has been enrolled in dialectical behavior therapy (DBT), a more intensive alternative to psychotherapy that focuses on learning specific, practical skills to help manage depression, relationships, and emotions. Although originally designed for people with borderline personality disorder, Mariana says DBT teaches “life skills that any emotional college student could benefit from learning.”
CPS has been offering a DBT skills class on Wednesday nights. Though DBT is a specific treatment, other students said they find seeing a therapist enough. There are also other alternatives, like yoga and spirituality.
Meanwhile, Andrew says that his medication has helped him stabilize his mood and cope with his substance abuse problems.
“They make me not want to drink as much ... I’m just more content with myself,” he said of medications, adding that he only drinks on weekends and his urge to use drugs has diminished.
Andrew’s experience with drugs and alcohol are not uncommon for people with bipolar disorder. In a National Institute of Mental Health study, more than 60 percent of patients with type-1 bipolar disorder (the most severe type) had substance abuse problems. Therefore, he said, his treatment for bipolar disorder and his treatment for substance abuse are directly related.
Despite Mariana’s decision to stop medication, she still sees it as an important first step towards recovery.
“I think there are definite ... benefits to medication,” she said. “I just don’t think they have to be lifetime treatments, you know? As a short term solution, however, they can really help.”