Psychiatric Medication and College Students

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A Tale of Two Psychiatry Sessions

When I began my career as a college psychiatrist in 1993, I would work with students like Lara, who came to see me for ongoing depression that had started a year prior after a break-up with a boyfriend. Lara had met with a therapist for two semesters, but she was still feeling down every day, lacking energy, sleeping too much, avoiding friends, and having difficulty concentrating in school. She was seeking medication as she was concerned about her declining school performance. I prescribed her Prozac (fluoxetine) while meeting with her every few weeks, and she began to feel better, reengage with friends, and do better in school. We tapered and stopped her medication after a year.

Fast forward to 2021, and more students like Liam were coming for treatment. Liam, a sophomore, had been on antidepressants since his junior year of high school after experiencing severe anxiety and depression with suicidal thoughts that led to admission to a psychiatric hospital. After getting a C in his English class at his hyper-competitive high school and worried he wrecked his chances of getting into a top college, he had gone into a downward spiral after getting a C in his English class. He had been on two different medications before he found one, Lexapro (escitalopram), that worked. Antidepressants like Lexapro (escitalopram) are often effective for both depression and anxiety. When he came to see me in my office, he reported that he was depressed and anxious again, despite still taking medication, and found the social isolation from the COVID-19 pandemic tough to bear. I prescribed Buspar (buspirone), an anti-anxiety agent which can also act as an augmenting agent to antidepressants. As we increased the dose, his anxiety and depressive symptoms lessened. He also joined an online therapy group, which helped improve his mood.

Depression and anxiety have increased in the college-age population over the last decade, and more severe symptoms have led to increased emergency room visits and hospitalizations. Furthermore, depression rates have risen in middle and high school students as well. Many thoughts about contributing to this increased distress in young people, including excessive academic competition, social media, and racial injustice. Even before the pandemic, college psychiatric providers have noticed an increase in students with severe problems and who may have already been on medication before coming to college.

Trends in Psychiatric Medication Use

How is increasing distress in college students impacting their use of psychiatric medication? To answer this question, we formed a research group to analyze data from the University of Michigan Healthy Minds study, which has conducted mental health surveys of university students throughout the country since 2007. While it was known that there were general increases in psychiatric medication use, we wanted to see which medications were increasing, if students were more likely to be on more than one kind of medication, and who was prescribing the medications - psychiatrists or primary care providers? Our recently published article in the journal Pharmacotherapy showed the following:

• Psychiatric medication use in university students doubled between 2007 and 2018-2019; now, one of four college students has taken psychiatric medication in the last year. Antidepressants, anti-anxiety medications, and stimulants were the most frequently used medications, likely reflecting that depression, anxiety, and ADHD are common psychiatric diagnoses seen in college students.
• One-third of students who took psychiatric medication were on a combination of different kinds of medications, e.g., antidepressants and anti-anxiety medications, or antidepressants and stimulants, increasing from one-fifth of students a decade ago.
• Psychiatric medications were more likely to be prescribed by primary care providers than psychiatrists, with 58.8% of these medications being prescribed by primary care providers in 2018-2019.

Given the growing complexity and severity of mental health problems on campus, it would be helpful for colleges to provide ways for students to obtain services with psychiatric specialists. However, only about half of campus counseling centers provide psychiatric services. Universities could increase access to psychiatric services by hiring psychiatric providers (psychiatrists, psychiatric nurse practitioners) to work on campus, collaborating with community psychiatrists, or working with telehealth companies. If primary care providers are prescribing psychiatric medication, it is helpful to have psychiatrists available for consultation.

If Your Child Is Taking Psychiatric Medication

Let’s say your child has had symptoms of depression and anxiety that are interfering with school and causing them great distress. They have tried to improve their mood with exercise, getting to bed on time, speaking with a therapist weekly, and getting a yearly check-up to ensure their general health is good. However, their symptoms persist, and they are considering medication. How can you be helpful as a parent in this situation?

1. Be open-minded. Medication is one of several tools (therapy, lifestyle changes) to address depression and anxiety. Let’s say someone has high blood pressure. You might recommend exercise and weight loss before starting medication, but medication is an option if these don’t work. Likewise, if behavioral changes or therapy do not work for depression, anxiety, or ADHD, medication is another tool to improve functioning.

2. Learn more. My book, The Campus Cure: A Parent's Guide to Mental Health and Wellness for College Students, describes best practices for treating common psychiatric diagnoses in college students like depression, anxiety, and ADHD. The benefits and risks of medications are also reviewed. Other sources of psychiatric medication information can be found at mayoclinic.org.

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3. Check in with your child. Ask them what medication they are taking and how it is making them feel. Encourage them to call their provider if they have side effects. If they are on more than one kind of medication, side effects could increase.

4. Encourage your student to sign a release or consent form allowing you and the provider to speak if your student has an emergency or you have concerns about the medication and you want to talk to the psychiatric provider.

5. Ensure your student is getting the level of care they need. In general, as the level of complexity in mental health problems increases, you will want a provider with more training in mental health care. For example, more complex problems may best be treated in a psychiatry clinic versus a primary care clinic.

Your child’s decision to take psychiatric medication is not an easy one, given the stigma associated with mental health treatment in general. They may be afraid to tell you, thinking you will react with fear or concern. Stay calm and listen to their point of view while encouraging them to reach out to their provider if medication is not effective or causing side effects. Your support will smooth their path toward recovery.

©2021 Marcia Morris, all rights reserved.
Details have been altered to protect patient privacy.