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Key points
- Antidepressant use among college students has doubled in the last decade.
- Parents who have concerns about their child's response to an antidepressant should encourage their child to notify their psychiatric provider.
- Parents can support their children on antidepressants and encourage their children to seek additional forms of help like therapy and exercise.
You are looking at your insurance statement online, and you notice your daughter has a charge for sertraline (Zoloft). Isn't that an antidepressant? Why is she taking medication? Last time you spoke with her, she said she was doing well. You call your daughter on the phone and ask her why she is taking an antidepressant.
There is a pause on the other line. Your daughter says “I knew you would react this way. I knew you would be upset if I took the medication, so I didn't tell you about it.” You say, “I'm just upset you didn't tell me what's going on. Have you been depressed?”
“I've been really stressed lately. I was glad to take in-person classes this summer, but now COVID is spreading on my campus, and I'm worried that all my classes will be online again in the fall. I'm anxious all the time and I've been feeling depressed. I've been working with a campus therapist for the last six months, but I feel myself getting worse. I met with a psychiatrist who thought I could benefit from medication. And since I started sertraline, I am feeling better, sleeping better, and finding new ways to cope with stress."
You are still wondering about the medication, but you tell your daughter you support any decision she makes. You just want her to feel better. Then you wonder, Have I done something wrong? Am I the only mother with a college student on an antidepressant?
You are not alone. In the last decade, past-year antidepressant medication use in college students has nearly doubled, from 8.0% to 15.3%, according to research I did with colleagues using the Healthy Minds Study. This increase may be explained both by rising rates of depression and decreased stigma in the college population.
I find, as a college psychiatrist, many students do not want to tell their parents they are taking medication because they are afraid their parents will feel guilty or believe their child is overreacting. If you find your child is on an antidepressant, it’s important to stay calm and learn these five facts that may ease your concern and show how you can support your child’s recovery.
1. Antidepressants include many different kinds of medications. Sertraline is a selective serotonin reuptake inhibitor that raises serotonin levels. Other antidepressants raise norepinephrine levels or raise serotonin and norepinephrine levels. Increasing certain brain chemicals can improve mood. Besides affecting the levels of certain brain chemicals, antidepressants can increase connectivity and decrease inflammation in the brain.
2. Antidepressants can be used to treat other mental health disorders besides depression. Sertraline, for example, is FDA approved to treat depression, panic disorder, social anxiety disorder, obsessive compulsive disorder, and post-traumatic stress disorder. For people who have both depression and anxiety, certain antidepressants can effectively treat both.
3. It is usually best to start antidepressants at a low dose and increase them slowly, every two to four weeks, until clinical efficacy is achieved. This reduces the risk of side effects in students who are concerned about being sedated and want to be alert for class. Common side effects for many antidepressants include headache, upset stomach, and sedation or insomnia. Most of these side effects diminish with time.
4. Students should meet with psychiatric providers (psychiatrist, psychiatric nurse practitioner) more frequently at the beginning of treatment. This is especially true of the 18-to-24 age group that we see on campus. Since 2006, antidepressants have carried a black box warning of increased suicidal thoughts and behaviors in patients 24 and younger. Some studies conflict with this assessment, and it is known that suicidality occurs in people who are depressed. Nonetheless, it is important to inform patients who are taking antidepressants that there is a small possibility they could experience an increase in suicidal thinking on starting medication, and they should let their provider know if this happens, so a different medication can be tried.
5. Antidepressants should never be stopped suddenly. Doses should not be missed. When patients do not adhere to a regular medication schedule, they can feel worse and not fully respond to medication. Students can benefit from pill organizers to remind themselves to take their medication. If medications are stopped for more than a few days, the student risks having discontinuation effects that could include: aches, pains, dizziness, fatigue, and infrequently electric shock sensations. If your student comes home and forgets to bring their medication, they should call their provider’s office and request a short-term refill until they get back to school. For students who have recovered from depression and anxiety and feel they have the coping skills and lifestyle habits (often developed through therapy) to prevent a future recurrence, consideration can be given to slowly tapering the medication. This may occur after nine to 12 months of treatment, although someone with recurrent depression or anxiety may choose to remain on medication longer.
Medication is just one tool among many to treat a variety of psychiatric disorders including depression, anxiety, and obsessive compulsive disorder. Therapy is equally important in recovery. Cognitive behavioral therapy has been shown to teach skills that sometimes allow people to taper off medicine. Wellness practices such as meditation, yoga, exercise, and a Mediterranean diet can improve mood. If your loved one is not fully responding to medication, ensure they are taking additional steps to feel better.
Students really care about what parents think. If you have concerns about your child being on psychiatric medication, you can learn more from WebMD and NIMH. You can also ask to speak with the psychiatrist to gain more information, after your child has signed a release of information form. You are an important advocate for your child and can provide valuable feedback regarding medication response and side effects. Ultimately, the student is at the center of their treatment and will chart their own course on what tools they will use to feel better, but you can assist in that journey.
