Do 1 in 4 college kids really need anti-depressants?

Overheard at Kenyon:

Student 1: Wait, where do you get your Adderall from?

Student 2: Chelsea, but she needs a refill soon. It’s cool, I have another hookup.

Every Kenyon student has heard conversations like this one; under-the-table Adderall (or other study drug) use has been standard practice in academia for a long time. But no one is ever sure if the stories they hear are representative or exceptional. How many Kenyon students are actually turning to Adderall to get through their classes?

I, along with psychology major Joshua Samuels, just completed a study in an attempt to quantify this anecdotal evidence that study drug use, among other forms of self-medication, are increasingly commonplace and socially acceptable as part of our college experience. Our survey was conducted online from Monday, April 22nd through Monday, April 29th and received responses from 374 students, nearly a quarter of Kenyon’s student body. We received levels of responses from various demographic groups (class standing, gender, race, etc.) that were in line with Kenyon’s student composition; given the level and nature of responses, we can be reasonably confident that our results paint a relatively accurate picture of Kenyon students’ behavior.

Attention Deficit Hyperactivity Disorder

In a recent New York Times article, it was reported that eleven percent of American children, including nearly twenty percent of high school boys, are diagnosed with ADHD. Moreover, two thirds of those who receive a diagnosis also receive a prescription for a stimulant, such as Ritalin or Adderall, in an attempt to treat the disorder’s symptoms.

Kid via Shutterstock

Kid via Shutterstock

And Kenyon is no exception. In our study, 11.7 percent of Kenyon students reported having a prescription for ADD/ADHD medication.

But some in the psychology community are becoming increasingly skeptical that such high levels of diagnoses are either necessary or beneficial. And given the behaviors of those who do have a prescription, their skepticism may be warranted. Only 30.5 percent of respondents with a prescription for ADHD medication reported taking their medication on time; a majority reported taking their medication only up to half of the times they were supposed to and students were more likely to completely ignore their medication than to take it on schedule:

Clearly, a significant percentage of students who have medication prescribed to them consider themselves perfectly able to function day-to-day without the use of their medication. And when a large number of pills are prescribed and not taken, a surplus is created. This surplus, as you can probably imagine, is used to spur academic performance:

To put these charts in perspective, if you line up ten Kenyon students, one of them will have a prescription for ADD/ADHD medication, which they probably won’t need, and at least two others who don’t have a prescription will have used such medication for the sole purpose of writing a paper or studying for/taking a test.

While an imperfect comparison, these findings are in line with prior literature, mentioned in the Times article, which pegs the percentage of ADD/ADHD medication that goes to non-prescribed friends at about 30 percent.

ADHD has historically been estimated to affect between three and seven percent of children, but, as pediatric neurologist William Graf notes:

Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.

And while current levels of diagnoses are already at record highs, the number is only expected to increase. As the Times article says:

…even more teenagers are likely to be prescribed medication in the near future because the American Psychiatric Association plans to change the definition of A.D.H.D. to allow more people to receive the diagnosis and treatment.

…The final wording has not been released, but most proposed changes would lead to higher rates of diagnosis: the requirement that symptoms appeared before age 12 rather than 7; illustrations, like repeatedly losing one’s cellphone or losing focus during paperwork, that emphasize that A.D.H.D. is not just a young child’s disorder; and the requirement that symptoms merely “impact” daily activities, rather than cause “impairment.”

There is no official test used to diagnose ADHD; psychiatrists evaluate patients based on extensive conversation with the patient, their parents and teachers. It is also common practice for doctors to allow their patients to “set their own dosage” by prescribing increasingly high levels of medication until the patient finds one that “feels right.”

Given the choice, many psychiatrists would rather wrongly diagnose someone with ADD or ADHD than to turn a patient away when they really do have a chemical imbalance. While this thinking is certainly not without merit, it opens the door for pharmaceutical companies, parents and patients to push for diagnoses that are increasingly unwarranted. When we make the (correct) choice to err on the side of caution, we must acknowledge that we are still erring.

Depression

While self-reports of ADD/ADHD prescriptions were high, 23.4 percent of respondents reported having a prescription for an anti-depressant, twice the rate of ADD/ADHD prescriptions.

The Center for Disease Control estimates that depression rates for Americans over the age of twelve is around eight percent.

It is possible that there is something inherently depressing about going to Kenyon, or about the lifestyle one must lead in order to get accepted to a college like Kenyon. But this explanation, on its face, doesn’t seem strong enough to account for a quarter of the student body. As seems to be the case with ADD/ADHD, it would appear that depression medication is, at least in part, being over-prescribed.

After all, one in four is an awfully high proportion for any psychological disorder, almost high enough to call the use of the word “disorder” into question. Like the third grader who doesn’t want to do their homework and winds up with a prescription for Ritalin, there’s a fine line between having an awkward phase in high school and having a persistent clinical disorder – a line that probably isn’t crossed as often as we think it is.

In conjunction with the findings related to ADD/ADHD medication, these numbers on anti-depressants could speak further to the idea that we are becoming increasingly reliant on pills and less reliant on each other when dealing with emotional stress/anxiety/hardship. While there’s no doubt that in many cases medication is necessary and does a lot of good, we may find it all-too-convenient to get a prescription instead of investing time in developing support structures and talking out our issues.

These sentiments aren’t new to the psychiatry community. University of New South Wales, Australia Professor Gordon Parker has spearheaded the growing concern that depression is being used to describe normal feelings of sadness, at the behest of pharmaceutical companies that have a vested interest in using depression as a “catch-all” illness. As the Guardian wrote:

[Professor Parker] said the drugs were being marketed beyond their “true utility” in cases in which people were unhappy rather than clinically depressed.

…the “over-diagnosis” of depression began in the early 80s, when the diagnostic threshold for minor mood disorders was lowered.

His 15-year study of 242 teachers found that more than three-quarters met the current criteria for depression.

Prescription anti-depressants are taken more regularly, and more responsibly, than ADD/ADHD medication. 59.8 percent of respondents with a prescription for anti-depressants take their medication on time; 19.6 percent reported never taking them:

Furthermore, only 6 percent of respondents who did not have a prescription for anti-depressants reported taking them for the purpose of coping with their environment. At Kenyon, using non-prescribed “happy pills” to cope is practically nonexistent compared to the use of study drugs.

Anxiety

While our survey didn’t dive as deeply into the use of anti-anxiety drugs as it could have, one interesting finding was that a higher percentage of respondents without a prescription for such drugs reported having taken them (16.0) than the percentage of respondents who reported having a prescription (12.7). Furthermore, students with a prescription for an anti-anxiety drug were even more likely to never take their medication (40 percent) than students with a prescription for ADD/ADHD medication (32.2 percent).

Perceptions

Not only are Kenyon students’ self-medicating behaviors high in volume, they’re freely discussed to the point at which Kenyon students are uncannily accurate in estimating the extent to which their peers are engaging in them. When asked what percentage of the student body they thought had used study drugs, the average estimate was 33.45 percent (actual percentage: 34). When asked to estimate the percentage of Kenyon students who take anti-depressants, the average prediction was 28.66 percent (actual: 23.4).

Perhaps the fact that study drug use is so candidly discussed is the reason that when respondents were asked to rate their favorability towards people who engaged in various activities, study drug use was barely rated unfavorably (3.41 on a scale of 1-7, with 1 being totally unfavorable, 4 being neutral and 7 being totally favorable), and was rated less unfavorably than cigarette smoking (3.25):

Kenyon is past the point at which everyone simply knows of someone who abuses study drugs, it is at a point at which everyone has a few friends who do it and find it socially acceptable to talk about openly.

Perhaps the most shocking result of our study is that the results aren’t all that shocking. The volume, knowledge and acceptance of study drugs and anti-depressants on Kenyon’s campus is highly distressing. Can Kenyon call itself a healthy community when one in three of its students are taking academic performance-enhancers and one in four are depressed? Should they really need to be medicated at this level?

It isn’t absurd to think that what’s true at Kenyon is true elsewhere. I hope that those with a better understanding of psychological research will conduct studies of their own on the seemingly pervasive medication culture in our colleges. We may not like what we see, but we have to know.

*A quick note on the possibility of selection bias in our sample*

When we first publicized the survey we sent it out over the college’s “all-student” email listserv, and the first “wave” of 100-150 responses that we received showed much higher rates of medication use than we wound up with (study drug use at 50 percent, anti-depressant prescriptions between 35 and 40 percent). Then, we sent the survey to each of the college’s residential listservs (each dorm/apartment complex has its own email listing), and the next “wave” of 100-150 responses brought our numbers down to their resultant levels. The final “wave” of responses, which came after we re-publicized the survey during the final days that it was open, did not change our averages in any significant way.

It is likely that, in the first wave of responses, the kind of student who responded to our survey was the kind of student who was likely to be on medication. After all, it was a survey about medication use. But the drop, and then leveling, of responses over the course of the week, along with our demographic results being in line with Kenyon’s overall population (as mentioned in the introduction), leads me to believe that selection bias is not as big of a concern here as it often is with research of this nature. Furthermore, the one demographic group that was underrepresented in our sample, smokers, showed rates of study drug use that were significantly higher than the general population. Had a representative sample of smokers taken our survey, our results may have shown even higher rates of medication use.

An earlier version of this post appeared in the Kenyon Observer. For a more comprehensive look at the results of this study or to request its data, please email Jon Green at [email protected], Joshua Samuels at [email protected] or the Kenyon Observer at [email protected].


Jon Green is a graduate of Kenyon College with a degree in Political Science and high honors in Political Cognition. A veteran of the campaigns of Congressman Tom Perriello in 2010 and President Obama in 2012, he writes on a number of topics, but pays especially close attention to elections, religion and political cognition. Follow him on Twitter at @JonGreen8, and on Google+. .

Share This Post

  • emjayay

    I’m glad you got the help you needed, and I’m glad that help was available today unlike in the rest of human history. The small number of people with your particular problems are not the problem. It’s the large numbers of kids who are on various drugs, and others who get the brain steriods to have an advantage over others.

  • Sweetie

    That’s what you think.

  • Sweetie

    Personally, though, I won’t touch any of them. I’ve been depressed ever since I grew up enough to realize the world sucks a lot more than it should, life has no real purpose, and getting old is a slow disintegration of mind and body that cannot be avoided. But, I’m not going to take pills to gloss over the facts. Besides, I’ve never had a medication that works for anything beyond the short-term. In the long term, the side-effects generally outweigh the positives. The only exception I can think of are anti-virals for those with HIV.

  • Sweetie

    Paxil causes mood swings (bouts of rage, inability to cope with frustration/disagreements), weight gain, terrible withdrawal symptoms, and more depression. That’s what I’ve seen. Zoloft was better. Its main side-effect was sleepiness.

  • http://adgitadiaries.com/ karmanot

    Plus, there is the fact that some children are just evil—like Damien and the ‘Bad Seed.’

  • http://adgitadiaries.com/ karmanot

    exactly

  • http://adgitadiaries.com/ karmanot

    PPPPfffftttttt

  • http://adgitadiaries.com/ karmanot

    I couldn’t agree more.

  • http://adgitadiaries.com/ karmanot

    Thanks for the scold.

  • condew

    Paxil is one of the mildest ones. When my doctor recommended an antidepressant, I refused and consulted my brother, who is an MD. He prescribed Paxil and told me to try it. They really are very convincing and very insistent. I know my brother was not trying to harm me. All told, at least 5 doctors have recommended I try antidepressants over the years and it is hard to say no to that kind of agreement. So I tried them, and along the way I think I acted strangely, too. It cost me the respect of my coworkers and some of my friends.

    Every old person I’ve visited in a home was on antidepressants, my grandmother, my best friend, and my father.

  • d3clark

    Not pertinent to this thread.

  • Sweetie

    The Catholic kids at my public school were generally the worst-behaved kids. I guess once they were away from the nuns they overcompensated.

  • Sweetie

    Laws… Ask Obama about habeas corpus.

  • Sweetie

    My husband’s doctor kept increasing his dosage, despite the side-effects. In fact, when the side-effects got so bad he responded by prescribing an additional pill, an anti-psychotic.

    He took this for one or two days and I asked him why he was acting so strangely, found out about it, and confiscated the pills. His doctor is a quack. I told him not to go on Paxil in the first place.

  • Sweetie

    People are supposed to move and fidget. It’s part of normal circulation. Lunatic educators treat people moving their legs as if it’s the symptom of a syndrome.

    What is NOT normal and healthy is the excessive stillness people are expected to display.

  • Sweetie

    binge drinking + lack of sleep = problems

    Our culture trains people to be so hung up about the body (OH NOES… Janet’s nipple!!!) and sex that young people get dressed in towels, don’t shower after working out, and binge drink because they need to be smashed before they can work up the courage to get it on.

  • d3clark

    There are laws preventing relationships like that between doctors and pharmaceutical companies that have been in effect for years.

  • d3clark

    Then by your logic, the only doctors who should treat pregnant women are women OBs who have had successful pregnancies.

    You don’t ever have to take a medication. Your doctor can prescribe one or more but it’s your choice to fill and use the prescription.

  • d3clark

    There have been many studies on college students and depression. Depression and suicide risk, depression and risk of academic failure, depression and chance for suicide attempts and many others. Research from Europe, North America, China, India and other countries show that depression is common in college students in the 15-20+% range depending on the study. Some of this research has been done on large populations of students (~17,000) in nation-wide research projects. There are many reasons that can cause this: separation from home, family, friends, sexual partner, etc. Moving into a high-stress situation/living independently. Limited support system. Academic pressure to succeed.
    People are looking for the quick fix. No one wants to spend two hours/week in therapy when there are any number of antidepressant pills that don’t require any time out of a busy schedule. Some people don’t even want to take a medication. They just want reassured that their symptoms (weight change, appetite change, sex drive changes, etc,) are due to depression and not due to something else. Their attitude is, “If I KNOW it’s just DEPRESSION, I can deal with that.”

    And ADHD seems to be largely over-diagnosed. Some physicians say that they get children for treatment of ADHD because the school says that they need treatment. Or the parents decide that the child has ADHD and they demand treatment. Again, the pill is much faster than any kind of therapy.

    These seem to just be two examples of our need to fix it ASAP. Most overweight diabetics when told to lose weight, exercise, make smart food choices, etc. just want a pill. Hypertensive patients when asked to lose weight, exercise, decrease sodium intake, etc. nod and then ask for a medication.

    Are pharmaceutical companies profiting from this? Yes, big time. But the market is there. The consumer who wants the magic pill that will fix them without making them change their lifestyles.

  • http://adgitadiaries.com/ karmanot

    We didn’t need meds in our classes at St Bernadette’s because Sister Thumper had a whap’ ruler and Sister Five wounds had the evil eye.

  • Naja pallida

    There is probably an untold amount of talent just wasted on telling people they have something wrong with them, and foisting pills on them, rather than finding ways to channel their energy and creativity appropriately. I’m not sure it has to do just with class size though, many of my freshman classes my first round in college had a whole auditorium of students, with absolutely zero one-on-one attention. I think it’s more about the boring, standardized curriculum that does nothing to challenge most students, only encouraging the memorization and regurgitation of raw data, and it does nothing to serve those who can’t keep up, for whatever reason, but make them feel inferior and instill even less incentive to participate. When you see your friends keeping up in class and still partying it up every weekend, but you’re steadily falling behind, even though you work hard, I can say from first hand experience that it is exceptionally frustrating. I’m not sure I would have resorted to taking a study drug, but I can easily see why some people would.

  • http://adgitadiaries.com/ karmanot

    I could agree more!

  • condew

    I remember one day while my doctor was still trying to treat my sleep apnea with antidepressants, coming off one while getting hooked on another. It felt like the end of the world, like I had lost my best friend or was facing execution; really bad. As an adult with a store of experience to draw on, I recognized this as something odd, something not right. But I think I have experienced first hand why some adolescents on antidepressants commit suicide.

  • TheOriginalLiz

    Big pharma makes it’s money by creating chronic conditions, not by curing them. There is a finite amount of money is curing diabetes or HIV, but there is an inexhaustible amount of money in treating a “chronic” condition. That includes ones that are made up as well as those that are the result of too much sugar and not enough physical activity or lack or self-discipline. Much easier to give a kid a pill than suggest alternative child-rearing strategies.

  • UncleBucky

    Well, yes, but I remember from 1957 to 1965 being in classes at a Catholic grade school with class sizes of 48 to 50 students. It seems to me that they needed enough students for US geography activities?

    Anyway, we did a lot of homework and we all held quite still for all morning and all afternoon. I never remember a problem with class management. I do remember a lot of strict nuns and funny, capable lay teachers, tho.

    To reply to your last sentence: This is why the USA is losing academically, intellectually and economically. We have trashed possibly TWO generations of people, who are now reacting to being trashed, and who are being blamed by bagguers and white supremacist “scolds” for our current situation.

    We could be another two generations getting back our self-respect for real, if we can only defeat the current GOP/TPer program to destroy this Nation.

  • UncleBucky

    Mike, I think that this is a huge factor. Not just Pfizer, but all of ‘em.

  • UncleBucky

    Is this driven by supply OR demand for drugs? ;o)

    It’s a subtle cycle of causation (not linear causation) that has grown since the 70s…?

  • HeartlandLiberal

    We have been on this insane drive to drug our youth for decades, and it has reached the point it is totally out of control. I am 67, and I still remember going to school and never once seeing an environment where 1/3 to a 1/2 of my class mates had been turned into zombies because they had been declared incapable of holding still.

    There is absolutely no rational medical or scientific basis in diagnosing this many children in this fashion. And it is utterly destructive to them during their former years.

    Should anyone be surprise at the negative consequences on them as they reach adulthood, unable to cope with advanced education or a job, and primed to believe that the solution to everything is further use of drugs and mind altering substances?

  • http://twitter.com/cofounderchris Chris

    I’m bias, but I think there is a more sustainable path to brain fitness. UCLA Neuroscientists + Venture capital backers = truBrain

  • condew

    I suspect that when you have a real problem, it is hard to ignore; but once a doctor starts to treat you for a maybe problem, it is almost impossible to get him to stop. I’m all for those who need the drugs getting them, but I think the number getting them has more to do with marketing than need.

  • condew

    I suspect a lot of the ADHD is just teachers overwhelmed with large class sizes. So better the class clown is zonked on something than disrupting the class. I wonder how much talent we waste this way.

  • condew

    Almost no doctors test for sleep apnea before prescribing antidepressants. The symptoms of sleep apnea look a lot like depression and only an overnight sleep test will tell. I guess the drug companies are in your GP’s office every week to push the pills, while the CPAP sellers only visit the Ears, Nose and Throat doctors, if at all. So if you don’t ask for a sleep test, you don’t get one; you just get one antidepressant after another, none of which can work because the real problem is disturbed sleep.

  • condew

    Doctors prescribe antidepressants as if they were as harmless as aspirin, and oblivious to the side effects, which are often pretty bad; like being just a little drunk and never allowed to get sober, plus dizziness, diarrhea, bad dreams.

    It makes sense for doctors to over prescribe because if your doctor says you are healthy he doesn’t get a pleasant office visit once-a-month that he can bill for. You will show up, because the withdrawal symptoms are often even worse than the side effects. Once you agree to try one antidepressant, doctors never consider the possibility you don’t need them, it’s always a search for the “right” one, without end; a new drug every month; simultaneous withdrawal from the last one with new symptoms from the new on; until you accept one of get fed up and tell the doctor to shove his pills where the sun don’t shine.

    When you get a little older, blood pressure medicine occupies the same niche, Gotta get that blood pressure down to 120/80, never mind you can barely walk, your ears ring, and your thinking is clouded. You’ve got to be made into an invalid now, because otherwise you might become an invalid later. That’s not to say doctors don’t slip old people antidepressants as well, and without telling them. It’s so much easier to take care of a wobbly, docile old man than one who is sharp, mobile, and stubborn. They will “try” antidepressants on people who have been happy and optimistic all their lives.

    Doctors are not happy unless everyone is sedated and addicted.

    No doctor who hasn’t been on the antidepressant they prescribe should be permitted to subscribe them.

  • http://twitter.com/#!/dameocrat Dameocrat

    A lot of big pharma conspiracy theorists and mental illness deniers are also people who deny hiv causes aids.

    Be careful who you are empowering.

    I feel that we are living in a time that is very stressful and lonely and I am not surprised people are cracking and need medical attention. The fact that these illnesses maybe situational does not mean they are not real and debilitating.

  • Mike Meyer

    Good ole Dr. Feelgood, he’s got the pill for YOU.

    The APA must have a cozy relationship with the good folks at Pfizer.

  • http://adgitadiaries.com/ karmanot

    There is a similar correlation in the adult HIV/AIDS population. AIDS fatigue syndrome is at a very high rate. Years of highly toxic pharmaceuticals and the various opportunistic pathogens leave their toll. For decades it was common to treat ‘fatigue’ as depression and thus over prescribe antidepressants, which in many cases made the symptoms worse. “23.4 percent of respondents reported having a prescription for an anti-depressant” One of the worse among these was Zoloft. Recently, Adderall has been found to be particularly effective, but contains the stigma of being a meth drug and thus patients who need it legitimately have to fight tooth and nail to justify its usage and doctors have attended too many seminars on third party dealers, who use prescriptions to sell on the black market.

  • Jon Green
  • http://www.facebook.com/elijah.shalis Elijah Shalis

    A lot of students get the meds through a family doctor not a psychiatrist with real testing.

  • http://www.facebook.com/elijah.shalis Elijah Shalis

    I have ADHD for real and my bi polar turned into schitzoaffective disorder. I wouldn’t have made it through college without meds.

  • Naja pallida

    It is highly unlikely that the rate of depression in students is significantly above the overall national rate, and even if it was, basic common sense would say that it is within one, two or three percentage points. It is most certainly not by 15 percent. If that were actually the case, we should be referring to it as a national mental health crisis.

    I’m one of those people who believes that the actual incidence of depression/ADD/ADHD is probably only a tiny fraction of what actually gets diagnosed as such. Poor parenting, poor social skills, and simple boredom with the crappy standardized curriculum foisted onto students all, and innumerable other factors, contribute to one’s inability to function academically.

    All in all, I think doctors are just all to happy to prescribe pills to someone because it is cheaper and easier than actually doing their job and taking the time to determine the root of a problem, or to even determine if there actually is a problem. Just a few days ago I happened to mention to my doctor that was having trouble sleeping. Without even batting an eye, or asking a follow up question, he was foisting Ambien and Lunesta samples on me, saying “Here, try these and see if they help.” In the end, not only does it make doctors look like fools, it leaves patients even worse off when they think they should be getting better, and are not – or even worse, have nothing wrong with them in the first place, and suddenly start taking medications which can seriously screw around with their brain chemistry – potentially causing a problem where there wasn’t one.

    As for people taking things just to improve academic performance, that’s a whole different issue. I see it as no different than giving the football team steroids, and if colleges want to be taken seriously, they should be doing something to address the problem internally, if the legal side of the equation refuses to take meaningful action.

© 2014 AMERICAblog News. All rights reserved. · Entries RSS