To avoid that stigma some people try medicating themselves with alcohol or drugs instead of seeking medical help. Usually that just prolongs the time without treatment and can lead to substance abuse problems. To prevent complications with antidepressants the Health Center recommends that students discontinue any alcohol and illicit drug use. "I've actually had some patients decline medicine because they thought they would be unable to decrease their alcohol use," Thompson said.

The complications from alcohol and other depressants go beyond physical effects. A socially isolated student may drink to escape or feel more comfortable in a crowd, but alcohol is a short-term solution, says George Ladd, a visiting psychology professor whose research includes adolescents and depression. "When the alcohol is not there again, you're back in the dumps," Ladd said. "You haven't learned any practical social skills." Drug and alcohol use also weaken positive buffers against depression, like relationships with friends and families, good conversations and successful academics. "If those things start disintegrating and you're just left with the drugs and alcohol, that's just not enough."

Expectations about college also can be blown out of proportion, exacerbating depressed students' confusion about what's wrong with them. Family and friends tell students that college will be the best four years of their lives. "Students realize they're in a privileged environment and if they're not feeling emotionally sound that's very distressing," said Newmen. "To call your parents who are spending all this money and say, 'I don't even know if I should be here because I can't sleep. I'm crying for no apparent reason,'" causes a lot of guilt in students. "But, if you're not feeling good inside, it doesn't matter where you are."

Depressed people may feel they should be able to snap out of it. But when people are near the point of clinical depression, they're "in a rut that's very difficult and rare to climb out of alone," Ladd said. Recovery doesn't automatically mean medication or long-term therapy, but Ladd says changes in the individual's behavior and circumstances need to take place. "It's not something that can be shook off."

There was one point where I just gave up. I just let go," said Anna, a junior who suffered from depression the spring of her sophomore year. She stopped paying attention to what she wore, how she looked or even maintaining friendships. "I wouldn't go out of my way to be nice or anything. I was just withdrawing."

Anna, who asked that her real name not be used, felt overwhelmed by academics, by deciding whether to study abroad and by petty misunderstandings among her friends. She didn't want to study during exam period. (Her roommate made a schedule and helped her through it.) By the time she went home for the summer Anna was so despondent she couldn't even face unpacking. "I'm a really organized person," she said. "I had let go of all that control and organization I had. From that point on everything else was a bigger deal and more overwhelming."

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