Depression, Eating Disorders and Other Mental Illnesses Are on the Rise. Colleges are Trying to Help.
By Ben Whitford, NEWSWEEK Updated: 1:51 PM ET Aug 27, 2008

Let's not mince words: college can be tough. According to a 2007 study by the American College Health Association, 43 percent of students reported having felt "so depressed it was difficult to function" at least once in the prior year. Other studies, based on student surveys, suggest that one in five undergraduates reported having an eating disorder, one in six had deliberately cut or burned himself and one in 10 had considered suicide.

Given those numbers, it's deeply troubling that in 2007 just 8.5 percent of students used their college's counseling services. In other words, students were more likely to consider killing themselves than to seek help. "After Virginia Tech, students feel more afraid to discuss mental-health problems," says Alison Malmon, the founder of Active Minds, a national group that promotes mental-health awareness on campus. "They think they'll be labeled as the crazy kid who'll shoot up the school."

Counselors say that while they do keep an eye out for students who might pose a risk to others, the overwhelming majority of their patients are no threat to anyone but themselves. "The things that make it into the media aren't people's everyday struggles," says Gregory Eells, head of Cornell's counseling service and president of the Association for University and College Counseling Center Directors. "We need to let students know that seeking treatment is a strong, smart thing."

Counseling services must look for new ways to reach out to troubled students. NYU freshmen are treated annually to a "reality show," in which NYU student actors perform skits on topics from depression to drug abuse. At Harvard, students can win iPods for attending mental-health screening sessions and are invited to "pajama party" panels, where flannel-clad counselors dispense milk and cookies along with advice about the importance of sleep. "There's still a high level of stigma," says Richard Kadison, head of Harvard's mental-health services. "We're trying to find creative ways of getting the message out."

Many campuses also offer online services allowing students to complete informal diagnostic quizzes away from the prying eyes of their peers. "You take it in the privacy of your own dorm room—not at some event where a bunch of other students might be watching you," says Katherine Cruise, a director of Screening for Mental Health, a nonprofit that serves about 500 campuses. The results are confidential, but can help nudge students toward counseling services.

Other organizations are confronting the stigma head-on. The Jed Foundation, a national suicide-awareness group, in 2008 launched a Facebook "mood ring" application that lets students broadcast their emotional state and send comforting "vibes" to troubled friends. "It's about trying to reach students where they are and in a way that they understand," says Courtney Knowles, the group's executive director. The foundation also worked with MTV Networks' college station, which now mixes music videos with clips of rockers like Mary J Blige and Billy Corgan talking about their struggles with depression, eating disorders or self-harm; the station also airs frequent public-service announcements directing students to Web sites where they can take screening tests or find more information.

And it's not just pop stars who can assist. Many colleges encourage parents to pitch in, whether by watching out for warning signs or by coaxing their kids to seek help. Philadelphia University now issues students' relatives with a calendar highlighting the toughest times of the year for freshmen, while the University of Minnesota offers online workshops, videos and podcasts where parents can learn about conditions such as anxiety and Asperger's syndrome. "Often, parents are the first to notice their child is in trouble," says Marjorie Savage, Minnesota's parent-program director. "We need to work with parents, because they can deliver these messages when students most need them."

Still, students and counselors agree that the most effective outreach programs are those led by students themselves. "It's different when you hear something from another student," says Semmie Kim, a neuroscience major who founded MIT's chapter of Active Minds in 2007. She's held events like a bubble-wrap stomp to help students vent pre-exam stress, but says her group's most important role is to provide troubled peers with a sympathetic ear. "We want to make students realize they're not alone," she says. College will always be tough, but there's no need to suffer in silence.

www.newsweek.com/id/154361

Depressingly Easy

We nuke prepared dishes rather than
growing our own food, and machine-wash
ready-made clothes rather than sewing and scrubbing.
Such conveniences may be contributing to rising
rates of depression by depriving our brains of their
hard-earned rewards

By Kelly Lambert, Scientific American, August 2008

For several decades, the multibillion-dollar antidepressant
industry has pointed to imbalances in the neurochemical
serotonin as the cause of depression. But research has yet
to find convincing evidence that serotonin imbalances represent
the indisputable cause of depression, and despite the unprecedented
number of pharmacological treatment options available
today, depression rates are higher than ever.

If Big Pharma does not have a cure for depression, shouldn’t we pursue
a fresh approach to this vexing problem? Could there be a non-pharmacological
treatment strategy that would bring relief to the increasing number
of people struggling with this mood disorder, for instance? What do we
know about how to preserve good mental health? Is it possible to maintain
a sense of control over our increasingly stressful daily lives, so that we can
re-focus our attention on more meaningful psychological endeavors, such as
the challenging issues of problem solving and planning for our futures?
Is there something about how we live today that’s actually toxic to our
mental health? Were earlier generations somehow less susceptible to depressive
symptoms? If so, what can we learn from how they lived that will help us
rebuild our resilience and emotional well-being?

To build a new, more integrated theory of depression, I have searched the literature for possible evolutionary triggers of emotional responses, re-evaluated what we know about
how the brain functions in both healthy and unhealthy ways, and identified
pivotal lifestyle factors that might be affecting our society adversely.

I began thinking about the impact our contemporary
lifestyle has on our mental health more than 10 years ago, after attending a lecture
by Martin Seligman, a psychologist and the pioneering
creator of the Positive Psychology movement,
who was then president of the American
Psychological Association. Seligman described
two studies conducted in the 1970s in which people
in different age groups were questioned about
bouts of depression they had experienced during
their lifetimes. The researchers then compared
the responses of different generations.

The result should be a no-brainer, I thought
at the time. Of course, older people would report
more bouts of depression. After all, they had
lived through the Great Depression and two
world wars and suffered far more hardships and
loss just by virtue of having lived longer. How
could their mental anguish compare with the
shorter (so far), easier and much less traumatic
lives of a younger generation?

To my surprise, the exact opposite was true.
Seligman reported that younger people were
much more likely to have experienced depression.
In fact, one study found that those born in the
middle third of the 20th century were 10 times
more likely to suffer from major depression than
those born in the first third of the century were.
These findings were later corroborated in a second
study.

What is behind this startling disparity? For
one thing, earlier generations did far more physical
work than we do today. I was reminded of
just how much our daily lives have changed six
years ago, while reading a bedtime story to my
younger daughter, who was three at the time.
Skylar had chosen Little House on the Prairie for
that evening—one of my childhood favorites.

Yesterday and Today

Over the years as I’ve read to my daughters
I’ve often used the time to think through my to do
list for the next day. This bit of cognitive
multi-tasking was a piece of cake with books such
as Goodnight Moon, which I had read countless
times when my girls were younger. “Goodnight
room”.… I need to update that section in Wednesday’s
lecture. “Goodnight moon”.… and remember
to take the chicken breasts out of the freezer.
“Goodnight cow jumping over the moon”…. I
have to finish those analyses of the rat brains in
the lab tomorrow. “Goodnight light”…. I need
to sign that permission slip for my older daughter
Lara’s field trip.

But that night the story about life on the prairie
somehow drew me in. I found the demanding
lives of Ma and Pa Ingalls so compelling that I
actually had to pay attention! Laura Ingalls
Wilder, their daughter, described in detail how
the family planted, harvested and hunted down
all their food throughout the year. That made my
trips to the supermarket and merely reading the
heating instructions for much of the food I “prepared”
seem, well, lame.

I had always complained about doing laundry,
but my efforts paled in comparison to those
of Ma Ingalls. She had to scrub every garment on
a washboard and then hang the clothes out to
dry. And she had made all the garments with her
own hands! Bathing my daughters did not require
collecting rainwater or drawing water from
a well; I merely had to turn on a faucet. The Ingalls
family had to make most of the things I simply
purchased, including toys, candles, soap,
honey and butter. Little House crashed this working mom’s self-pity party
that evening. My life is a walk in the park compared with the lifestyles
of a century earlier, I realized.

Clearly, I’m not suggesting that we go back to
churning butter and tanning hides. But I do think
we have to examine whether our cushy, digitally
driven contemporary lifestyles—replete with
SUVs, DVDs, laptops, cell phones and, yes, microwave
ovens—may be at the root of the soaring
rates of depression in people born in the latter
part of the 20th century.

Did we lose something vital to our mental health when we started pushing
buttons instead of plowing fields? From a neuroanatomical point of view,
I believe the answer is an emphatic yes.

Will work for Pleasure

Our brains are programmed to derive a deep
sense of satisfaction and pleasure when our physical
effort produces something tangible, visible
and—this fact is extremely important—meaningful
in gaining the resources necessary for survival.
In fact, our brains have been hardwired for
this type of meaningful action since our ancestors
were dressed in pelts. After all, nature needed
a way to keep the earliest humans from becoming
“cave potatoes.” Hanging out all day
didn’t put freshly caught game on the campfire or
help maintain a safe place to live.

I call this emotional payoff “effort-driven rewards.”
There are other important benefits to
this type of effort beyond a greater sense of psychological
well-being. We also experience an increased
perception of control over our environment,
more positive emotions and, perhaps most
critical, enhanced resilience against mental illnesses
such as depression.

Think about effort-driven rewards as a clever
evolutionary tool, a way to motivate early humans
to maintain the physical activity needed to
obtain the resources to live—to find food, protect
themselves from the elements and procreate to
continue the species. Effort-driven rewards don’t
come just from physical effort, however. They
also involve complex movement coupled with intricate
thought processes. Imagine thousands of
years ago, when our ancestors were tracking a
pack of wild boars through a forest or across a
plain. Because these animals are such vicious
fighters, a successful strategy typically involved
the coordinated efforts of a few hunters, requiring
effective social communication and support.
They needed to be wily as they chased their game
or lured their prey into a trap that they had built.
All their efforts were fueled by anticipation. In
fact, anticipating something pleasurable creates
more activity in the pleasure center of the brain
than actually achieving the goal does. Once they
caught their prey, our hunters were suffused with
a sense of accomplishment and satisfaction as
they skinned the animal before dinner.

Effort-Driven Rewards

From an evolutionary perspective, it is easy to see why they have always
been so critical to our survival: they allow us to
gain control of our environment. In fact, an essential
premise of the proposed effort-driven rewards
theory is that movement—and especially
hand movements that lead to desired outcomes—
plays a key role in both preventing the
onset of and building resilience against depression
and other emotional disorders. Furthermore,
we are predisposed to preferring hand movements
that our ancestors needed for survival—
those necessary for nurturing, cleaning, cooking,
grooming, building shelter and farming.
But these days we shop at Whole Foods and
drive Hummers. What does all this history have
to do with our modern lives and depression? Our
brains are generally the same size and have all the
same parts and chemical composition as those of
the earliest humans. Even though our lifestyles
have changed radically, we have retained the innate
need for achieving effort-driven rewards.
Is it okay that we have systematically removed
physical effort—and all the complexity of movement
and thought processes that it implies—from
effort-driven rewards? Is contemporary society
actually robbing us of certain forms of pleasure
so fundamental to our mental health?

How our Brains Reward Effort

As I looked for the possible evolutionary triggers
of depression, I also began to re-examine the
primary symptoms. Over the past few decades
researchers have identified certain areas of the
brain associated with some of these symptoms.
But could I match every single one—including
loss of pleasure, feelings of worthlessness, slowed
motor abilities and difficulty concentrating—to
a specific part of the brain? And, significantly,
were those different brain areas interconnected
or linked in some clearly identifiable way?

A natural place to start was the nucleus accumbens.
This peanut-size structure is known as
the pleasure, or reward, center of the brain, and
it keeps us engaged in behaviors that are important
to our survival, including eating and having
sex. It plays a crucial role in how the brain functions,
as it determines how to respond to environmental
stimuli such as a piece of chocolate cake
or that handsome guy at the bar.

An integrating center of the brain, it receives
inputs and outputs from many neural areas. But
for our purposes, I am focusing on its intimate
connection to three other primary areas. The accumbens
is positioned in proximity to the brain’s
motor system, or striatum, which controls our
movements, and the limbic system, a collection
of structures involved in emotion and learning.
Essentially, the accumbens is a critical interface
between our emotions and our actions. The
closely linked motor and emotional systems also
extend to the prefrontal cortex, which controls
our thought processes, including problem solving,
planning and decision making.

It is this accumbens-striatal-cortical network—
the crucial system that connects movement,
emotion and thinking—that I call the effort-
driven-rewards circuit. It is the proposed
neuroanatomical network underlying the symptoms
associated with depression. In fact, it is possible
to correlate every symptom of depression
with a brain part on this circuit. Loss of pleasure?
The nucleus accumbens. Sluggishness and slow
motor responses? The striatum. Negative feelings?
The limbic system. Poor concentration?
The prefrontal cortex.

As if to impart renewed energy to our behavior,
the motor structures that control our movements
are intimately connected to the reward
center—where we register pleasure—and to the
cortical area of our brain that controls higher
thought processes. Because of the interconnectivity
of the brain areas that control movement,
emotion and thinking, doing activities that involve
a number of these components fully engages
the effort-driven-rewards circuit.
In fact, the more the effort-driven-rewards
circuit is kept activated and humming, the greater
the sense of psychological well-being that re
results.

It is as if an electric current is coursing
through the network. When it is buzzing at top
capacity—when, for example, installing that new
light fixture requires both hands—the cells in
those areas of the brain are turned on and secreting
neurochemicals, such as dopamine and serotonin,
which are involved in generating positive
emotions. Neural connections are strengthened
and reinforced. Perhaps most important, this
kind of meaningful action—that is, effort-driven
rewards—likely stimulates neurogenesis, the production
of new brain cells. Neurogenesis is believed
to be an important factor in recovering
from depression.

Our hands play a crucial role. They occupy
most of the real estate of the motor cortex, located
in the higher cortex (the brain’s outer covering).
In fact, our hands are so important that
moving them activates larger areas of the brain’s
complex cortex than does moving much larger
parts of our bodies, such as our backs or even
our legs.

As I continued to delve into the scientific research
on depression, I found myself thinking
more and more about the role of hands-on work
and effort-driven rewards in our mental lives.
Could adding simple tasks to our daily repertoire
of activities help maintain emotional resilience?

For the answer, there was just one place to go—
back to the laboratory.

The Trust Fund Rats

Because the rat brain has all the same parts as
the human brain (it is just smaller and less complex),
rodent models are a great starting place for
mental health research. Could the rats tell me if
there was anything to the connection between
depression and physical effort?

Two undergraduate students, Kelly Tu and
Ashley Everette, helped me design a study to test
my theory. We put four mounds of cage bedding
in the testing apparatus and buried a Froot
Loop—a culinary favorite among my laboratory
rodents—in each mound. We trained the rats to
search the mounds for the treat, and each day we
changed the positions of the mounds randomly.
The animals soon learned that each new mound
had a Froot Loop, so once they retrieved one
prize they moved on to the next mound. I designed
this task to mimic “harvesting”—picking
fruit, vegetables or, in this case, Froot Loops
from the “fields.”
Within a few days the rats immediately approached
the mounds and started digging for
their prized cereal pieces. We trained these rats
every day for five weeks so they would have ample
opportunities to make associations between
their physical effort and desired rewards.

Our control group consisted of rats that we
also placed in this novel environment every day.
But regardless of the physical effort they exerted,
they received their Froot Loop rewards in a lump
sum in the corner of the apparatus. My students
enjoyed calling these rats the “trust fund rats”
and the digging rats the “working rats.”

In the next phase, we developed a puzzle that
the rats had to learn to solve. We wanted to assess
whether the worker rats or the trust fund rats
were more persistent in problem solving. We put
a Froot Loop in a plastic cat-toy ball, a novel toy
stimulus that would be mildly threatening to the
animals because it had a bell in it. We made certain
that the coveted cereal piece would not fit
through the openings. That meant that no matter
how clever or bold the rat was, it would not be
able to retrieve the reward in the test’s three-minute
time frame. Of course, the rats would not
know this factor, so we could assess the amount
of time they spent trying to get the treat. The task
involved boldness and persistence—characteristics
that serve us all well during challenging
times.

To make this task official, Craig Kinsley, my
colleague from the University of Richmond who
collaborated on this project, suggested we call it
the “novel manipulandum task.” This sounded
much more impressive than the “cat-toy test.”
What did we find? Although we made sure
that both groups had equivalent levels of “emotionality,”
or anxiety, before training began, we
observed remarkable differences in how the animals
approached the challenge task. The worker
rats picked up the ball in their mouths and slung
their heads from side to side, tossing the ball
across the cage. They also tried to stick their tiny
paws through the openings to obtain the reward.

Although the trust funders were just as motivated
to retrieve the Froot Loop (both groups
were on the same food-restriction regime) and
used similar strategies, they were not nearly as
persistent.

In fact, the worker rats spent approximately
60 percent more time trying to obtain the Froot
Loop reward and made 30 percent more attempts
to do so than the control group did. In their own
way, the worker rats were telling us that their
prior training sessions had made them more con-
fident that they could overcome the challenge and
retrieve the reward.

As I considered these findings, I was reminded
of the widely reported study conducted several
decades ago by Seligman and his colleague,
psychologist Steven F. Maier of the University of
Colorado at Boulder. In this famous experiment,
dogs gave up responding and problem solving after
they realized they could not escape from cages
in which they received mild shocks. The researchers
referred to this effort-consequence disconnect
as “learned helplessness.” Could our
findings, then, be called “learned persistence”?

Clearly, we had empirical evidence of the
adaptive value of effort-based rewards. The simple
behavior of digging in mounds of bedding for
cereal rewards had given the rats the motivation
and confidence to persevere on a completely different
challenging task.

The Lifestyle-depression Link

Even though our nervous systems have the
same anatomical makeup and chemical composition
as those of our ancestors—or even people
who lived a mere century ago—we are clearly using
our brains and our hands differently. The percentage
of farmers in the workforce was 38 percent
at the start of the 20th century but less than
3 percent at its end. Today many more of us are
knowledge workers than physical laborers. There
have been vast increases in service-related jobs,
from 31 percent of the workforce in 1900 to 78
percent of all workers in 1999.

Of course, you may feel a sense of accomplishment
when you zip through your cognitive
to-do list. The pleasure derived from just intellectualizing
a problem is rewarding because it
activates the prefrontal cortex. But effort-driven
rewards activate the problem-solving prefrontal
cortex plus the movement-controlling striatum
and the reward/motivation center known as the
accumbens, leaving you with a fuller brain experience
that prepares you for life’s next challenge.

The decreased brain activation associated with
increasingly effortless-driven rewards may, over
time, diminish your perception of control over
your environment and increase your vulnerability
to mental illnesses such as depression.

What can we do to protect ourselves against
the onset or tenacious persistence of depression?
Poring over a scrapbook project or knitting a
sweater may distract you from the stress in your
life and engage your brain in intense ways that
are beneficial to your mental health.

Going out to the park or gym to exercise, especially if you
perceive the activity as meaningful, can also
boost important, emotionally relevant neurochemicals
such as serotonin and endorphins.
Such activities may alter the brain in more meaningful
ways than any dose of a single drug could
accomplish. Why? Because they are performed
within the context of your life. When you are
faced with a challenge and embark on the dynamic
process of deciding on an effective strategy,
implementing the plan and observing the final
desirable outcome, your brain takes note of these
situations so that it can access similar response
strategies in the future.

Just as a gymnast needs to complete simple
muscle repetitions before she can learn complex
routines, we need ongoing, positive experience
with simple effort-driven rewards to execute the
complex mental gymnastics that enrich our mental
lives. Anything that lets us see a clear connection
between effort and consequence—and that
helps us feel in control of a challenging situation—
is a kind of mental vitamin that helps build resilience
and provides a buffer against depression.

About The Author: Neuroscientist and psychologist Kelly LamBert (www.kellylambert.com) is chair of psychology at randolph-macon college.