It is clear socially, academically, and financially that today’s generation has an increased number of individuals with stress than previous generations. Most of this stress falls under chronic stress which interferes with people’s ability to function normally long term. The highest stress level is currently found in millennials born from 1984-1999, aged 18-33 years old with an even higher concentration in college students. Common symptoms that occur are mood swings, lack of or excessive amounts of sleep, drug or alcohol abuse, social withdrawal, lack of motivation, anxiety, and feeling overwhelmed. However, at what point does it stop being college/young adult stress factors and actually becomes a mental challenge that gets in the way of daily activities. The symptoms typically used to describe depression include all of the ones previously mentioned from stress, however at a more profound emotional state and includes anhedonia, the lack of anything pleasurable, and also when an individual seems capable of harming themself or others. It is often common for individuals in high demand jobs or those with pressure in daily tasks and assignments to brush off serious symptoms in behavior and just call it stress in fear of seeing a mental health professional because of lack of time or being accustomed to their concerns being trivialized by others. A social initiative to be properly trained in recognizing factors across students, faculty, instructors, bosses, and friendly strangers can help give the individual support and to not fear asking for help when it is necessary. This review will focus on finding if there is a correlation between stress and depression, as well as what differentiates them and how further research can help find ways to lessen the amount of stress or depression in individuals and how to combat it.
What is depression?
Depression has been mentioned in literature since the pre-Hippocrates era. Greek mythology recognized mania and melancholy as abnormal mood states. Aretaeus of Cappadocia, a medical scholar from the first century A.D., described the commonality between melancholia as the beginning of mania and the two as counterparts. A Persian physician in the eleventh century described symptoms that included anxiety, phobias, and suspicions of other systems. Emil Kraepelin in 1896 made the key distinction in defining depression from schizophrenia as having manic and depressed phases however, without any intellectual deterioration. Freud declared a connection between melancholia and mourning or grief in 1917. In the mid 1970s, the possibility of depression occurring due to a chemical imbalance in neurotransmitters of the brain came to light and was called major depressive disorder. Today, 15 million Americans a year struggle with depression by itself and along with other mental and physical health concerns that affect bodily functions such as disruption of sleep, appetite, and weight. While there is no distinct cure, depression is highly treatable, even and especially if it is focused in treating according to each individual.
Depression however, is not the same as sadness or unhappiness. It includes an extended period of time in a profound emotional state of feelings such as worthlessness, desperation, and hopelessness to the point where one loses libido and energy and has suicidal or harmful thoughts. Different forms of depression can be broken down into subcategories such as grieving, secondary depression, clinical depression and bipolar depression, as organized by Harold Sontheimer. Grieving differs since it typically lasts up to 12 weeks after losing a loved one or dealing with life struggles such as being laid off or financial struggles where daily motivation is hard to come by. Secondary depression is associated with the difficulty in dealing with illness where treatments or solutions are uncertain. Clinical depression tends to occur in young adults but is twice as common in women as it is in men and has a direct correlation as age increases. Bipolar depression includes unexplained mood swings that can vary between euphoria and depression. Individuals can have states of severe mania with paranoia and delusions or be in a manic state or high states of enthusiasm, expectations and energy. It is the leading disability for young adults from the ages of 20 to 30 and affects males and females equally. It is also believed that higher depression rates in this age group could be an underlying factor explaining higher rates of substance abuse of recreational drugs, alcohol and smoking. Individuals often experience changes in cognitive function which in turn affects cognitive performance in executive functions, attention, memory, and psychomotor speed (Hammar & Årdal, 2009).
On the molecular level, depression has been associated with region specific neuronal cell loss and retraction of dendrites which causes changes in synaptic activity. This has been seen in the effect of antidepressant drugs in imaging studies. The neural circuits that are primarily affected in the brain include the prefrontal cortex, the hippocampus, and the limbic system and its structures including the ventral tegmental area, nucleus accumbens, locus coeruleus, thalamus, hippocampus, and amygdala. There are all structures known to affect and regulate emotions, reward feelings, motivation and executive functions. Patients with chronic depression have shown enhanced activity of the amygdala, decreased gray matter volume in the prefrontal cortex and hippocampus which also leads to a reduction in size of pyramidal neurons and a loss of GABAergic interneurons as well as a decline of astrocytes and oligodendrocytes in the prefrontal cortex. Antidepressant drugs prescribed today focus on changing the concentration of monoamines in the brain and balancing the connectivity of neural circuits and their signaling cascades in the networks of emotion as shown in Figure 1. The blockage of serotonin reuptake causes the activation of G-protein-coupled receptors leading to enhanced cAMP signaling which leads to transcriptional changes in the cAMP-protein kinase response element binding pathway also known as the CREB pathway. This pathway is responsible for increasing or decreasing the transcription of downstream genes. A number of genes including neurotrophic factors such as BDNF (brain derived neurotrophic factors) are transcribed. Chronic treatments of antidepressant medication increase BDNF-mediated signaling because BDNF transcription and signaling in the hippocampus has been shown to be reduced in patients with stress and in post-mortem hippocampus of humans with depression (Krishnan & Nestler, 2008). Understanding the molecular pathways of depression is a continuous process with tremendous amount of information still unknown.
A greater lifetime risk of mood disorders has been reported as well as an increase in each successive generation. In longitudinal studies done by Compton et al., the prevalence of depression in U.S. adults rose from 3.33% to 7.06% between 1991-2 and 2001-2. In college students and young adults, it was found that their psychopathology score on the clinical depression scale in 2007 compared to 1938 was 6-8 times more likely to meet the cutoff. In a Swedish population study 1947, 1957, and 1972, researchers observed the increased risk of depression for all age groups however, young adults exhibited a tenfold increased risk from 1957 to 1972 (Compton et al, 2006). The rise in depression amongst individuals has been credited to the changes in diagnosis criteria that fail to include and recognize the variation of symptoms to classify the normal response of sadness as a mental disorder (Hidaka, 2012). However, it can also be attributed to change in societal concepts and culture that the youth face when growing up and learn to yearn for a feeling of acceptance or of fitting in throughout social media platforms, in friend groups, or within their family and community. An increase in alcohol and drug usage found more commonly in young adults may also be a factor as to higher depression rates amongst this age group. “Anxiety in children and college students has increased almost one standard deviation from the 1950’s to the 1990’s” (Twenge, 2000). A direct correlation amongst developed countries and the prevalence of psychiatric disorders has been observed as urban citizens have higher mood and anxiety disorders compared to rural citizens. Since young adults and college students are at the forefront of modernization in lifestyle, social networks, media and more, a higher depression prevalence and risk can be associated. Along with modernization, western culture has gained the reputation for not being as health conscious in terms of nutrition and physical health and fitness. A poor diet with low levels of physical activity and distractions that lead to more time inside and less sleep can all lead to the imbalance of body functions related to the endocrine and nervous system. It is commonly known that most young adults and especially college students lack proper nutrition as they are now responsible in providing their own meals and also rarely reach the recommended hours of sleep for their age range. The higher the level of stress the body faces, the higher its successability to depression (Wood & Bhatnagar, 2014). There is a difference with clinical depression and the large amounts of stress that can be obtained from jobs and school that leads to similar symptoms, however detecting the difference is the main concern of this review.
What is stress?
Stress is the body’s natural response to a pressure or threat. In small amounts it can be motivational, especially in the work environment as it keeps individuals alert, focused and energetic. However, in large amounts, it becomes easier for the body to be in a continuous heightened state of stress that can lead to health problems. As an individual’s age increases, stress commonly accumulates in a direct correlation as more responsibilities are assigned to the individual. It is mostly done at a manageable rate where the individual accustoms to the increasing amount and is not fully aware as to the levels of stress they endure until it begins to take a noticeable toll. This toll affects and suppress the immune system, digestive and reproductive system as well as circadian rhythms, it increases the risk of heart attacks and speeds up the aging process. It leaves individuals more susceptible to anxiety, depression, and other mental health problems.
There are different kinds of stressors that individuals will encounter. Primarily in young adults, intrapersonal sources of stress are the most frequent and reported source. Changes in sleep habits, breaks, eating habits, workload, and new responsibilities are what causes the highest amounts of stress (Ross et al, 1999). A study done on the association between computer use and mental health symptoms in young adults found sleep disturbances due to high and medium computer usage in men, and high email and chat usage in women (Thomée et al, 2012.). Computer usage can be synonymous to smartphone usage as it has become the most common and easiest mode of access to media. For college students, the transition to college is a natural stressor in itself as students try to fit in and become accustomed to life on their own while older students deal with the challenge of earning their degree, finding a job or in some cases a potential life partner. Regardless, all students deal with the common frequent stressors such as evaluations,
tests, critiques from professors or coaches, and sometimes it’s even more daunting when a student feels uncomfortable in the classroom or surroundings that they are in, or in relationships with faculty members. Ultimately, perceived stress is an important risk factor for low mental health and suggest that mastery and self-esteem are important protective factors of mental health among young adults (Bovier et al, 2004). It is important for students, faculty, family members and really anyone to be able to recognize the difference between stress and depression before it is too late.
Call to action
So, what should be done?
Beginning with the people who spend the most time with young adults and students, faculty and staff of schools and colleges, camps, and community areas should all be aware of symptoms and make the individuals know that they are welcomed and always available as a listening source that can also provide the individual with connections or further resources if needed. Counseling services in the wellness center need to be able to accommodate appointments for all the students who come to them, and also create a common practice of speaking to the student body about recognizing the different symptoms within themselves and peers as well as destroying any taboo misconceptions that mental health is a myth or something that they can just get over with on their own. Having resources such as creating a stress management program may also be very beneficial as a different course of action for individuals who don’t know where to start or wish to improve their mental health. Assessing the different stressors to individuals including the ones that accumulate over time. The College Chronic Life Stress Survey created in 1996 by Towbes and Cohen focused on the frequency of chronic stress in the lives of college students and evaluated how many times students dealt with these stresses on a weekly basis. They found that first year students had higher levels of chronic stress than the other students. Keeping an updated survey like this can be beneficial in helping faculty or school counselors realize where different individuals stand and assist them in an individualized matter. It can also help boards of higher institutions evaluate these results to see if there is a commonality amongst the students that is causing repeated high levels of stress and possibly adjust to accommodate the student body as a whole. Providing workshops or educational lectures that teach students how to recognize symptoms is important as many students would rather talk and confide in a friend before reaching out to a professional. Close friends can also detect abnormal behaviors in the individual that act as a signal for them to step in and help. They don’t have to become their friend’s therapist or certified counselor, however they can help by finding resources and in more serious cases, they can take action by reaching out to professionals for their friend or by practicing the concepts of QPR training which stands for question, persuade, and refer. This practice is a training done by many colleges or wellness centers to teach others how to recognize and help those at risk of suicide or who have thoughts of suicide. It can be applied to depression by gently confronting or bringing up the topic to their friend in mentioning that they have noticed a difference and are there to help them. Providing reassurance to the individual and helping them escape their doubts until a professional may be reached is a simple way a friend can help. Aside from educational staff and friends, family members and society as a whole needs to be reminded and educated that mental health is a real thing. It is not “just a phase” that one can easily get over with after a few days. Providing education and facts and reaching out to the public is the most essential way to get the message across which in turn creates a larger push for more research in labs and medication for individuals.
In research, finding better or more animal models that correlate to human’s mechanisms of actions may assist in further understanding both stress and depression in individuals. It is also important to keep in mind that young adults are not the only ones dealing with mental disorders. Frequently, individuals have struggled growing up but have never reached out or been told to seek help. There is a high percentage of older adults with mental disorders that still struggle on a daily basis who have just as many rights to access in resources and medications at their point of life as well (Kennedy & Ceϊde, 2017). Being able to recognize any symptoms or disabilities related with depression, anxiety, stress, and impaired cognition earlier on can lead to an easier or better appreciated lifestyle further on.
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