Anxiety and depression are treatable disorders, and at Boston University, help is always close by. But many students suffer in silence. Mary and Lisa (not their real names) are two of them. Before they got help, they were casualties in what the Chronicle of Higher Education calls “an epidemic of anguish.”

Mary (CAS’15), an athlete unable to climb out from under a heavy burden of anxiety and despair, stopped eating regular meals, pulled all-nighters, cut herself, and contemplated suicide. Lisa (CAS’17), a dancer with an injury that prevented her from dancing, binged on ice cream, junk food, and alcohol, and made what she calls a harrowing foray into hookup culture. Away from their families, hobbled by what they saw as overwhelming expectations, outpaced by academic demands, and surrounded by temptations to numb the pain in harmful ways, both young women credit taking that difficult first step of confiding in someone for their recovery.

A 2012 study by the National Alliance on Mental Illness reported that 40 percent of college students with a diagnosable mental health condition did not seek help. But after first confiding in friends, Lisa and Mary eventually got the treatment they needed, and now consciously practice what clinicians call self-care: healthful diet, regular exercise, socializing, and embracing constructive hobbies and passions. Both women want others who are suffering to know that even with the highs and lows common to both anxiety and depression, things get easier after seeking help. They want them to know that like anyone seeking treatment for a physical condition, such as diabetes or allergies, going to a mental health professional for depression or anxiety isn’t a reflection of a personal failing. Nor is it uncommon.

In its checklist for students who may be suffering from anxiety or depression, the college mental health advocacy group Active Minds cites neglect of personal care as a potential warning sign: Have you stopped caring about your appearance or stopped keeping up with your personal hygiene? Students are also asked to be honest with themselves about reckless or impulsive behaviors: Are you drinking or using drugs excessively? Are you behaving unsafely in other ways?

Binge drinking, drug abuse, eating little or eating too much, self-harm, reckless hookups, suicidal thoughts—all of these hover seductively when someone is in acute psychic pain. In a 2010 study, part of the National Epidemiologic Survey on Alcohol and Related Conditions, of a nationally representative sample of 34,653 American adults, 13 percent of the people who had consumed alcohol or drugs in the previous year said they’d done so to reduce anxiety, fear, or panic about a situation.

Depression, anxiety, and alcohol abuse often coexist, creating a vicious cycle in which one fuels the other, according to the Anxiety and Depression Association of America. About 20 percent of Americans with an anxiety or mood disorder such as depression have an alcohol or other substance use disorder, the association reports, and about 20 percent of those with an alcohol or substance use disorder also have an anxiety or mood disorder. (Alcohol, it’s important to remember, is itself a depressant.)

Top priority—preventing alcohol abuse

Preventing alcohol abuse is the top priority of Wellness & Prevention Services at Student Health Services (SHS), says director Katherine Mooney (SPH’12). With anxiety and depression sweeping college campuses, troubled students seeking solace are most likely to turn to alcohol, the biggest public health concern on college campuses, Mooney says. About half of college students who drink alcohol also indulge in binge drinking, according to the National Institute on Alcohol Abuse and Alcoholism. The institute also reports that 1,825 college students between the ages of 18 and 24 die each year from unintentional alcohol-related injuries.

During the fall 2015 semester, 71 BU students were transported to local hospitals for acute intoxication, down from 112 in the same period the previous year. To date this fall, there have been 25 hospital transports. Boston University Police say they believe the decline in transports last year is due, in part, to continued enforcement and education.

“I had, unwillingly, done everything in my power to isolate myself from the people who cared about me. I barely spoke to anyone anymore and completely withdrew from social situations.”

For Mary, self-harm involved resuming the habit of cutting, something she’d done in high school. She describes her lowest point: “My cutting intensified with every mistake I made. It didn’t really need to be anything major to get me to cut anymore. I had begun to sleep much less; I went to bed at all hours of the night due to schoolwork, and pulled a quite a few all-nighters. Those nights had left me almost worthless at team practice the next day. My appetite had also decreased, causing me to get faint during workouts and practices. I had gone from calling my parents three nights a week to twice a month. I just kept giving them the excuse that I was busy with schoolwork, when really it was just too much energy for me to act happy while on the phone with them. I had, unwillingly, done everything in my power to isolate myself from the people who cared about me. I barely spoke to anyone anymore and completely withdrew from social situations. I found my mind telling me that I couldn’t laugh or smile because I didn’t deserve to be happy, with failing grades and a failing social life.”

Many people are likely to recognize their own symptoms in Mary’s downward slide. In his classic memoir Darkness Visible, William Styron calls depression “a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self—to the mediating intellect—as to verge close to being beyond description.”

From her experience, says Victoria Pae (CAS’16), former president of the University’s chapter of the national mental health advocacy student group Active Minds, “BU is particularly stressful. I think it’s because everyone is doing so much, everyone appears to be at the top of their game, and that is very anxiety-producing. You have all these large introductory courses, and you’re too scared to speak out.”

During freshman year, Pae had been overwhelmed by stress and anxiety, but was afraid to seek help, she says. After joining Active Minds, she began to see an off-campus therapist to help treat her anxiety, and she says that she’s “definitely doing better than I was a couple of years ago.”

Ultimate priority: taboo subject of suicide

A major concern, and still something of a taboo subject, is suicide. “Suicide is the ultimate thing we should be prioritizing—it’s the second leading cause of death in young adults, and it’s preventable,” says Kate Bentley (GRS’16), a researcher and counselor at the BU Center for Anxiety & Related Disorders.

“College is a particularly vulnerable period,” says Bentley, who emphasizes the need to identify and distinguish between the phases in the potential progression from thoughts about suicide to suicide plans to suicide attempts. “In terms of prevention, one of the most important things is improving our understanding of why suicide happens,” she says.

There are many common risk factors: mental illness, depression, substance use, schizophrenia, personality disorders, hopelessness, acute agitation, and access to lethal means, “but what we’re becoming more and more aware of is that there’s really no simple solution or algorithm,” she says. “We have to improve our understanding of preexisting vulnerabilities, including childhood experience, and in college, academic stress, financial stress, and breakups.” Regardless of the trigger, Bentley says, recent research indicates that when college students are experiencing suicidal thoughts, the person they’re most likely to tell is a friend. “They won’t go first to a clinician or a professor,” she says

What should that friend do? “The first thing I would say is, get in touch with a clinician,” advises Bentley. “If it’s the middle of the night, call the Student Health Services emergency line, 617-353-3569, and make sure the suicidal person is safe. When someone, be it a peer, a friend, a romantic partner, discloses that they are thinking about suicide, those thoughts must be taken seriously whether you think they mean it or not. What can be really difficult is if a student says, ‘Promise you won’t tell anyone.’ A lot of individuals will try to keep the person they tell quiet because they don’t want to be forced into treatment or are afraid they’ll be kicked out of school. But we have very effective treatments for depression and anxiety, so it’s important to encourage people who are struggling, suicidal or not, to seek help.”

Healthy lifestyle—for mind and body

Carrie Landa, director of Behavioral Medicine, says that some students can improve significantly by making simple adjustments to their lifestyle. Maintaining a regular sleep pattern, stopping abuse of alcohol and drugs, and getting regular exercise are all likely to improve a student’s well-being, even if he or she is waiting for an appointment with a therapist. So whether they suffer from anxiety, depression, or a combination of both, students can learn healthy coping mechanisms, Landa says.

On that front, BU has been proactive, with SHS Wellness & Prevention Services distributing Art of Stress Relief kits, with activity books, Play Doh, and star-shaped squeezable stress balls. Available as well are Create a Good Night’s Sleep packets, which include an eye mask, earplugs, a bag of lavender, a calming herbal tea bag, and a handbook for good sleep hygiene, with reminders to turn off those laptops and phones. Also in the sleep packet is a copy of Good Night, Comm Ave, designed by Mooney with a cover evoking Good Night, Moon (the Citgo sign hovers outside the window). A Finals Survival Guide was added last fall, with healthy snacks and Biodots skin thermometers so students can check their stress levels.

Mainly preventive, Wellness & Prevention programs like the Stress Buddy workshop use trained student health ambassadors as liaisons between SHS and BU students. This year’s diverse group of 16 ambassadors help their peers recognize and avoid stress triggers by teaching them stress management strategies. The 45-minute workshop also includes discussion of the types and physiology of stress, the ways stress can affect students’ lives, and instruction in exercises students can use to better manage their stress, says director Mooney. Last spring, Wellness & Prevention also cosponsored the inaugural Fresh Check Day, a wellness fair designed to spark conversations about mental health, reduce prejudice and misconceptions, and generate awareness about suicide prevention. Based on the success of last year’s event, the fair will be held again this year.

“Everyone is different, and it might take some time to find coping skills that work best with your lifestyle. Suggestions may arise in therapy that don’t seem appealing at all, but give them a try; you may discover something new that ends up working.”

These days, Lisa is managing her anxiety and depression in a variety of ways. “I exercise a lot,” she says, working out three to five times a week. “I’m a lot more spiritual now than I was when I was younger. I’ve found my way back to religion as an outlet.” She also benefits from the intimate socializing that comes from cooking with friends. And she’s eating more healthfully.

“Things have improved greatly for me,” says Mary, who is on antidepressant medication and sees her psychiatrist monthly. The most important thing for her, she says, “is to build a support system everywhere I go. These systems consist of people I know I can call in times of need or crisis, such as friends or doctors. Working out is something I still incorporate into my everyday life. To take the edge off of my anxiety and wanting to cut, I find that getting outside and going for walks with music are helpful, as well as doing any sort of manual labor, yard work especially.

“My therapist also encouraged me to set up a dinner or an outing with a friend once a week, so I would have something to anchor my week around and look forward to—these dates are now my light at the end of the tunnel. All these things have helped me manage my depression and anxiety in healthier ways,” she says. But she adds that no matter how much better she feels, she must constantly work on maintaining her mental health.

Mary’s advice to students in the position she was a year ago? “Seek help. This was obviously not the first thing I thought of when I began to really struggle, but I do wish I had done it sooner. If seeking help is an option, be prepared to work on yourself both in and out of therapy.” People in treatment should not expect that “what works for one person will automatically work for you,” she adds, “and definitely do not expect to instantly feel better. Part of therapy is working with your therapist to find out what works for you. Everyone is different, and it might take some time to find coping skills that work best with your lifestyle. This also means keeping an open mind. Suggestions may arise in therapy that don’t seem appealing at all, but give them a try; you may discover something new that ends up working.”

Both Mary and Lisa say that the importance of not isolating oneself cannot be understated. “Depression and anxiety have a way of forcing you to push people away, and that is what makes it so lonely,” Mary says. “Leaning on those close to you doesn’t necessarily mean having to let them in on what you are feeling. Instead, accept that invitation to go see a movie or go to dinner. It will be a lot less lonely, and keep you from ruminating in your thoughts, even if it’s only temporary.”

Those seeking free, confidential mental health counseling can contact Student Health Services Behavioral Medicine (617-353-3569) (available 24 hours for psychiatric emergencies), the Center for Psychiatric Rehabilitation (617-353-3549), the Danielsen Institute (617-353-3047), and the Center for Anxiety & Related Disorders (617-353-9610). Faculty and staff with mental health issues can contact BU’s Faculty & Staff Assistance office (617-353-5381). The Samaritans of Boston suicide prevention hotline is 877-870-4673. The Active Minds student support group is best reached through its Facebook page. For crises related to crime and interpersonal or sexual violence, BU’s Sexual Assault Response & Prevention Center crisis counselors are available 24 hours a day, 7 days a week (617-353-SARP) (7277). If you, or someone you know, have questions about their drug or alcohol use, Wellness & Prevention Services can help (617-358-0485). Students who require academic or other accommodations for a psychological disability can also consult with BU’s Disability Services (617-353-3658). Accommodations and services could include testing modifications, reduced course load, developing skills in self-advocating with faculty, executive functioning coaching, and more. Services are free and confidential.