When Stress Is More Than Stress: Anxiety and Depression in College

Insights by Shannon Strohl, Assistant Professor of Clinical Mental Health Counseling

Anxiety and depression are two of the most common mental health challenges affecting college students, yet they are often misunderstood or discussed interchangeably. While the conditions can occur at the same time, mental health professionals emphasize that they differ in meaningful ways — differences that matter when it comes to recognizing symptoms and seeking appropriate support.

Dr. Shannon Strohl, assistant professor of clinical mental health counseling at Lebanon Valley College, explains that depression is far more complex than stereotypes of sadness or low motivation. “Depression could feel like difficulty getting out of bed or feeling disconnected from others,” Strohl said. “If the things you typically do with ease or enjoy begin to feel like chores and obligations to avoid, that may also be a sign of depression.”

Among college students, depression can also appear in subtle ways that are easy to overlook or misinterpret as typical stress. Strohl notes that irritability, withdrawal from others, and a loss of interest in activities students once enjoyed are common warning signs. In some cases, students may experience passive thoughts about wanting to sleep excessively or disengage from daily life or turn to increased substance use as a way to cope.

Clinically, depression presents in different forms. Major Depressive Disorder is marked by more acute and severe symptoms lasting at least two weeks, while Persistent Depressive Disorder involves milder but chronic symptoms that can continue over a longer period. Both forms, Strohl explains, can significantly interfere with daily functioning if left untreated.

Anxiety, by contrast, is driven by excessive worry that is difficult to control. “Anxiety revolves around excessive worry that can be hard to soothe or manage,” Strohl said. “This worry can be related to a particular topic or a general sense of worry about different things.”

While some anxiety is developmentally appropriate for college students navigating new responsibilities, an anxiety disorder goes beyond everyday nervousness. Symptoms may include racing thoughts, difficulty relaxing, sleep disturbances, muscle tension, irritability, and problems with concentration. Anxiety also often presents physically. “Physically, a person experiencing anxiety may notice symptoms like sweating, hands shaking, or heart racing,” Strohl said, noting that these symptoms are not typically associated with depression.

Behaviorally, the two conditions may look very different. Students experiencing anxiety may appear restless or on edge, while those experiencing depression are more likely to withdraw socially or disengage from academic and extracurricular activities. However, Strohl cautions that these patterns vary and are not the same for everyone.

Because anxiety and depression share overlapping symptoms — including sleep issues, irritability, and difficulty concentrating — distinguishing between them can be challenging. “The best way to be sure you are experiencing depression, anxiety, both, or neither would be to meet with a trained mental health professional,” Strohl said, emphasizing that the distinction matters because treatment recommendations may differ depending on symptoms.

When untreated, both anxiety and depression can affect multiple areas of a student’s life, including academic performance, social connections, and overall well-being. Students may begin avoiding classes, procrastinating on coursework, or pulling away from friends, even if they appear to be managing day to day.

For students who are unsure whether their feelings are serious enough to seek help, Strohl encourages reaching out sooner rather than later. “If you are wondering if it’s ‘serious enough,’ then that in and of itself is enough to at least meet with a mental health professional,” she said. “They can help determine next steps, whether that involves counseling, medication management, or strategies for managing typical college stress.”

Above all, Strohl emphasizes the importance of paying attention to mental health — in oneself and in others. “Asking for help or noticing symptoms in someone you care about can be life changing,” she said. “Your mental health and wellbeing matters.”