Major Depression to Bipolar II as a VC-backed software entrepreneur

First occurrence was diagnosed as Major Depression, and the second occurrence was reclassified as Bipolar II (3 years later)

As this was nearly 10 years ago, the specifics are a little foggy, but I’ll try.  I was a few years younger than 30 years old, co-founding a company with a couple other people. Raising our first money took much longer than I ever expected—we got somewhere between 80-90 no’s in a row over the course of several months.  I had never fundraised before.

I didn’t really realize it, but in hindsight I stopped sleeping very well due to increasing levels of anxiety during this process.  I know my self-confidence took a major hit.  My chest felt like it was in the tightest knot possible, all the time. Getting out of bed became harder and harder; sleeping was the only way I could not feel anxiety. I would gorge on candy–eating sweets was temporary relief from my fear and anxiety, although just momentarily.

I stopped showering for days at a time — I didn’t feel worthy of being clean.  I stopped saying anything in fundraising pitches because I would second guess myself.  I felt I had no way out of the startup due to the commitment I had made to my co-founders.  I worried constantly about whether or not I could pay my bills (my fiancé and I had plenty saved up; it’s my primary irrational fear).

To the complete credit of my co-founders, given that I was saying nothing in our pitches at this point, we got our first yes from an investor, and money started to come in from multiple angels and VCs.  But I still felt impending doom, like we couldn’t deliver on what we were pitching, and I felt like I had even less of a way out of the startup now that we had taken money (I think all our good investors would have understood a health-related leave of absence or even full departure).

At its worst point, I was barely able to get through each day without a lot of hand-holding.  Making even the smallest decisions like what to order on a menu became paralyzing — I would just order whatever someone else was getting.  I was certain that we were going broke despite having plenty of income coming in from my fiancé and having enough savings for more than a year of survival – to the point that I would drink pasta water out of where pasta had been cooking.  I thought I was going to get sued for something and go to prison, but I had no idea what – it was just a constant feeling I had.  I had no emotions. I wasn’t happy or sad.  Where my heart and emotions had been, it literally felt like there was a black ball of tar.  

On occasion I would think of ways to end my life as a way to escape what I was going through,  A very detailed and graphic image of me driving my car off a bridge and what would happen thereafter would appear regularly in my head, but this was nothing like the constant ideation I had in my second experience (more on that later)

My fiance was the first to notice and bore the brunt of dealing with, and taking care of me. Eventually against my (impaired) wishes, she called my mother, who also has a history of depression, to help.  On the other hand, my co-founders knew something was wrong as well, but didn’t know anything about mental health and so didn’t have the slightest idea on what to say or do. 

It would take 3-4 months to get back to some semblance of normal.

My fiancé knew she had to get me to a doctor, but I adamantly refused to go see a psychologist because I thought they would indefinitely commit me to an institution.  Luckily for everyone involved, I got an infected nail (likely from lack of self-care) that was painful enough for me to admit I should go see a doctor.  At the exam, she brought up the fact that I had not been feeling myself, and once the GP asked me questions about it, I was prescribed (the wrong dose) of medication; but also instructed me to find a psychiatrist. That was the push I needed.  With continued and repeated encouragement from my fiancé, I called several psychiatrists and found one I liked.  I was diagnosed with major depression and prescribed a sedative for immediate anxiety relief, and an SNRI for ongoing treatment of major depression.

In just a couple days I was feeling miles better.  One night early on I stayed up for hours because my brain finally felt unlocked from the haze it had been under for the last multiple months.

It wasn’t long before I was contributing at my startup again.  A little too much, perhaps.

Not all was well. I went into, what in retrospect, was a hypo-manic phase for several months (an important side-effect we overlooked at the time).  I got my first-ever speeding ticket for driving aggressively on the freeway.  I would get insanely mad at people who cut me off on the freeway, honking for 30 seconds or more.  I felt like I was more intelligent than almost everyone else, and overly optimistic about things.  I imagine for those months I was almost as hard to get along with as when I was going through my major depression.

After a few months my hypo-mania subsided and I felt normal for 3 or 4 years.  I kept my psychiatrist and tried finding a few different psychologists, but I never really connected with any of the psychologists. 

Fast forward a few years down the line, and I was in between jobs, not making an income.  I was preparing to raise money for my next startup, but I wasn’t able to find an idea I was ready to sell to investors.  Then symptoms started to hit again, but in very different flavors. The knots in my chest started, but then I became increasingly paranoid–I always thought the police were going to arrest me for something, again for no reason.  I would be so paranoid, for example, that if anyone else was in the gym I did everything I could to avoid eye contact and would typically just leave.   This time around, I ideated on suicide nearly constantly: I had picked out a variety of places and times that would be ideal to cross train tracks.  I searched for gun stores around my area constantly.  For a month or two, whenever I was alone, I would search the internet every 30 minutes for suicide methods.  And of course I knew that if I admitted any of it to my wife or psychiatrist I could end up in a hospital “against my will” (but for my own good), so I didn’t say a word about that part.

This period again was extremely hard on my wife and my family.   But they are the reason I’m still here; no matter how badly I ever wanted to escape the hopelessness and helplessness, I didn’t want to cause them the pain of losing a loved one.

My wife (again) was forced to be the one to push for me to get more help from my psychiatrist. We tried switching SNRIs over the course of a month and half or so, but that didn’t work.

My psychiatrist thought it was possible I had Bipolar II (different from the traditional Bipolar), and medication to treat major depression can actually worsen symptoms of Bipolar II.  He prescribed me a mood stabilizer as well as an SNRI, and I started to recover from my second episode from there, and haven’t had another one since then.

10 years on since my first experience, and I continue to take a mood stabilizer.  I’ve slowly decreased the SNRI dose; I’ll continue to reduce it during periods of my life that are less stressful.  Whenever I forget a dose, I get generally anxious and a little lightheaded, but can’t pinpoint anything I’m anxious about..

After my second experience, I was able to find a psychologist that I connected well with. I see both my psychiatrist (primarily medication focused) and psychologist (more mindfulness focused) once a month.  I’ve found it’s actually really nice to have an hour on a regular interval to “zoom out” on my life a little bit.  Day to day life often gets in the way of that, without a scheduled time.

I’ve tried a few techniques for managing daily anxiety.  What works best for me is trying to name the precise emotion that I’m currently feeling - and that doesn’t come easily for me.  I wasn’t taught a wide vocabulary of emotions growing up and taking about emotions wasn’t something my family was good at.  Once I name the right emotion I’m feeling, I notice my anxiety level go down after a minute or two.

If the anxiety is more persistent, I also take 20 minutes to myself, and list out everything that pops into my head that might be worrying me.  At some point the same things keep popping up in my head, and I’ve already written them all down.  Once I see them all written out, without anything missing, I can feel myself relax. It’s as if everything I need to remember to worry about is already on the page.

There are several physiological symptoms I experience that indicate my anxiety level to me, when I’m paying attention. 

The first and most obvious sign is gastro-intestinal pain.  I started to notice that in college when exams would be approaching.  It’s become a sign that I have some acute anxiety to a situation or deadline, but not more generalized or severe.

The next sign that I’m having more significant anxiety is that I’m more irritable or have limited patience with people.  It takes far less emotional work to recover from my anxiety from here, but it’s been pretty subtle for me to pick up on; usually my wife has to point it out to me.

Tightness in my chest is the big warning sign for me.  Without addressing it, the  tightness will continue to worsen and I’ll generally be miserable myself and miserable for others to be around.  This is typically where I notice the signs and take action, but I’m working on picking up on issues earlier.

On a side note, when I feel numbness of my teeth (a sign of hyperventilation I’ve been told), and find the room overly warm and uncomfortable, it’s a certain indication that I forgot to take my medication.  It takes me a couple days to feel normal anxiety levels when I miss a dose.

• Typically, what I’m anxious about, are valuable concerns to have (not including when I’ve been in one of my two episodes).  Something actually is not going as well as it could, whether at work or in my personal life.  It’s just that the level of worry is out of proportion with the potential problem. So it’s actually helpful to have the anxiety, as long as I make note of what it’s warning me about.  I used to try to push away the anxiety; but if instead I try to figure out what it’s warning me is a problem, I can actually course-correct it.  And I’m usually aware of brewing issues most others aren’t until much later.

• My anxiety is nearly always rooted in one of the following areas: financial security/insecurity of having my job, or feeling of overwhelm.  Having financial security be a trigger is a major bummer from an entrepreneurial standpoint, let me tell you – they say good leaders eat last, and I guess my worry is that sometimes the founders don’t eat at all.  I’ve never been in that situation of course, but my body has an irrational fear of it.  The other reason I’ll feel anxiety is if I’m feeling overwhelmed with everything I feel I have to get done.  I don’t always take the time I should for aggressive prioritization on a day to day basis.

• My love for myself was based primarily on accomplishing my professional goals.  I had the epiphany in therapy while my dog was accompanying me; my love for my dog (and family and friends) had nothing to do with what they were able to attain, but who they were.  It’s a slow process changing how I feel about myself – I still enjoy accomplishing and striving to accomplish professional goals, some of which I have had since I was in middle school. But life is happier when I am able to remember to treat myself as I do anyone else I love.

• I used to think that decisions were made rationally and logically, but it was clear that without an emotion driving me, I couldn’t decide one way or another.  Now I wonder if rather we humans make an intuitive decision, and use rationality and logic to retrospectively justify that emotionally driven intuition.  

I‘ve recently read stories my friends have shared semi-privately, which made my experience more normal.  I hope to do the same for others.  I also hope others are encouraged to share for the same reason.