When Depression Struck
A medical student from Bethesda found a different way to help others after depression upended her life
STEPHANIE ROSEN KNEW something was wrong when she failed anatomy during her first year of medical school in Philadelphia in 2004. Stephanie, who grew up in Bethesda, had excelled academically at Walt Whitman High School and at Northwestern University, where she earned a degree in genetic and molecular biology. She hoped to specialize in infectious diseases and work for Doctors Without Borders, treating patients in developing nations. But suddenly, at the age of 23, she found herself oversleeping and showing up late to class. She couldn’t concentrate on studying and started to feel hopeless. She was crying every day.
Stephanie Rosen is executive director of Montgomery County’s chapter of the National Alliance on Mental Illness. Photo by Lisa Helfert.
“I’d gotten into med school with a scholarship. …This behavior was so unlike me—I had no idea what was happening,” she says. “I just thought it was because my boyfriend was in Chicago and I was in med school in Philadelphia and med school was tough.”
She was having distorted thoughts that she couldn’t control—paranoia that someone was in her apartment at night, the feeling that no one liked her, and an overwhelming sense that something bad was going to happen. Her student adviser at Jefferson Medical College (now Sidney Kimmel Medical College) at Thomas Jefferson University suggested that she see a school psychiatrist, something she says he often recommended to struggling medical students.
“It was a revolving door,” says Stephanie, who now lives in Kensington. “I’d see a classmate come out of the office, I’d go in, and when I came out, I’d see another classmate waiting.”
She’d never felt anything like this before. Growing up, she was easygoing, inquisitive and always up for a challenge. Her Saturdays were filled with ballet classes, horseback riding lessons and art shows. She was involved in so many activities that she became an expert at changing clothes in the car. In high school, she did especially well in math and science, and flourished as an artist. For a time, she considered becoming a reconstructive surgeon, which someone told her was the perfect combination of science and art.
But everything changed after her undergraduate years at Northwestern. For Stephanie, it was the beginning of an ongoing struggle with depression, one that has involved doctors, medication, failure, success and an unexpected change of plans.
STEPHANIE USED TO WONDER if she should talk about her depression, whether people would think she was “damaged goods.” But she began to realize that the stigma connected to mental illness is part of the reason people don’t get help, she says, and that sharing her experiences might benefit others. According to a report by the Substance Abuse and Mental Health Services Administration, one in five U.S. adults age 18 and older suffered from mental illness in 2013, and only about 45 percent received treatment. In Montgomery County, the percentage of adults reporting that they’ve been diagnosed with anxiety and/or depression increased between 2009 and 2013, according to Healthy Montgomery. Nearly 144,000 adults and 12,000 children in the county live with a mental illness.
At 34, Stephanie is a long way from where she thought she would be, but given her struggles with depression, she believes she’s right where she should be. Two years ago, she was named executive director of Montgomery County’s chapter of the National Alliance on Mental Illness (NAMI MC), one of the leading mental health organizations in the county.
It’s a big job for someone who used to be so overcome with sadness that she didn’t think she’d amount to anything. Founded in 1978, NAMI MC is dedicated to improving the lives of county residents with mental illness, their families and their caregivers through free classes, support groups and advocacy. The nonprofit organization assists with everything from housing and legal referrals to providing help in crisis situations. The help line receives about 2,400 calls a year, referring some individuals to NAMI MC programs or to the county’s 24-hour crisis center.
Stephanie understands what some of her clients are going through: She still sees a psychiatrist regularly, and her husband, Jared, stops by her Rockville office a few times a week to make sure she’s eaten and taken her medication. She once thought about ending her life; now she spends her days working with donors, running fundraisers, writing grant applications, and promoting the organization’s mission on social media. She also gives speeches, and recently did her first live television interview—something she thought she’d never have the confidence to do.
Under Stephanie’s leadership, NAMI MC is growing. Her original staff of one has expanded to four full-time and 10 part-time employees. The organization’s annual Heroes gala, which honors individuals who have made a significant contribution to mental health advocacy, policy, stigma-busting, education and research, brought in $18,000 in 2012, Stephanie says. In 2013, her first year as executive director, the event raised $43,000, a figure that grew to $53,000 the following year, when Virginia state Sen. R. Creigh Deeds was honored for his work to reform access to mental health in the wake of his son’s 2013 suicide.
But Stephanie doesn’t define her success in dollars. Instead, she revels in the fact that NAMI MC’s programs, which in previous years reached about 4,000 people, will reach five times as many in 2015. NAMI MC recently partnered with umttr (texting shorthand for “you matter”) to bring Sources of Strength, a suicide prevention program for adolescents, to four Montgomery County high schools, with several more—including Whitman, Stephanie’s alma mater—scheduled for the fall. Umttr, founded by local teens and Sue Rosenstock, the mother of Winston Churchill High School sophomore Evan Rosenstock, who took his own life in 2013, works to raise awareness of depression and suicide.
“Stephanie’s proven herself a real asset,” says NAMI MC board member Mimi Kress, whose 24-year-old son has struggled with mental illness since he was 10. Kress first met
Stephanie when Stephanie was teaching a course at NAMI MC called Family-to-Family, which focuses on ways for relatives to cope with the trauma of mental illness, and how to problem solve. “I saw firsthand her compassion for those families,” Kress says.
During her interview for the executive director position, Stephanie told the board of directors that she had never written a grant application or worked with a board, and that she didn’t know how to read financial statements. She thought she blew the interview, she says. But she brought something else to the job: an in-depth knowledge of the anguish that mental illness causes for individuals and their families, and a passion for helping them heal.
LIKE MANY PEOPLE, Stephanie thought her depression might be a one-time thing. The psychiatrist she saw in medical school prescribed Lexapro, a drug used to treat generalized anxiety disorder and depression, and Stephanie noticed a change quickly. “I would tell anyone who would listen: ‘You’ve got to take Lexapro,’ ” she says. “It really was a miracle drug.”
But Stephanie only saw that doctor twice. When another psychiatrist took over the practice, Stephanie thought, “Things are better. I guess I’m done.” She didn’t make an appointment with the new doctor and stopped taking the Lexapro. “I should’ve stayed on the medication and I should’ve been in therapy,” she says.
Stephanie spent the summer after her first year in med school studying for the anatomy exam, which her professor allowed her to take again. She started eating more and moving less as a result of the stress and her depression, which had started to come back. “When I got back to school, one close friend looked at me and said, ‘What happened?’ ” she says.
The start of her second year marked another downhill slide. This time her symptoms appeared more slowly than they had before, and she found them easier to ignore. She muddled through school and managed to pass all of her classes.
Stephanie’s mother, Mary Custer, could tell something was wrong when she talked to her daughter on the phone. “She would cry. She couldn’t get out of bed or do her laundry. She wasn’t studying,” says Custer, a grants administrator at the National Institutes of Health.
Finally, while home on winter break, Stephanie saw her primary care physician and asked for a new prescription for Lexapro. According to a report on the American Psychological Association (APA) website, a 2009 study showed that nearly four out of five prescriptions for psychotropic drugs are written by physicians who aren’t psychiatrists and who may have limited training in the treatment of mental health disorders.
This time, the medication Stephanie had viewed as a miracle drug didn’t work. A month later, the doctor doubled the dosage, but there was still no relief—and no recommendation for psychotherapy, which is shown in some studies to be just as effective as antidepressants, according to a 2012 report on the APA website.
Stephanie once thought about ending her life; now she spends her days promoting NAMI MC’s mission and programs. She recently gave a live TV interview, something she never thought she’d have the confidence to do. Photo by Lisa Helfert.
After her second year of medical school ended in 2006, Stephanie went through one of the most painful periods of her life. She took Step 1 of the three-step United States Medical Licensing Examination (USMLE)—and failed. “That doesn’t happen,” she says. “All of my friends passed and were continuing with their course work, doing their rotations, and I wasn’t.”
After an intensive nine-week boot camp in Dallas that summer, Stephanie took the USMLE again, and failed. Jefferson Medical College’s policy was “three times, you’re out,” Stephanie says, so she began to feel intense pressure to pass on that third and final attempt.
As her depression worsened, she sought help from another school psychiatrist and cried through the appointment. “I remember asking him, ‘How do people feel good about themselves? How is self-esteem even possible?’ I felt I had let a lot of people down. It’s painful to think about even now,” she says.
When she asked the doctor for his prognosis, he told her he thought she needed intensive inpatient treatment—and that she probably would never be able to hold down a job.
STEPHANIE WAS SO terrified to take the exam again that she waited a year to do it. She spent her time studying, and made frequent trips to Bethesda to see her parents. During a visit home in November 2007, she met Jared Rosen, an account manager with Nolan Financial in Bethesda and a part-time disc jockey, at Flanagan’s Harp & Fiddle in Bethesda. That night, Jared was standing outside the bar talking on his phone when a woman walked by and they made eye contact. “She was beautiful,” he says. “There was an attraction right away.” When he returned to his friends inside, the same woman, Stephanie, was sitting at their table. His friends had invited her, as well.
After that night, the two spent more and more time together, commuting between Bethesda and Philadelphia, where Stephanie still had an apartment. Jared loved her adventurous spirit, and they were out all the time—playing shuffleboard at Dave & Buster’s, taking a food tour of Philadelphia, spending afternoons at the park with Stephanie’s dog, Louie. At first, Stephanie only hinted at the depression. She’d say, “There are things you don’t know about me,” or refer to the medication she had taken. When she finally told him, Jared thought he knew what depression was. But Stephanie was able to hide her symptoms from him when they were together. In hindsight, he says, he didn’t fully understand what it meant to have depression.
In August 2008, Stephanie took the licensing exam for the third time. “Everyone said, ‘You’re going to pass, you’re going pass,’ ” she says. She failed by one point and was dismissed from medical school.
Looking back, Stephanie’s mother says she wishes she’d done things differently. “I accepted that Stephanie had depression and that she probably needed medication, but I didn’t really know what that meant in terms of how it would affect her life,” Custer says. “In retrospect, we should have withdrawn her after her first year and given her more time to heal.”
At 27, Stephanie moved back to her parents’ house in Bethesda. She found a psychiatrist she liked, started taking a combination of Lexapro and the antidepressant Wellbutrin, and went regularly for psychotherapy. “The doctor made me understand that my depression is chronic. It isn’t going to be ‘take your magic pill for three months and everything’s going to be better,’ ” she says.
But it was difficult being home. Stephanie’s high school friends had graduate or law degrees. They were getting married and buying houses. “They just kept saying, ‘Why aren’t you doing anything, Stephanie? What’s wrong? Just do something,’ ” she says.
Stephanie got a job at Georgetown University working on a stroke disparities study, and continued calling medical schools in a desperate attempt to get admitted so she could take the licensing exam again. Jefferson Medical College told her she would have to agree to repeat classes before they would even consider letting her return. “I finally came to the realization that medical school wasn’t going to happen,” she says.
Stephanie and her husband, Jared, married in 2013. Although his wife’s depression is a small part of their relationship, Jared says, it’s always there. Photo by Lisa Helfert.
IN NOVEMBER 2010, Stephanie found a new job in a lab at the University of Maryland. She moved to Baltimore three months later and got a place by herself. Jared visited when his weekend DJ business allowed. “A few months into it, she said, ‘I’m not going to work today,’ ” he says. “She didn’t feel like calling in sick, but she stayed home and just did nothing. I didn’t know what it was, or why telling her, ‘Just go to work,’ didn’t change anything.”
Six months later, he convinced Stephanie to move back to the Bethesda area and live with him. That’s when he began to recognize the signs of her depression. “You can hide it for a while when you’re dating,” Jared says. “You don’t necessarily know when there’s something wrong because it’s all on the inside. But you can’t hide it when you live together.”
Two years after their wedding, Jared, 33, says he’s still learning what it means to live with someone who has depression. It’s a small part of their relationship, but it’s there, he says. Stephanie works long hours and sometimes comes home depleted. “I don’t want to confuse that with the depression,” he says. But he can tell when it’s more than exhaustion. “She’ll go three or four months without anything, and then she’ll have a day when she can’t do anything but lay in bed, order pizza and watch movies,” he says.
“I sympathize with him,” Stephanie says. “It’s frustrating when you don’t totally understand.”
When Jared has something to do, he wants to tackle it right away, he says, but there are times that Stephanie can’t. So he’ll return the broken wedding plate that sat in a box for months, or sort through Stephanie’s online purchases and pack up what needs to be shipped back. He knows that the worst thing he can do is push her.
“Jared has all of this energy to clean the house or do this and do that, and I don’t,” Stephanie says. “It’s not that I don’t want to be a good partner—it’s not that I don’t want to contribute as much as he does. But sometimes I have to do it in a different way.”
If Stephanie feels like going out to dinner or to a friend’s house, they go, Jared says. If she doesn’t, they stay in. Some days, Jared wakes Stephanie before he leaves for work and hands her a drink and her medication. “I’m so focused on work right now that I can forget to take it for a few days. It’s not good. I have an illness and I have to take it,” Stephanie says.
She once asked a friend who suffers from depression: What is the best thing your family ever did for you? “She said, ‘They just told me that they loved me,’ ” Stephanie says. “Sometimes it’s just about unconditional love.”
AROUND THE TIME she moved in with Jared in 2011, Stephanie accompanied her sister, Kathy, to a NAMI MC Family-to-Family class to learn more about Kathy’s son, who’d had episodes of mental illness. She was in denial, though, thinking that she needed to go for her nephew and not for herself. As she listened to the families in the classroom talk, she ended up learning a lot about herself. “I blamed myself for all the things that had happened, but they weren’t my fault,” she says. “I understood I have a treatable illness, but I wasn’t necessarily in the right treatment plan. I finally forgave myself.”
In 2012, Stephanie made the decision to teach Family-to-Family as a volunteer, and she convinced her mother to join her. The three-day teacher training was intensely personal. That was the first time she told her mother that she had once made a plan to die by suicide. “It had gotten that bad,” Stephanie says. “I felt so ashamed telling her, but she did the best thing that anyone has ever done. She said, ‘It’s OK, it wasn’t you. It was just your depressed brain telling you to do that.’ ”
As she continued to volunteer, Stephanie realized that her goals had shifted. She had wanted to be a doctor, but what she really enjoyed was patient education. She loved the nonprofit environment and the advocacy. Stephanie told the executive director that she intended to work at NAMI MC one day. In January 2013, Kress recommended her for a Family-to-Family program coordinator position, and later for the top job.
“I never thought of myself as an executive director. I was working only part time and had to think about full-time work and my mental health. Would the stress be too much? One thing I’ve learned is that I have limits,” Stephanie says. Jared says you wouldn’t know it during those weeks when she practically lives at the office.
“It’s the hardest job I’ve ever had. I’ve had to grow a lot, but it is whatever I want to make it. This is exactly what I want to do and where I want to do it,” she says. “I haven’t felt this way in a long time.”
Gabriele McCormick is a frequent contributor to Bethesda Magazine.