DBSA Young Adult Council Member, Sonam Vyas, sat down with Professor and Director of Community Medicine at Saint Louis University School of Medicine, Fred Rottnek, MD, to discuss navigating college life while living with a mental health condition. Dr. Rottnek details how his experience living with major depression altered his life in college and what steps he had to take to find wellness.

What is your experience relating to mental health and how it’s changed your life path and career?

I now know that I experienced major depression since grade school. But in my youth, we didn’t discuss depression—as a family or in society. I managed my depression through a zealous pursuit of academic success. But after a few spectacular “failures”—including leaving a doctoral program in bioorganic chemistry at Harvard, after only 1 month, and an 8-day stay in the Jesuit novitiate in Denver, I returned home to Saint Louis and saw a psychiatrist. Prozac was new back then in 1989. This class of safer medications changed the way society talked about depression and mental illness. After lots of medication changes and lots of therapy, I began medical school at Saint Louis University in 1991.

I knew I had found a community where I could thrive. As the first one in the family attending college, and as the child of a working-class-turned-middle/upper-class family with long histories of depression and alcoholism, I found conversations around health and illness came easier for me with people outside of formal health care settings. I enjoyed learning to build rapport with people who were not familiar with successfully accessing care in traditional settings. The scrappiness of this work, which included driving around a minivan full of medication samples and extra dressings provided the introduction to a career in which I could leverage the resources of the healthcare establishment to treat populations that had been marginalized due to mental illness and substance use disorders. My own struggle with depression allowed me an easy-to-access starting point for care—I had friends and family to help into treatment and recovery. These folks were no different from me in their humanity, but they didn’t have the security of housing, food, and other major supports of health.

Working with individuals experiencing homelessness led me to my next career phase—correctional healthcare. I completed a 15+ year sentence as the medical director of the Saint Louis County Corrections Medicine program. I was the chief physician at the county jail and juvenile detention at family courts. Walking into the facilities on the first day, I felt it would be like my earlier work with individuals experiencing homelessness—but with more staff and resources. And I loved the work—particularly the patients. They typically were grateful for the care, open and honest, and never, ever boring. They were human beings who found themselves in terrible conditions that they did not aspire to as children. I had the honor of being their physician and helping lead a dedicated staff of healthcare professionals who knew this population needed extraordinary patience, education, and respect.

Almost three years ago, after much turbulence in local government and the press, I took a deep dive into the freshly recognized field of addiction medicine. I would never have had the courage or the comfort level to take on a new focus—much less a new board exam—in my 50’s without my practices of the previous decades. And I am busier than ever as I try to formalize coursework, clinical practice in addiction, and a fellowship. My patients and colleagues have made me a better person and a better physician by helping me search for the deeper stories of people with mental illness and substance use disorders. The principle of charity calls us to expect the most rational and best intentions behind an individual’s actions or words. I am a far more charitable person today as a result of my depression and the lens it has provided me in my career.

What are the best supports or strategies that people with depression or bipolar disorder can use to overcome stressful times when going through school (ex. college or graduate school)?

 Develop a reflective mindset so that you know your strengths, your vulnerabilities, and your best coping skills. Know your red flags—when there may be signs of depression or other mood changes. For me, they include days I don’t want to get out of bed or times I dread answering a ringing phone.

Consider your healthcare providers as team members in your success. When you experience stressful times or anticipate possible stressful times, get in touch with your providers so you can put together a game plan for coping with adversity and thriving in the long term. Don’t wait for problems to happen—get in front of them with positive activities and thoughtful and regular communication.

How can people with depression, bipolar disorder, or another mental health disorder who have to take time off from school or feel like they have fallen behind their peers best move forward?

Taking time off to care for your health is an investment in your future. Ignoring mental illness is not a sustainable plan! Just as we invest in education, a home, or a smartphone, we need to invest in our own long-term health and well-being. Addressing mental illness provides us a way to strengthen our core, much like physical exercise.

What are some resources for young adults without insurance who are seeking help for depression or bipolar disorder?

 If young adults don’t have insurance, they can contact their local federally qualified health center or community mental health center, https://findahealthcenter.hrsa.gov/https://findtreatment.samhsa.gov/. These agencies have alternate sources of funding that allow them to work with patients through free or reduced sliding scale fees.

What do you think the future holds in terms of treatments for people with depression or bipolar disorder?

 In the U.S., we tend to “over-medicalize” conditions. We tend to look for that magic pill to “fix” us. We know better. And we need to care for ourselves better. Physical activity is important—anything that gets us away from monitors and screens on an intermittent basis is important. Mindfulness, various talk therapies, and simple conversations with people who support us are important ways to see the world, our relationships, and ourselves in a healthier light when depression and bipolar disorder seem to skew our perceptions. Other treatments are interesting and show promise—new medications are being developed every day and they are more often coupled with a program of therapy and behavioral change. Other treatments, such as Transcranial Magnetic Stimulation, also show promise when added to the treatment plan of people with mental illness.

How can future generations best combat the stigma related to mental health disorders? 

One of the joys of my career is teaching. I have worked with medical students and residents throughout my career, and I am encouraged with the generational changes reflected in our learners today. Learners see the connection between biology and external risk factors to the development of mental illness and substance use disorders. They are more accepting of the notion that people struggle because of these factors, not because they are lazy, or stupid, or morally weak. Learners today want to understand the tools to work more effectively to help patients, families, and communities find the lives they want and deserve. I see a bright future!

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