Last summer, Seth Rosen, co-founder of local startup CustomMade, started to get dizzy and feel sick. He went to numerous doctors, thinking he had some sort of gastrointestinal issue. But the doctors couldn’t find anything wrong. Rosen said that he became “obsessed” with figuring out what was causing his issues, to the point where he stopped eating bread products thinking he might have a gluten allergy.

Ultimately, it wasn’t the bread causing the problem: It was a moderate case of depression, an affliction that often goes unacknowledged and undiscussed in the startup world.

It was Rosen’s co-founder, Mike Salguero, who told me that I should talk to Rosen about depression and founding a company. Having had friends who had gone through depression, I saw the possible benefits but was wary of delving into someone’s personal life.

“No, it’s okay,” Salguero told me. “It’s important, Seth’s story can help other people.”

Why would HE be anxious?

When we talked in February at CustomMade’s Cambridge headquarters, it took a little bit of time to get to the topic of depression. It’s a difficult issue to dance around, especially with someone who, running a company, is expected to project an air of invincibility at all times.

One common theme among the numerous founders and entrepreneurs I spoke to for this piece was the struggle with the aloneness and anxiety that comes with leading a company. Rosen, who has a co-founder in Salguero, still felt as if he was alone in dealing with the heavy responsibility that eventually led to what he called a “moderate” bout of depression.

“Nobody cares if I’m anxious about what’s going on [in my company],” he said. “I took money from people, and I feel a deep sense of obligation to get them their money back.”

He added that part of the denial that you are depressed comes from a sense that people won’t appreciate what you are going through, that someone looks at him as a founder of a successful company that has raised over $25 million and says, “Why would he be anxious?”

“I’m anxious because I want to make this […] successful, I spend all night thinking about ways to do it and to try to be as productive as humanly possible.”

Salguero added his own take on the pressures of starting a company. “‘It’s such a roller coaster, and you are not able to ride either good or bad. You just yank the excitement out of the whole thing, because you have be steady.”

“The way you have to be able to manage your emotions is not to ride the highs and the lows,” said Salguero.

“That’s where anxiety comes from,” Rosen added. “That’s why you have anxiety and depression. You can’t ride the highs and ride the lows, it’s just too hard.”

The Myth of Founder Invincibility

Rosen isn’t alone in his feelings about running a company. Happier founder and chief executive Nataly Kogan recently told me that running her small startup is the hardest thing she has ever done—harder than growing up as an immigrant in project housing and harder than raising kids.

“Nothing compares to this, it’s extremely challenging, yet you are in this position where you are a public figure, even to your own employees, and you are walking this line where you want to lead,” she said. “You are the least able to talk about the challenges and you have the most of them.”

“It’s very hard to talk about it with your team, it’s hard to talk about with someone who hasn’t done it, and it’s hard to talk about it with people who have done it, if they are your peers,” she added.

Matt Lauzon, who founded and led Gemvara and who is currently in the midst of launching a workplace betterment tool called dunwello, has spoken to me at length about some of the ways depression can be debilitating for founders.

“I think one of the unique dynamics of being a founder, and more specifically, a founder CEO, is that — as cliché as it sounds — you are on an island,” Lauzon said.

“The reality is that even in the most successful companies, it is not linear in terms of the path from inception to success, it’s these very high highs and these very low lows.”

He added, “One way to think about it is that you are responsible for keeping an even keel, which means that when things are really bad, reminding people that they’re not that bad, and when things are really good, reminding them that they’re not that good.”

“Imagine that you are standing on stage in front of 500 people getting everyone to drink the Kool-Aid of whatever your movement is, and knowing that you may not be able to make the next three payrolls,” Lauzon continued. “It is just destructive because if you don’t do that, the reality is, you don’t have any shot at surviving.”

Lauzon got some help from an executive coach and spent time in a CEO peer group.

“What it made me realize,” he said, “was that even in the cases where things are going really well, all these CEOs felt that same sense of loneliness, stuck somewhere in between the board and the executive team. In all those cases, everyone is dealing with the same issues.”

Both Lauzon and Kogan referred to the “founder porn” that pervades the world of executives and founders where everyone tells each other that things are going great and that everyone is happy.

As Lauzon told me, “I remember looking at Inc. magazine, and their list of ’30 Under 30′ and thinking that these guys got their shit together. Then I remember distinctly being in it, and opening up the magazine, getting all sorts of congrats from all over, and thinking to myself, ‘Those guys don’t really have their shit together’.”

“It’s this cycle where everyone wants to project the absolute best. And the reality is that when you are going through challenging times, that’s a destructive thing,” Lauzon concluded.

“I was always going to be an entrepreneur,” Kogan said on why founders put themselves through such psychological aloneness, “I was going to run a company, its an affliction. I can’t not do this, but this is really hard, on my life, my personal life, and my health.”

“I don’t actually know what happened to me…”

Last summer, before he was diagnosed, Rosen was just driven to find answers — and figuring out how to get better. Blood work didn’t provide any clues, and giving up gluten didn’t help, either.

“I don’t actually know what happened to me,” Rosen explained. “I just found myself depressed, and I didn’t know what it was because I had never experienced it before.”

Finally, one doctor told him that anxiety was causing his problems. As Rosen said, “I couldn’t understand how those physical symptoms could manifest themselves as gastrointestinal issues and dizziness.”

“My perspective on depression and anxiety had always been that those people who are depressed should just get their shit together, [I didn’t understand] this whole idea that depression is a medical condition and genetic.”

“It just got worse and worse and worse,” he added. “It never got to the point where I couldn’t get out of bed or anything but I got to a place where I would just cry for no reason.”

One of the most difficult times that Rosen talked about was a weekend when his wife was away on business when he says he couldn’t leave his house. At one point, he came to grips with the fact that he was going through a serious case of depression, and he spoke to his brother who is an executive at another Boston company, and, who had dealt with his own anxiety. He asked his brother how bad he thought what Seth was going through was and he told him it was mild to moderate, and that when “you start not being able to go out for a walk”, the issue is on the moderate end of the spectrum.

“Severe [depression] will […] kill you,” Rosen said, “because this is deadly. I never considered hurting myself or anything like that, but I can see why this is really risky, why people kill themselves. Depression is really risky.”

Rosen eventually went on medication, which, along with the support of Salguero and his CustomMade team, and the guidance of one of the company’s investors, allowed him to return to work. Today, he says he is in a much better place and wants to help others who are going through the same experience.

A Big (Unspoken) Problem

It should be obvious from Rosen’s comments on the risks of depression just how dangerous it can be, especially when those feeling the effects of anxiety or depression are in positions where they may be hesitant to talk about their feelings.

Earlier this week, the Globe revisited into the story of Aaron Swartz, the brilliant and controversial technologist who took his life last year while facing federal prosecution. Swartz suffered from depression and even wrote a lengthy blog post about his health in 2007.

The connections to Rosen’s own feelings of being sick are eerily similar. Unfortunately, suicide among chief executives and others, like Aaron Swartz, who take on a lot responsibility for a company or movement, is all too common.

While it seems like a difficult subject matter to broach, there are many people, like Seth Rosen, who think that maybe if they share their story, it could help out a founder or executive who believes they are alone and have no one to turn to.

Brad Feld, of the Foundry Group and a co-founder of Techstars, has written a great deal about his own personal struggles with depression. In his blog, Feld wrote:

“For some reason we’ve embraced failure as an entrepreneurial trait that is ok, but we still struggle with acknowledging and talking about depression. Entrepreneurs function with a wide range of stresses and emotions that often have overwhelming intensity. In many cases, we are afraid of admitting depression, and are often highly functional when we are depressed. But that doesn’t deny the fact that entrepreneurs get depressed. To deny this, is to deny reality, and that’s against my value system.”

In his book Startup Life about “surviving in a relationship with an entrepreneur,” Feld and his wife, Amy Batchelor, talk about Brad’s depression and tactics to take to to avoid falling into too dark of a place.

Their main piece of advice, “If you are having anxiety of depression that interferes with your ability to live a whole life, please seek professional help.”

“There is no magic formula to getting the help just right,” Feld and Batchlor added. “Instead, we encourage you to try different things, like we did.”

The help Seth Rosen received allowed him get back to doing what he loves most, running CustomMade.

Nataly Kogan talked about her daily ritual about finding one good thing about each day before driving from work and finding time for a regularly scheduled break. For Kogan that means yoga at the same time each Thursday.

Matt Lauzon joined the professionally moderated CEO peer group and also hired a coach whose specialty he said, “was somewhere in the middle of being a therapist and being an executive.”

“He became someone who I could be very transparent with about what was going on,” Lauzon added of the executive coach. “He helped me be more comfortable being vulnerable to everyone involved.”

These are just some suggestions that may help alleviate the depression and anxiety anyone, not just tech entrepreneurs, may feel.

For anyone feeling overwhelmed by depression or is having thoughts of suicide, here are a couple of helpful resources: