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In the early 2010s, a clinical professor and entrepreneur by the name of Dr. Michael Freeman surveyed 242 entrepreneurs about their mental health.
Of the 242 entrepreneurs he surveyed, 49% reported having a mental-health condition.
Depression was the highest-reported reported condition, being present in 30% of all entrepreneurs. ADHD (29%) and anxiety problems (27%) followed close by.
That’s a dramatically higher percentage than the US population at large, where only about 7% identify as depressed.
What do actual entrepreneurs have to say about their experiences with burnout and depression?
1. Marc Andreessen – Netscape, A16Z
“First and foremost, a start-up puts you on an emotional rollercoaster unlike anything you have ever experienced. You flip rapidly from day-to-day – one where you are euphorically convinced you are going to own the world, to a day in which doom seems only weeks away and you feel completely ruined, and back again. Over and over and over. And I’m talking about what happens to stable entrepreneurs. There is so much uncertainty and so much risk around practically everything you are doing. The level of stress that you’re under generally will magnify things incredible highs and unbelievable lows at whiplash speed and huge magnitude. Sound like fun?” [source]
2. Elon Musk – Tesla, SpaceX
“Running a start-up is like chewing glass and staring into the abyss. After a while, you stop staring, but the glass chewing never ends.”
3. Tim Ferriss – NYT best-selling author, angel investor
"The fact of the matter is this: if you’re driven, an entrepreneur, a type-A personality, or a hundred other things, mood swings are part of your genetic hardwiring. It’s a blessing and a curse."
4. Rand Fishkin – Moz founder
"Depressed Rand is weird. Don’t get me wrong, regular Rand is weird, too. But depressed Rand magnifies the bad 10X and minimizes the good. He refuses to even acknowledge good news and, because he’s a pretty smart guy, he can usually argue for why that good news is actually just temporary and will turn to shit any minute. The weird part is, I think depressed Rand is actually a very authentic version of myself. When I felt depressed, I upheld TAGFEE – particularly the values of transparency and authenticity – as the reasons why I could and should be such a raging, all-consuming, negative naysayer."
5. Brad Feld –, Foundry Group
"It's not a topic the start-up community understands well. After all, this is the very culture that turned the chestnut "pick yourself up by your bootstraps" into a much-celebrated verb. Admitting you struggle with depression is like admitting you can't reach your bootstraps. It's assumed that successful people can just "shake it off."
But that's not how it works [...] depression carries a stigma. Most of the success stories we hear involve an entrepreneur who pushes himself beyond his physical and emotional limits. He's unbalanced--but in a good way.
My own experience has made me realize that this imbalance is no way to live the start-up life, and, in fact, it's detrimental to this kind of work. The only way I survive the dark periods is by constantly renewing myself and my perspective. Starting over is part of the process of starting up. That's something those in the entrepreneurial community should understand better than anyone else."
6. Aaron Swartz, Reddit co-founder
"Surely there have been times when you’ve been sad. Perhaps a loved one has abandoned you or a plan has gone horribly awry. Your face falls. Perhaps you cry. You feel worthless. You wonder whether it’s worth going on. Everything you think about seems bleak — the things you’ve done, the things you hope to do, the people around you. You want to lie in bed and keep the lights off. Depressed mood is like that, only it doesn’t come for any reason and it doesn’t go for any either. Go outside and get some fresh air or cuddle with a loved one and you don’t feel any better, only more upset at being unable to feel the joy that everyone else seems to feel. Everything gets colored by the sadness."
(Aaron tragically committed suicide in 2013.)
7. Minnie Ingersoll, co-founder of Shift
"But for me, it was a very profound experience. It made me more resilient, which I think is how a lot of people feel about that first real setback. It turned me into a more sympathetic person, which is more important in business than you'd think. And it just broadened my experience of the world.
For a while after, I felt a lot of shame about it—being depressed, being suicidal, having an eating disorder. But it got easier. I got way more open about it over time, because a lot of people struggle and I've found it's better to talk about it."
7. Mark Suster, Upfront Ventures
“I am lucky that my brain isn’t chemically wired for depression but I’m all too aware that it is a disease and clinical condition that needs to be de-stigmatized. I have had friendships with too many people in my lifetime who had depression not to know this.
And if you are one of the lucky ones like me not prone to depression you need to have more compassion for people whose minds are wired differently. I remember living in the stiff-upper-lip environs of London where the common refrain to depressions was, “pull your socks up, mate! Life isn’t that bad. You have nothing to be depressed about!”
I used to think that about people who were depressed. I no longer do. I came to realize through reading about it that it’s a condition. It’s a wiring the brain. It’s not something that one can just “shake off.”
8. Noah Kagan – Sumo founder
"Write out everything when you are feeling sad. It’s really funny to laugh at when you are feeling better. Do the opposite when you are in a great mood. Look for patterns about where, when and why you are in this mood. I wrote this out on a post-it note and try to put myself back in those places when not feeling great."
9. James Altucher – bestselling author
"In mid-2002 I was so depressed I simply ran out of ideas.
Depression scorches the earth of your brain.
I would sit in it at 3 in the morning in the dark. Lord of my crumbling kingdom. Every day I went a little more broke and there was nothing I could do about it. Going broke is very scary.
I would drink to help me sleep. Then I would refuse to wake up. Then the fear would repeat until I fell asleep again.
I pretended to smile at my children. I pretended to smile at my wife.
People say when you pretend to smile it often triggers happiness because you fool your brain into thinking you are happy.
I can tell you: my brain was not fooled. If anything, fake-smiling made me more depressed."
10. Christina Wallace – Founding Director of BridgeUp
"When my startup, Quincy, was on the brink I fell into a funk. I don’t know if it was a true, clinical case of depression. I didn’t see a professional during that period so I have no way to know. What I do know is that I crawled into bed and didn’t leave for three weeks. I didn’t talk to anyone. I didn’t leave my bed, except to answer the door when the occasional Seamless delivery arrived. I watched all seven seasons of The West Wing top to bottom and I sobbed.
I mourned the end of my company. I also mourned the death of the grandmother who raised me, which had occurred just three weeks prior. And — if we’re being totally honest here — I was mourning the end of my relationship with my co-founder and friend (though happily that turned out to be only temporary).
But the end of my company wasn’t the first time I’d felt this way. There were so many moments throughout the nearly two years that we built Quincy where I cried myself to sleep. I had friends to talk with — fellow founders to commiserate with, grad school friends who took me to dinner and were kind enough to pick up the check, and exes who were still friendly enough to take a call and talk me off a proverbial ledge."
11. Ben Horowitz – Loudcloud, A16Z
"I have seen CEOs try to cope with the stress by drinking heavily, checking out, and even quitting. In each case, the CEO has a marvellous rationalization why it was OK for him to punk out or quit, but none them will every be great CEOs. Great CEOs face the pain. They deal with the sleepless nights, the cold sweat, and what my friend the great Alfred Chuang (legendary founder and CEO of BEA Systems) calls “the torture.” Whenever I meet a successful CEO, I ask them how they did it. Mediocre CEOs point to their brilliant strategic moves or their intuitive business sense or a variety of other self-congratulatory explanations. The great CEOs tend to be remarkably consistent in their answers. They all say: “I didn’t quit.”
What’s The Most Difficult CEO Skill? Managing Your Own Psychology 
12. Sam Altman – Y-Combinator
"If you ask a founder how her startup is going, the answer is almost always some version of “Great!”
There is a huge amount of pressure as a founder to never show weakness and to be the cheerleader in all internal and external situations. The world can be falling down around you—and most of the time when you’re running a company, it is—and you have to be strong, confident, and optimistic. Failing is terrifying, and so is looking stupid.
Founders end up with a lot of weight on their shoulders—their employees and their families, their customers, their investors, etc. Founders usually feel a responsibility to make everyone happy, even though interests are often opposed. And it’s lonely in a way that’s difficult to explain, even with a cofounder (one of the things that work about organizations like Y Combinator is that you have a peer group you can lean on for support).
So a lot of founders end up pretty depressed at one point or another, and they generally don’t talk to anyone about it. Often companies don’t survive these dark times."
Conclusion: Entrepreneurs have it tough.
It's possible that people with mental health challenges are likelier to become entrepreneurs, almost out of necessity (because they aren't quite so well suited to 'ordinary' jobs).
And it's clear from listening to founders that entrepreneurship is itself a tremendously stressful affair.
If you're going through difficult times as a founder or entrepreneur, know that you are not alone – and that there are others out there who are eager to listen and help.