It wasn't an unusual move for an entrepreneur under pressure. Several years ago, a founder in his late 30s made a risky decision to take out a second mortgage on his house--without telling his wife--to finance the company he launched a year and a half prior. He received seed funding, and investors promised him a Series A round, but things were moving slowly and he needed the cash.

Then the investors backed out, his house went into foreclosure, and his wife divorced him, the founder told Michael Freeman, a psychiatrist, clinical professor at the University of California, San Francisco School of Medicine, and mentor at the Entrepreneurship Center at UCSF. Freeman says the founder then experienced the type of upheaval and subsequent mental-health episodes that are common among entrepreneurs.

"He was totally grief stricken, traumatized, and in a deep depression after that," says Freeman, who met the entrepreneur at FailCon, a conference that helps startup founders learn from and prepare for failure. "He basically had to check out of life for a while and really couldn't function."

For many founders, starting a company is an emotional rollercoaster. The twists and turns of managing a fledgling business can be frustrating, exhilarating, and devastating, all in the span of a single day. What's more, the odds don't exactly lower anyone's stress level--half of startups fail after five years. One of the most important things entrepreneurs can do to prepare for such sudden changes in emotions is to arm themselves with knowledge about their own mental-health and emotional predispositions.

At least 49 percent of entrepreneurs are likely to have a mental-health episode, like a bout of depression, in their lifetime, according to a May 2018 study that Freeman wrote with three other experts called "The Prevalence and Co-Occurrence of Psychiatric Conditions Among Entrepreneurs and Their Families." Freeman adds that most entrepreneurs are susceptible to episodes like depression and substance abuse, but he also frequently sees genetic conditions like attention deficit hyperactivity disorder and diagnoses on the bipolar spectrum in entrepreneurs.

"The reason for that is that the personality characteristics that lead to success in entrepreneurship are also features in mental-health conditions," Freeman says. "People who have elevated levels of creativity, emotion, and energy are also more likely to be on the bipolar spectrum or deal with substance abuse--they are all kind of part of the package."  

Freeman isn't just a professional expert on mental health and entrepreneurship; he's lived through it. About 18 years ago, he was the CEO of an executive education and leadership development company called Centralink. But after 10 years of operation, the business model became obsolete and he had to rapidly downsize the company. One-third of the business closed and he was forced to lay off employees whom he worked closely with for a decade. He describes that time as very emotionally difficult.

"Even though I was psychiatrist, I hadn't been trained in coping skills and stress management," Freeman says. "I definitely can personally relate to everybody who goes through this." 

Know Yourself

Freeman says there are two types of mental-health conditions: One is what people are genetically predisposed to and the other is the result of an event. Either way, he believes that entrepreneurs can prepare for the difficult days ahead by taking some precautionary measures.

Freeman says most founders with a known genetic predisposition could anticipate how the stresses of the job might impact their state of mind and better prepare themselves for adversity. He added that these people should seek out mental-health professionals, brief them on their background, and work on identifying warning signs. For instance, if a founder has a history of depression, he may want to start taking antidepressants when warning signs become evident.

Those without prior mental-health issues should focus on wellness, specifically on their diets, sleep, exercise routines, personal relationships, and mindfulness, Freeman says. He recommends their taking advantage of whatever tools most help, whether it's a class or even an app specifically focusing on coping skills or stress management, if they want to take some precautionary steps. 

"Even if you don't have any mental-health predispositions, if you go through bankruptcy and get into a dispute with a co-founder, those things can create mental-health problems," Freeman says. "Even the most well of entrepreneurs need to be resilient to cope with the predictable crises that occur when launching a business."

Common Traits Among Entrepreneurs 

Freeman says two of the most common mental-health conditions he sees among entrepreneurs are ADHD and depression. He adds that there are traits within each diagnosis that could benefit founders, so long as they manage the other symptoms. 

For example, people with ADHD have characteristics associated with impulsivity. In many circumstances, ADHA allows entrepreneurs to make decisions quickly and to avoid getting stuck on "analysis paralysis," Freeman says. The key is being aware of the condition and adjusting appropriately so it doesn't cause negative circumstances. 

Freeman knows of a founder who was diagnosed with ADHD and had problems managing time. One day, the man missed an important meeting and lost a vital business opportunity. To tackle the problem, he hired an executive assistant who could help him manage his appointments and keep his calendar throughout the day. 

Another condition that's widespread among business owners is depression, due in large part to the highs and lows that come from entrepreneurship. People who suffer from depression can have great empathy, a helpful trait for entrepreneurship, as the capacity to understand what another person is experiencing emotionally is crucial in the startup space, given that founders sometimes have to forge personal connections very quickly. Compassion is similarly characteristic for entrepreneurs running startups, as part of the daily routine involves managing multiple personalities within teams that work closely together. Entrepreneurs who experience depression also can be more realistic than they otherwise would, and therefore run a lower risk of being blinded by optimism, Freeman says. 

The recent high-profile suicides of entrepreneurs Kate Spade and Anthony Bourdain reignited conversations and headlines about mental health. While there is no simple solution for managing mental-health conditions, things like getting enough sleep, eating healthy, and cultivating nurturing and supportive relationships can go a long way, according to Freeman. One of the most important things for entrepreneurs to remember, he says, is that there's always way out. Events that trigger extreme feelings of dread are not the end of the world.

"If you're an entrepreneur, you're going on an emotional rollercoaster ride. There will be horrible days, horrible months, great days and great months," Freeman says. "Nobody is beyond the need for support."  

If you or someone you know needs help, call the National Suicide Prevention Lifeline at 1-800-273-8255.