When Kate Edwards founded Heartbeat, she knew the road ahead wasn't going to be easy--starting and running a company never is. But as time went on, Edwards had to face the music. She wasn't just having a few bad days. She was dealing with founder's depression.

Defining the crisis

As a psychiatrist, Dr. Jehangeer Sunderji points out that founder's depression can share symptoms of traditional depression. For example, you might engage in self-destructive behavior, including slacking on self-care (e.g., poor hygiene, missing doctor's appointments, substance abuse). But two other big symptoms are:

Poor work-life balance

  • Working weekends and holidays
  • No outside interests
  • Few outside relationships

Negative work behaviors

  • Canceling meetings more often, particularly in the morning
  • Closing your door more than you normally would
  • Making decisions irrationally with an overly negative assumption about your business's prospects

As a sufferer, however, Edwards draws the distinction between "regular" and founder's depression this way:

"I would define [founder's depression] as feelings of sadness or despondency that you become accustomed to, a constant onslaught of feeling desperate or overwhelmed with negativity. ... When someone is normally depressed, they feel like all hope is lost. When someone has founder's depression, they still feel like the whole world is against them, and negativity abounds, but for some illogical reason, they keep going."

Why so many founders are struggling

Edwards says that, when you start a company, you can feel like you're under constant watch from investors, peers, and employees. That feeling morphs into a crippling sense of paranoia and grief--you feel obligated to push through no matter what.

"The problem," Edwards explains, "is that we let our mental health decline before our businesses', because we see our businesses as reflections of ourselves. We equate the business thriving with ourselves thriving, but we're actually neglecting our personal needs completely. Eventually, because starting a business is so hard, it's impossible to tell the difference between happiness and sadness entirely, so we end up saying 'screw it' and being OK with being miserable, as long as the company is thriving."

Sunderji agrees.

"The heart of founder's depression is the projection of their identity on to the business," he says. "It often takes so much emotional energy, time, and sweat to start an enterprise that boundaries almost always get blurred. ... And if they don't meet expectations they, not just their company, are a failure. And then the brain, as all brains do at some point for everyone, becomes oversaturated and starts fatiguing. When a founder is vulnerable, every significant piece of bad news takes a toll even though most won't show it. They won't show it to co-workers out of shame or fear of disturbing morale. They swallow their emotions. And as they accumulate, they begin to succumb into depression."

"I don't want to be seen as weak, or emotional, or needing support, especially when women already have everything stacked against us in tech," Edward admits. "I've gotten better about talking about mental health, but I still am afraid to discuss it with investors or our board, because they might view me as incapable or incompetent. I personally know I'm highly capable, even while depressed, but it's tough to get people to believe that other than yourself. Why discuss it when investors might pull the rug out from under you, when you've worked so hard and given so much of yourself already?"

Ivka Adam, founder and CEO of Iconery and Heartbeat's CMO, says that for her, founder's depression kicked in when she got her first real investment and set of employees. That made things real, shifting enthusiasm for a dream to cold, hard reality where there was something on the line.

"Founder's depression is effectively choosing to put yourself in a place of cognitive dissonance for a long period of time: You absolutely believe in the vision and mission of your company, while being consistently questioned or declined by investors, partners, and buyers. It's psychologically uncomfortable and mentally degrading," Adam says.

"I think the key feature is that you're choosing, against all odds, warnings, and better judgment to put yourself on this path, which means you're accountable for it."

She adds, "Additionally, you are 100 percent responsible for the success of the company and the livelihood of your employees ... There's so much uncertainty built into the first several years as a founder, and the intense fluctuations between successes and failures, liquidity and not making payroll, all while staying positive and motivating your employees to keep working for low comp can be overwhelming."

How to reclaim joy and protect others

Adam cautions that, while founder's depression is definable, it's not always obvious to those looking in--it was only after talking to other founders she realized everyone else seemed to be in the same boat. But it's precisely because everyone is in the same boat that other founders can become a vital support network. They understand exactly what you're going through and can offer an empathy you won't get anywhere else.

And while investors, advisers, and employees can be the ones creating pressure, they also can be part of the solution. By being open with them about your feelings and needs, they can understand how to support you and avoid stressing you out. From Adam's perspective, it's worthwhile for investors to protect their interests by protecting the mental health of their founder with helpful systems.

Edwards also recommends formal therapy. Your spouse and friends, she says, take you only so far, and an objective therapist can prevent you from putting undue pressure on loved ones and subsequently alienating them. And, as Adam recommends, other coaches can help you manage specific areas or clarify your objectives.

And take. The. Vacations. When Adam allowed herself to do this, she not only got the break she needed, but also came back to a more self-sufficient team that had learned to rely on one another better. With that "stress test," she was more confident delegating. A vacation or other personal activity also provides a chance to maintain a sense of self outside the business, which Edwards sees as crucial.

And, if you recognize you're in trouble, be willing to learn and have some faith that the experience can yield good.

"It can be quite educational and even help the founder be more insightful about their life and role in the company," Sunderji asserts. "The insights gained in the healing process really provide a rich second perspective through which many founders have better understood themselves, their life, and the purpose of their talents. And more than a few founders I have worked with have founded new companies based on their discoveries as they heal."

But whether you're the founder struggling or someone who recognizes another person suffering, Edwards's last piece of advice is perhaps the most important.

"[Recognize] that we're all humans," she says. "Oftentimes, it feels like our employees think we are robots who are constantly pushing toward a goal. We have life events, we have sick days, people in our lives die, we have mental health issues. Knowing that we sometimes falter, and that the company will still be OK, makes founders feel supported."