Those at the top of their industries are no more protected than the rest of us from depressive symptoms or full-blown clinical depression.
Business leaders and entrepreneurs might even be more vulnerable because of the outsized stresses of their jobs and the traits that have brought them success in the first place.
The genesis of a depressive episode can be biological or external — for example, a personal loss, a health crisis, business troubles or legal woes. Or it could be spurred by a collision between personal values and company actions, like compromising safety for profit, said psychologist Peter Pearson.
What's more, the stresses executives face, combined with fears of not delivering, may be compounded by social media. Relative to the days when no one really knew who the CEO was, "social media has a way of amplifying expectations and pressuring people to perform for a broader audience," said psychotherapist and executive coach Steven Berglas.
Of course it's cliche to say it's lonely at the top, but it is. And many executives have a hard time confiding in others, said psychologist and executive coach Marilyn Puder-York. "A lot of CEOs are confident they can manage on their own and they slip into overdrive."
The last thing they want is to display any weakness or vulnerability to employees and investors.
Depression in the C-suite has gained attention in Silicon Valley lately, where ever-growing expectations and capital for promising startups can overwhelm anyone.
One study found nearly 50% of entrepreneurs reported having a mental health condition. A full 30% reported a lifetime history of depression.
Disengagement and inability to concentrate can be key signs of a depressive episode.
Venture capitalist Mahendra Ramsinghani says, "as investors our duties are to support the founders. ... I've seen founders who are struggling. You see that they are clearly not with it — they may appear stressed and are not taking care of themselves."
Ramsinghani has wanted to find ways to better support those struggling and is currently working on a book about depression among business leaders. He decided to write it after experiencing a dark period in his own life following two suicides by people he knew: Austen Heinz, in whose genomics company he had invested; and a friend and fellow investor who sent Ramsinghani a letter to read to the friend's elderly father in India after his son died.
His book will center in large part around the responses he gets to the anonymous online survey he's posted in which he asks founders and other organizational leaders to share their experiences with depression.
Ramsinghani hopes the book will start a dialogue about the issue.
Even though some executives have gone public with their struggles, many feel they'll be stigmatized if they admit to being depressed. "There's still a sense of shame because depression is perceived as weakness. It's more frequently denied than substance abuse," Berglas said.
What those in denial fail to acknowledge is that depression can be as much a disease as diabetes is, and may require help from drugs and psychotherapy. "You wouldn't eschew the use of insulin, so why eschew psychotherapy?" Berglas notes.
When a CEO or other executive starts to exhibit behavioral or performance problems, they might be assigned an executive coach. But both Berglas and Alyssa Freas, founder of the Executive Coaching Network, stress that if the problems are stemming from depression, no one can coach that out of you. And any ethical coach will recognize that and recommend instead that the executive seek outside help.