From therapy and peer groups to vulnerability and psychedelic drugs, entrepreneurs open up about their strategies for dealing with mental health challenges.
Jason Gardner, the founder and CEO of payment processing startup Marqeta, was going through another bout of depression. It was early 2016, and he struggled to sleep and eat in his Oakland home. Sometimes he just laid on the floor and stared at the ceiling. “I could barely get out of bed and couldn’t smile. I felt like things were crumbling around me, but I had to find the wherewithal to continue to raise money and build the company,” he says. Marqeta was weeks away from running out of cash.
He and his wife Jocelyne had maxed out their credit cards and were even putting their mortgage payments on credit card checks while raising their 15-year-old son and 8-year-old daughter. “Sometimes I don’t know how I survived. Not because of something I would do to myself, but due to my body breaking down, or my mind,” says Gardner. He went on to turn the company around, eventually taking it public and stepping down as CEO in January 2023.
Today he speaks openly about the struggles he faced as a founder—a topic that, even in an era when people share intimate details about themselves on social media, still isn’t discussed often enough. Nearly all entrepreneurs face serious mental health challenges. According to an April 2023 survey by research organization Startup Snapshot, 72% of founders say the job has affected their mental health. Thirty-eight percent have experienced depression, anxiety, bipolar disorder, ADHD or substance abuse, according to a 2022 study by researchers including Viginia Tech professor Richard Hunt and Michael Freeman, a psychiatrist who has been coaching entrepreneurs since 2000. Over the past five years, several studies have shown that entrepreneurs have significantly more mental health conditions compared with different comparison groups, Freeman adds.
Founders are often afraid to show a shred of weakness in themselves or their companies, largely for fear of how it might affect their startup’s reputation and employees’ morale. Ryan Caldbeck, the founder and former CEO of fintech startup CircleUp, remembers being asked by venture capitalists several years ago to meet with other CEOs whose companies were floundering, to give them some advice. “I go to coffee with the CEO–and I remember this on two or three occasions–and the CEO would just talk about how their company was crushing it, even though the VC just told me they were in a lot of trouble,” he says. “That is Silicon Valley in a nutshell, putting up this facade.”
Over the past few years, elite athletes like Naomi Osaka and Simone Biles, celebrities including Demi Lovato and Selena Gomez and U.S. Senator John Fetterman have publicly discussed coping with mental illness, and entrepreneurs are starting to follow suit. In February 2022, Pedro Franceschi, the cofounder of credit card startup Brex, wrote a moving blog post about his mental health issues, which resulted in him having a panic attack even though the company was growing rapidly and becoming a Silicon Valley darling. A few months later, Andy Dunn, the cofounder and former CEO of men’s clothing brand Bonobos, published a book, Burn Rate: Launching a Startup and Losing My Mind, chronicling his daunting challenges with bipolar disorder.
While performance coaches have been around for decades, interest in more basic mental health services is now growing rapidly. Michael Freeman says he’s speaking with venture capitalists once a week on the topic, whereas a few years ago, he received no calls from investors about it. In Andreessen Horowitz’s annual report of the largest consumer-facing marketplace startups and private companies released in March 2023, mental health was the fastest-growing category by far.
Forbes spoke with over a dozen CEOs plus a half-dozen psychologists, coaches and venture capitalists to gain a better understanding of the mental health challenges founders face. From therapy and meditation to peer groups and showing more vulnerability in front of employees, founders are starting to open up about their mental health challenges–and the strategies they’re using to manage them.
Work-Life Out of Balance
One of the hardest parts about running a startup is facing an endless stream of daunting problems, which can make even the good times feel bad. Some common examples: you have a major disagreement with your cofounder; you lost an important customer; one of your top salespeople left; there’s a serious human resources issue between two employees; a competitor launched a promising new product. “If your startup’s failing, it feels like someone’s punching you in the face,” says Michael Seibel, a managing director and partner at startup accelerator Y Combinator. “But when your startup is working, it feels like someone’s punching you in the face too.”
Founders’ emotions often soar or plummet in the course of an afternoon. “I knew there were high highs and low lows. I just didn’t know the frequency,” says Anita Hossain Choudhry, an executive coach and CEO of The Grand, a group-coaching startup. “It can literally happen in minutes where you’re like, ‘Everything is amazing. This is going great.’ And then you get an email and you’re like, ‘This is not going to work. This is awful. Why are we doing this?’”
Entrepreneurs feel intense pressure from investors, customers and their own employees. “You’re almost expected to be superhuman,” says Aditi Shekar, cofounder and CEO of digital banking startup Zeta. “There’s constant pressure to overdeliver, outperform, be overly understanding, overly politically correct, overly everything. And it’s not a temporary pressure. It’s a persistent pressure that invariably has a mental toll.”
Social and cultural dynamics can make things worse. Shekar says female founders face a unique hurdle: they’re expected to be “empathetic, kind, lovely and nice, but at the same time cutthroat and competitive.” Ryan Williams, the African-American CEO of real estate investing platform Cadre, says that growing up, he didn’t know what depression or anxiety was because the topic never came up. “There are certain communities where mental health is something people see–especially if you acknowledge you’re having some issues–as a real weakness and almost a personal defect, especially in the Black community,” he says. “I don’t want to generalize, but that was the case where I grew up and with my family.”
Overwork often causes founders to hit low points. During his first handful of years as an entrepreneur, Brex cofounder Pedro Franceschi felt the urge “to be productive at every second.” He worked 80 to 100 hours a week, sleeping just six hours a night, and felt guilty about taking vacations. In October 2019, Brex had launched an important new product, a business bank account called Brex Cash. But instead of feeling excited, Franceschi felt anxious, and his despair culminated in having a panic attack the morning after attending a Halloween party with friends in New York. He describes the feeling as “pretty desperate, especially when you don’t know what’s happening … You don’t know if you’re having a heart attack.”
A month later, he took a week off, unplugged and started feeling better. He began seeing a therapist weekly and a psychiatrist quarterly, taking medication and seeing a coach every two weeks. Today he gets between seven and a half and eight hours of sleep. “I don’t think I knew where the line was for me” of working too much, he says today. His therapist has helped him better understand himself and why he has certain feelings, and now he can recognize signs of his anxiety much earlier. In November 2022, Brex announced Catharsis, an initiative aimed at normalizing mental health conversations and offering discounts on mental health services for Brex customers.
Moments when personal and professional setbacks coincide can be particularly debilitating for founders. In mid-2016, Ryan Caldbeck, then CEO of CircleUp, completed a round of layoffs after the company made a strategic pivot. Around that time, he and his wife began having fertility issues–they wanted to have a second child but couldn’t get pregnant–and to top it off, he was diagnosed with cancer. Despite an investor telling him to take six weeks off in late 2017, he kept working. “After a lifetime of gritting things out, I told myself I didn’t need to take a break,” he later wrote in a blog post, adding that it was the biggest mistake of his career.
The next year, he tweeted about how mental health wasn’t discussed enough, writing, “I feel all consumed. All the time. It’s hard for me to feel present in non-work conversations. On my Friday date night with my wife, I often struggle to focus on us–my mind slips to work. I hate that.” Another tweet in the same thread read, “I feel incredibly lonely. As CEO it’s hard to fully open up about my company and it’s hard to find other CEOs who are willing to be vulnerable and talk honestly about the hard things.”
In the fall of 2019, the last straw came. His five-year-old daughter looked at him and said, “Daddy, you always look so sad.” She said it twice, and he couldn’t get the comment out of his head. A year later, he announced he was stepping down as CEO.
Strategies for Managing Mental Health
There are major financial incentives for founders to stay at their companies. According to a 2010 study by Babson professor Joel Shulman, the investment returns were 10 to 20 times better for founder-led public companies than comparative businesses led by professional CEOs.
To prepare for the tough journey, founders should set up their mental health “infrastructure” as early as possible, Ryan Caldbeck argues, especially since it can take time to find the right professional help. “I would like to see the world treat mental health like dental health–preventatively,” says Brad Baum, a co-creator of the Founder Mental Health Pledge, an initiative to destigmatize mental health and encourage entrepreneurs and their backers to invest in founders’ mental healthcare.
THERAPY, COACHING AND MEDITATION
Therapy is one of the most popular ways founders are starting to manage their mental health more proactively. For Pedro Franceschi, therapy is “like having a trained professional invested in your well-being.” It helps him manage stress and answer questions such as, “What are your values? Who are the people you want to surround yourself with?” Jackie Reses, the former head of Square Capital and CEO of Lead Bank, meets with a therapist weekly and has been doing so for years. “It’s a way to improve how you are in the world, and it’s ultimately the most hedonistic gift you can give yourself,” she says.
Bonobos cofounder Andy Dunn believes every founder should be in therapy for at least six months at a time, every two or three years. He also advocates for companies setting up a $2,000 per year, per employee stipend for out-of-pocket mental health expenses. “The rates of insurance reimbursement are abysmally low,” he says.
Couples therapy can be helpful too. Years ago, Jocelyne Gardner felt frustrated that her husband Jason seemed to be always thinking about Marqeta. “Even if he was in the room, a lot of times he wasn’t in the room–his mind was elsewhere,” she says. They did Imago therapy, which involved a therapist asking Jocelyne to answer a question and explain how she felt. Jason had to repeat what Jocelyne said without commenting or reacting. “It actually softens you,” Jason says. “You begin to really internalize [the other person’s feelings], because you’re thinking about what they said, and you’re almost putting yourself in their shoes.” Jocelyne says the therapy also helped her have more compassion for the intense pressure Jason was feeling at work.
Coaches are also very popular. Caldbeck sees a coach once a month and a therapist three times a month. Stephany Kirkpatrick, the cofounder and CEO of payments startup Orum, meets with a coach weekly, and sometimes more often. Chris Dean, the CEO of banking software startup Treasury Prime, also meets with one weekly. René Lacerte, the founder and CEO of publicly traded fintech company Bill, has met with a coach regularly for 17 years and has used therapy periodically, when personal issues of stress have arisen.
For founders choosing between a coach or therapist, clinical psychologist Sherry Walling says that business coaches often provide “practical insight into mindset and focus. They work for the well-being of the business.” A therapist focuses more on “the well-being of the human. They have much deeper, longer training and insight into how family issues from your childhood, for example, affect the way you lead your team.” Therapists are also required to have certain education (such as a master’s degree in counseling), licensure and a minimum number of supervised clinical training hours with patients. There are no official requirements or qualifications for being a life or business coach.
Meditation has grown into a widely used practice for decades, and many notable billionaires founders including Salesforce’s Marc Benioff, hedge fund titan Ray Dalio and Oprah preach of its benefits. Lead Bank’s Jackie Reses meditates for 20 minutes every day. “Increasingly, I have people coming at me from everywhere, and I absolutely need the down time and silence to calm my brain, reset it, and bring myself back to a creative place,” she says. Franceschi meditates twice a day. Ryan Caldbeck and Stephany Kirkpatrick meditate daily, and Cadre CEO Ryan Williams tries to meditate every day too.
SLEEP, EXERCISE AND SETTING BOUNDARIES
Despite the hustle-culture ethos that has long pervaded Silicon Valley, where founders brag about sleeping five hours or less a night, there has been a new movement toward getting more sleep. University of California Berkeley neuroscience professor Matthew Walker’s 2017 book, Why We Sleep, which contains extensive scientific evidence on the health and productivity benefits of getting seven-plus hours of sleep a night, has made the rounds in tech circles. Soups Ranjan, the cofounder and CEO of fraud prevention startup Sardine, and Franceschi say the book has made a big impact on their lives. Eight of the 13 CEOs we spoke with for this article get seven to eight hours of sleep a night. Mark Zuckerberg does too.
Many entrepreneurs Forbes spoke to also exercise daily. Bill CEO René Lacerte exercises every weekday for 30 to 60 minutes–often going for a run without headphones to spur creative thought–and 90 minutes or more a day on weekends.
In mid-2021, Zeta CEO Aditi Shekar’s father passed away from Covid, and she started setting more boundaries. She prioritized seeing family more often and stopped working on most weekends, which she says helps with creativity and prevents her company from becoming her entire life. Kathleen Stetson, an executive coach and former startup CEO, became depressed after her tech company failed in 2017. “I realized that the crux of that depression really was this: I had made the startup my identity. It took people saying, ‘Hey, you’re not Trill, you’re Kathleen.’”
Many founders say that peer groups, which let them privately share their trials and tribulations with other entrepreneurs, are among the most helpful tools they have for managing mental health. Cadre CEO Ryan Williams says such groups were critical to him during the first several months of Covid lockdowns in 2020, when everyone was adapting to remote working and the murder of George Floyd brought social injustices against Black Americans into sharp relief.
The fintech-focused VC firm QED has an annual conference for entrepreneurs it has invested in, and one session involves putting all the founders in a room, having every investor leave and closing the doors. An outside moderator guides the conversation. “Those are extremely helpful,” says Treasury Prime CEO Chris Dean.
Membership organizations like YPO (the Young President’s Organization) and The Grand set up peer groups where founders, executives and employees can openly discuss the challenges they’re experiencing.
OPENING UP TO EMPLOYEES
Every entrepreneur has a different comfort level for showing vulnerability with employees. “For the first five years of being CEO, I was pretty closed in terms of what I would express about my fears and insecurities, professionally and personally,” says Ryan Caldbeck. “That was one of many factors that contributed to loneliness and depression.” He has since found that opening up more–for example, saying something like, “I feel worried that we haven’t nailed our strategy, and I am determined to do that”—helps him build trust and feel more connected to his colleagues.
QED managing partner and Capital One cofounder Nigel Morris argues that being vulnerable with employees shows them you’re real and authentic. “Vulnerability is a strength,” he says. “To say, ‘I’m not sure what to do,’ or ‘I’m confused,’ or ‘I’m worried’–it doesn’t promote weakness. It promotes loyalty and commitment.”
Andy Dunn believes in “selective and strategic vulnerable disclosure.” He suggests founders take opportunities like a brief email or fireside chat to discuss a challenge they’re working through. “It can be fast, and then you move on, and it’s back to work,” he says.
Dunn gives an example of an email a founder can write: “You could say, ‘Hey, if you’re noticing I’m dealing with a little lower energy, I’m in a bit of a low spot. I have a history of depression, and I take meds and see a doctor. But I’m powering through it, and I’m so grateful for the work you all are doing. Thanks for picking up and operating at such a high level, and I’ll be there with you soon.’”
“People will be riveted” when you do this, Dunn says. “And you just created a safe space for anyone in the organization to experiment with sharing their own feelings.” He adds that, when showing such vulnerability, it’s important to simultaneously share the action plan for meeting the challenge.
WHAT INVESTORS AND COMPANIES CAN DO
In some ways, founders are more accountable to the venture capitalists who back them than anyone else, so VCs “have the loudest voice in the room,” says Founder Mental Health Pledge co-creator Brad Baum. One thing investors can do is simply check in with entrepreneurs and ask how they’re doing on a given day. Nigel Morris says, “It’s about calling people up and saying, ‘How are you feeling? What’s on your mind? What are you worried about? How are you doing personally?’”
In 2018, Silicon Valley-based VC firm Felicis began a “1% Founder Development Pledge” program where, for every initial investment check it writes to a startup, Felicis adds 1% in non-dilutive capital that founders can spend on mental health expenses. More than 50 founders have taken advantage of it, says Dasha Maggio, Felicis’ co-COO who created and leads the program.
Alexis Ohanian’s venture firm Seven Seven Six has since launched its own spin on Felicis’ initiative, creating a “2% Growth and Caregiving Commitment” where the firm invests 1% on top of every initial check for “founder personal growth” and another 1% for caregiving. But such 1% programs haven’t gained wide adoption, likely because they’re seen as too expensive.
Founders themselves have begun taking steps to support their own employees’ mental health. Payments startup Orum gives staff the first Friday of every month off for a “mental health Friday.” Employees are still on call to customers, but they don’t take sales calls or outside meetings, and they stay off email and Slack, says CEO Stephany Kirkpatrick. The company also closes its offices between Christmas and New Year’s, and it pays 100% of its employees’ health insurance. At Treasury Prime, Chris Dean encourages employees to speak up if they’re having mental health issues and sometimes tells them to take a couple of days or a week off, and they come back feeling better, he says.
FRIENDS, NATURE WALKS AND PSYCHEDELICS
Psychiatrist Michael Freeman says it’s critical to stay close to friends and family so you have a strong social support network of people who aren’t associated with your business. He adds that regular “exposure to more primitive natural environments like mountains and rivers and streams” can have a restorative effect, and it elevates creativity.
Using drugs like MDMA (otherwise known as ecstasy or molly), psilocybin (magic mushrooms) and ketamine to manage mental health is a recent trend. “A lot of my entrepreneur clients are interested in talking about using psychedelics, both in mental optimization and in treatment,” says psychologist Sherry Walling. “It’s already happening a lot in Silicon Valley.” She occasionally uses ketamine-supported psychotherapy with patients and expects that MDMA and psilocybin will eventually be approved by the FDA for medical use.
The CEOs we spoke with for this article say they haven’t tried using any of these drugs to improve their mental health, but they don’t write them off either. Franceschi says he’s “aware of the extensive research being conducted in this field, and I find it both interesting and promising.” Caldbeck says he knows people who have tried them, and they “rave about the effects.” Elon Musk has reportedly used ketamine to treat depression (he didn’t respond to Forbes’ request for comment). He tweeted in June that ketamine “occasionally is a better option” to treat depression than the widely prescribed antidepressants on the market.
Walling cautions that the risks of using experimental strategies are that “sometimes these become take-home strategies … when done improperly, some of these medicines can be really problematic.” Y Combinator partner Michael Seibel notes the risks as well, saying, “Your mechanisms for coping with stress can’t be more harmful than the stress.” They have to improve your health in both the short and long term.
This article was first published on forbes.com and all figures are in USD.