Symptoms of high-functioning depression are dangerously subtle: How to recognize them

When it comes to mental health, entrepreneurs have dangerous jobs.

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In one survey, 72% of founders reported feeling concerned about their mental well-being. Entrepreneurs also experience high rates of depression (30%) and substance use conditions (12%). These scary statistics are compounded by subtle warning signs that make it difficult to get help.

In my experience as an entrepreneurial psychologist, the type of depression that afflicts high performers is also the hardest to pinpoint. Referred to as high-functioning depression or walking depression, it comes with subtle symptoms that some business owners dismiss as fatigue or stress.

The same instincts and willpower that drive business leaders to take risks can convince them to act as if everything is fine, even when they’re hurting. Here are some warning signs.

What is high functioning depression

Part of the criteria for a diagnosis of major depressive disorder is functional impairment, which means you may have difficulty completing basic tasks, such as getting to work on time or brushing your teeth, and several areas of life suffer critically. This isn’t the case for everyone, though. Those with high-functioning depression typically don’t see major changes in these areas.

While not a formal diagnosis, high-functioning depression is an accessible phrase for those living under the burden of depression with less obvious outward signs.

While some dispute the term high-functioning depression, in my experience it reflects the knee-jerk reaction of high-performing people to emotional stress: keep going.

High functioning vacuum warning signals

Entrepreneurs can muster motivation and forced optimism like no other, leading them to start ventures with low success rates (and high perceived risk of failure) instead of seeking more stable employment. Most entrepreneurs I’ve worked with don’t experience functional impairment until their depression is severe, instead they push themselves through difficult things.

A sign of high-functioning depression is diminished pleasure, as if the volume of your life is turned down. You don’t feel like yourself enough because you don’t get as much enjoyment out of your favorite activities. And, while you’re able to perform tasks, you feel a bit like a zombie while doing them, going on autopilot from one thing to another.

Common signs of high functioning depression include:

  • having an appetite, but not enjoying the food

  • be marginally interested in intimacy, but sex is not as pleasurable as it used to be

  • stick to hobbies or exercise routines, but not as often or as vigorously

  • feeling less rested, despite the same sleep pattern

  • difficulty making decisions, even simple ones, such as what to prepare for dinner

  • spending time with friends and family, but feeling disconnected

  • deal with the ups and downs of running your business, but victories aren’t so sweet

Goal-oriented people tend to wait to address these emotional needs. Do you find yourself creating arbitrary benchmarks for when you might be feeling better? I just gotta get through this day, this quarter, this year. I’ll be fine after I hire a few keys. This annual report is the real cause of my stress. Your health is not just another goal.

Seeing through the haze (and seeking help)

The stereotypes surrounding depression call to extremes. We expect depressed people to eat too much or not enough. They sleep too much or not enough. They have irrational outbursts or feel nothing at all. But depression can also feel like the graying out of your emotional life.

If you’re concerned that low spots are becoming more frequent, journaling might help. Rate how you feel at the end of each day using a scale of one to 10 and note any significant emotional experiences. If you score below five most of the time, a two to three week period, consider therapy.

High-functioning depression can be dangerous for business owners because it works like a leak in a dam. It’s hard to spot given the constant movement of the water, but catastrophic if extra pressure is applied. When entrepreneurs experience a significant mental health crisis, the onset can seem rapid to the outside observer. However, in most cases the problems were brewing months or years before a crisis. Paying attention to high functioning depression can potentially save your life.

In many cases, high-functioning depression can be resolved with a combination of psychotherapy, personal introspection, and practices such as sleep, movement, connection, and hobbies. Sometimes medications are a helpful avenue as well.

May is Mental Health Awareness Month, a time to remember that prevention is preferable to intervention. It’s much easier to engage in a structured and thoughtful dialogue before things go wrong. The outward signs of high-functioning depression can be obscure, but a trained mental health professional will spot them.

Entrepreneurs will justify speeches or leadership coaches as business expenses, prioritizing production over welfare. They stop supporting mental health care as a business priority. It’s time to change that mindset.

This story was originally published on Fortune.com

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