This is an edited and updated version of Michelle Nickolaisen's original article that appeared on Shopify Plus in 2016; if you're looking for help, jump to the Resources here

Ask any entrepreneur. We don't measure time in weeks or months … but from deadline to deadline, launch to launch, and failure to failure.

Remember the euphoria of your first sale? Your first major media appearance? When you broke through the six-, seven-, or eight-figure sales mark?

We crave these moments and fight for them with superhuman intensity.

Unfortunately, few people talk about how addictive and fleeting that high can be. Even less about how weak a defense it is when — as the title of Susan Blauner's book puts it — "my brain was trying to kill me."

Entrepreneurship can be a grisly, volatile mess of toxic ingredients on the verge of combustion, threatening to consume your health, relationships, and life.

Entrepreneurship & Mental Health

According to the Gallup Wellbeing Index, 45% of entrepreneurs report being stressed compared to 42% of "other workers." Entrepreneurs also report being more likely to have "worried a lot" — 34% vs. 30%.

At first, those deviations can sound small. However, a more recent study — the first research of which was approved by the UC Berkeley Institutional Review Board and published in the journal Small Business Economics — found:

"Mental health differences directly or indirectly affected 72% of the entrepreneurs in this sample, including those with a personal mental health history (49%) and family mental health history among the asymptomatic entrepreneurs (23%). "

In addition, entrepreneurs were more likely than comparison participants and the general population to experience …

· Depression: 30% compared to 15% and 16.6% (APA)

· ADHD: 29% compared to 5% and 4.4% (NIMH)

· Addiction: 12% compared to 4% and 8.4% (SAMHSA)

· Bipolar diagnosis: 11% compared to 1% and 4.4% (NIMH)

While the above study has yet to be replicated, academic literature on the connection — i.e., correlation rather than causation — abounds (see footnote at the end for more).

In popular culture, recent news of the suicides of Kate Spade and Anthony Bourdain have given entrepreneurial faces to wider statistics, most notably the 30% rise in suicide since 1999 in America. Tragically, even among the uber-successful, Spade and Bourdain are far from alone:

· In 2011, Ilya Zhitomirskiy, CEO of Diaspora, took his life

· In 2013, so did Aaron Schwartz, from Reddit, Jody Sherman, founder of Ecomom, and Ovik Banerjee, Sherman's colleague

· In 2015, Austen Heinz, CEO of Cambrian Genomics, and Faigy Mayer, CEO of Appton, succumbed as well

In total, this sampling of data and names is not meant to be morbid. Nor is it meant to clinically substantiate a causative link between entrepreneurship, success, and mental illness.

Instead, the point is to drive home that …

Entrepreneurial swagger is often a thin veneer. Running alongside possible chemical issues are situational factors: the more successful you are, the more people depend on you, and the more is at stake if you fail.

If you feel like you're living on the edge of a knife, you are not alone.

The Toxicity of Chronic Stress

"Everyone was telling me how great it is and how amazing life is and how they are hiring a bunch of people and closing out rounds of funding. And it was like, 'Okay, yeah, I get that. But let's have a real conversation.'"

"I found it very difficult to find people in my life who were willing to let their guard down and be honest and real."

Brian Bordainick, Founder of Dinner Labs

Temporary stress is normal and can be healthy. But, as the saying goes, everything in moderation.

Chronic stress, on the other hand, is where the physiological effects become more dangerous:

· Headaches

· High blood pressure

· Heart problems

· Suppressed immune response

· And much more

Prolonged exposure to chronic stress can lead to memory loss, anxiety, irritability, depression, substance abuse, social withdrawal, weight gain, insomnia, suicidal thoughts, or worse.

We've all heard stories or experienced firsthand the devastating toll this takes on relationships with spouses, children, colleagues, and family.

But what's really going on inside the body?

Beneath chronic stress, your endocrine system, responsible for regulating your "fight or flight" response, isn't returning to a healthy state.

Instead, it overrides everything the brain deems non-critical, like sleep, digestion, and the reproductive system, while enhancing the systems useful during times of high alert — namely, your muscular and cardiovascular systems.

"When I'm stressed," wrote Michelle Nickolaisen in the original version of this article, "I clench my jaw, even while I sleep. During one particularly stressful month in 2015, I woke up unable to turn my neck to either side without intense pain. Weeks of tension took its toll. Fortunately, after several days and a few deep tissue massages, I was able to move my neck like a human being again."

Of course, the effects can be far worse, as noted above.

Fortunately, more entrepreneurs are speaking out and sharing their experiences.

"Loneliness, darkness, hopelessness … those words don't capture the feeling of the profound self-doubt that sets in after a failure. Loneliness. Darkness. Hopelessness."

"Those words describe the environment of depression. Self-doubt? That shakes you to the core and starts a fracture in your identity that makes you question if you should even exist anymore."

Ben Huh, "When Death Feels Like a Good Option"

You Are Not Your Work: The Problem with Passion

For those of us who monetize our passion, these are hard words to internalize. But it bears repeating:

You are not your work.

Earlier this year, Harvard Business Review highlighted a study on the relationship between entrepreneurship, burnout, and two types of passion.

The first type was identified as "harmonious passion," which leads to high levels of concentration, attention, and absorption:

"While these entrepreneurs said they often felt totally taken by their work, they also allowed themselves breaks from it and had more flexibility. Overall, [they] were able to balance their job with other activities in their lives without experiencing conflict, guilt, or negative effects when not engaging in work."

By contrast, while the second type of passion — defined as "obsessive" — does lead to exceptional job fit, such entrepreneurs also struggled to pay attention at work due to "the roles and responsibilities they were neglecting (such as family and staying healthy)."

Most telling, obsessive entrepreneurs reported they "couldn't live without their work … felt emotionally dependent on their work, had difficulty imagining their lives without their work, and felt their mood depended on them being able to work."

Not surprisingly, "obsessively passionate" entreprenuers are far more at risk for burnout than their "harmonious passion" counterparts.

We all need outlets and hobbies beyond our careers to be healthy human beings.

One study showed that having a creative hobby, such as playing the piano or pottery, resulted in a measurable decrease in cortisol levels (the hormore associated with stress) after the activity was completed. Studies have also found spending time walking in nature has helped people become happier, more attentive, and "present."

When you identify with your business, you set yourself up for an existential crisis every time it changes — which is inevitable on the path to success.

You're also setting yourself up for interpersonal and professional crises once your business is successful; risking micromanagement, forgetting to share praise with your team, and overcommitting to new opportunities.

Relying on any single facet of your life for the entirety of your personal fulfillment is unhealthy and unrealistic. Mark Woeppel found solace in playing music during his business' downturn:

I used to be like, 'My work is me.' Then you fail. And you find out that your kids still love you. Your wife still loves you. Your dog still loves you.

Kevin Eschleman, an assistant professor of psychology at San Francisco State University, showed that people who are more engaged in creative activities often scored 15-30% higher on performance rankings than people who were less engaged: "We found that in general, the more you engage in creative activities, the better you'll do at work."

Remember to Make Time For Self-Care

It's a vicious cycle: you're working so much that you forget to eat right or go to bed on time, so you wake up late, which puts you behind, so you work late again, and wake up at an even greater deficit.

Soon, you're burned out and want to avoid working altogether. Creating self-care habits isn't just a good idea in general, it can also do a lot to reduce stress and its side effects.

"I make time and space to care for my mental health," says Brad Feld, about how he deals with his depression as an entrepreneur. "I stopped setting my alarm for five a.m. and let myself sleep until I wake up naturally. I observe digital Sabbaths in which I stop checking email, keeping up with the news online, and checking into Foursquare. I travel less. I read and run more.

I do all of the things that the prevailing start-up culture tries to squeeze out of my life. And as a result, I'm far more productive in the business of building and investing in companies.

You might find it hard to justify spending an hour at the gym, 20 minutes a day meditating, or even getting to bed at a reasonable hour.

That trepidation is itself a symptom of the problem. Which is why picking just one or two of the self-care habits below and making incremental changes is so crucial …

Sleep

For most adults, 7-9 hours per night is the recommended amount, although your personal needs could be a little more or a little less. Sleep is often one of the first things to go during a busy period, but reducing sleep to 4-6 hours a night is shown to have a significant impact on cognitive functioning.

Recommended resource

The Sleep Revolution: Transforming Your Life, One Night at a Time by Arianna Huffington

Meditation

Meditating doesn't have to be a New-Agey experience with crystals and incense; it can be as simple as firing up an app for five or ten minutes in the morning. Shopify's CEO Tobi Lütke swears by Headspace.

Recommended resource

Altered Traits: Science Reveals How Meditation Changes Your Mind, Brain, and Body by Daniel Goleman and Richard J. Davidson

Exercise

Aside from the myriad of health benefits, exercise is yet another way to get relief from stress. You can do something as quick as the seven-minute workout, or you can aim to find a fitness activity that's both healthy and fun. On the app front, there's Couch to 5k, high-intensity interval and bodyweight trainers like Sworkit and Seven, and yoga apps (here's a list of free or cheap ones for both platforms).

Recommended resource

The 4-Hour Body: An Uncommon Guide to Rapid Fat-Loss, Incredible Sex, and Becoming Superhuman by Tim Ferriss

Ergonomics

Not necessarily a habit, but since we're talking about health and entrepreneurs, it's worth noting: make sure your workspace is set up properly.

Recommended resource

"How to Ergonomically Optimize Your Workspace" by Whitson Gordon

Remember, You Are Not Alone

No matter how much you love your work, it's not worth sacrificing yourself for.

If you're experiencing serious symptoms of anxiety or depression, talk to a doctor or therapist. The most obvious symptoms are changes in sleeping or eating patterns, alongside feelings of listlessness, panic, paranoia, or fear.

But there are plenty more — for both anxiety and depression — and these disorders manifest in odd ways sometimes.

"During my worst depressive episode," wrote Nickolaisen, "my memory was terrible. I reached the end of a month and realized that I had no memory of that entire month, barring one or two experiences — everything else was sort of a gray mist in my head (and still is, to this day)."

In the words of Andrew Solomon, a researcher on depression and mental health:

“One of the first people I interviewed described depression as a slower way of being dead. That was a good thing for me to hear early on because it reminded me that that slow way of being dead can lead to actual deadness, that this is serious business.

It’s the leading disability worldwide, and people die of it every day.

Personally, clinical depression isn't an issue I've faced myself. But depression and suicidal ideation have marked a number of the intimate relationships in my life. Proactively seeking education, understanding the warning signs, listening without judgment, and being willing to have hard conversions have made all the difference.

Conversely, substance abuse and what HBR called "obsessive passion," I have known firsthand.

While I don't pretend to speak as an expert on either subject, my life — personally and professionally — has been helped greatly by getting ruthlessly honest about the dark things, setting mundane boundaries (like daily and weekly Sabbaths), and, above all, the support and love of recovery communities.

In addition, the writings of Mark Manson, Timothy Keller, and Amy Anderson(the former Editor in Chief of Success Magazine) have restored my sanity on more than one occasion.

There's a very real stigma around talking about mental health in general, not to mention talking about your struggles in entrepreneurial circles. But if you're dealing with depression in particular, you need to talk to someone.

Resources for Immediate Help

· Suicide Prevention Lifeline: 1-800-273-8255

· Canadian Association for Suicide Prevention Crisis Centres

· American Foundation for Suicide Prevention

· World Health Organization: Suicide Prevention

The most important thing to remember is that you don’t have to do it alone. 

Source: shopify.com