“The notion that you can be vulnerable, the notion that you can share a weakness, those are antithetical to the great CEO archetype,” Feld says.

As a result, many founders believe they are struggling alone, and slowly become isolated from social networks and resources that could potentially help them recover. Fortunately, some influential players have started to speak out, including Y Combinator President Sam Altman, who wrote an encouraging blog post addressed to founders dealing with depression and anxiety this past June. "Most of the founders I know have had seriously dark times, and usually felt like there was no one they could turn to," Altman wrote. "For whatever it’s worth, you’re not alone, and you shouldn’t be ashamed."

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Depression is hardly exclusive to tech. The disorder is the leading cause of disability worldwide, according to the World Health Organization, and costs employers billions of dollars a year in lost revenue. Multiple people I talked to for this story pointed out that entertainers are also known for melancholy. For writers and artists, neuroses are practically required.

Yet certain elements of startup life and culture may make people particularly susceptible to depression. Stress, uncertainty, youth and isolation—the virtual cornerstones of today’s startup—have all been shown to increase likelihood of developing the disorder. Irregular work hours and constant high stress levels can lead to both social isolation and sleep disturbances, which can aggravate depression and make people even more volatile. It’s almost a perfect storm, says Maurice Ohayon, a professor of psychiatry at Stanford University School of Medicine. “Any psychiatrist can tell you that this population is particularly exposed,” he told me.

Most founders operate under a huge amount of pressure. They are responsible for employees, shareholders, and maintaining company morale, mostly before reaching the age of 30. And especially in the early stages of running a startup, they shoulder that burden mostly alone.

Two years ago, Patrick Campbell, 27, founded Price Intelligently—a Boston-based company that helps app developers figure out the optimal price for their product—and was hit with anxiety early on. “For the first six months it was literally me in an office trying to make things happen,” he says. As the only full-time employee he made all the decisions, and would often stay up late to get everything done. “It started to eat away at my life.”

Worst of all, he says, there was no break. “It doesn't matter how last quarter went. Nothing is ever good enough, because there's always another lead and another target.”

This constant stress is punctuated by moments of sheer panic as founders have to deal with continuous threats to their fledgling companies. A woman we’ll call Evelyn, CEO of a startup headquartered in Amsterdam who asked not to be identified by her real name, says she’s been through long stretches of moderate depression and recently went through a period of extreme burnout. After getting word that a sponsor had withdrawn funding when cash reserves were already dangerously low, she burst into tears at a conference. “It's very much a roller coaster,” she says. Sometimes “everything seems to be going as it should, and then there can be dark patches, and those are the hardest bits to climb out of.”