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

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 made worse by subtle warning signs that make it tough to get help.

In my experience as a psychologist for entrepreneurs, the type of depression that plagues high performers is also the hardest to spot. Referred to as “high-functioning depression” or “walking around depression,” it comes with subtle symptoms that some entrepreneurs brush off as fatigue or stress.

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

What is high functioning depression

Part of the criteria for a diagnosis of major depressive disorder is functional impairment, meaning you may struggle to complete basic tasks, like getting to work on time or brushing your teeth, and several domains of life suffer critically. This is not the case for everyone, however. Those with high-functioning depression typically don’t see major changes in these areas.

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

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

Warning signs of high-functioning depression

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

One sign of high-functioning depression is diminished pleasure, as if the volume is turned down on your life. You don’t feel quite like yourself because you don’t derive as much enjoyment out of your favorite activities. And, while you’re capable of performing tasks, you feel a bit like a zombie while doing them, moving on autopilot from one thing to the next.

Common signs of high-functioning depression include:

• having an appetite, but not enjoying food

• being peripherally interested in intimacy, but sex isn’t as pleasurable as it used to be

• sticking with hobbies or workout routines, but not as often or with as much vigor

• feeling less rested, despite the same sleep pattern

• difficulty making decisions, even simple ones, like what to make for dinner

• spending time with friends and family, yet feeling disconnected

• attending to the ups and downs of running your business, but the victories don’t feel so sweet

Goal-oriented people tend to wait to address these emotional needs. Do you find yourself creating arbitrary benchmarks for when you might feel better? I just need to get through this day, this quarter, this year. I’ll be fine after I make some key hires. 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 out extremes. We expect depressed people to eat too much or not enough. They sleep too much or not enough. They have irrational outbursts, or they feel nothing at all. But depression can also feel like the greying out of your emotional life.

If you are concerned that low points are becoming more frequent, it may be helpful to keep a journal. Rate how you’re feeling at the end of each day using a scale of one to 10, and note any significant emotional experiences. If you have scores lower than five much of the time—a stretch of two or three weeks—consider therapy.

High functioning depression can be dangerous for entrepreneurs because it functions like a leak in a dam. It’s difficult 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 may seem fast to the outside observer. However, in most cases trouble was brewing for months or years before a crisis. Paying attention to high functioning depression can potentially be life-saving.

In many cases, high functioning depression can be turned around with a combination of psychotherapy, personal introspection, and practices like sleep, movement, connection, and hobbies. Sometimes medication is also a helpful route.

May is Mental Health Awareness Month, time for a reminder that prevention is preferable to intervention. It’s much easier to engage in structured, reflective dialogue before things go south. External signs of high-functioning depression can be shadowy, but a trained mental health practitioner will spot them.

Entrepreneurs will justify speaking or leadership coaches as business expenses, prioritizing output over wellness. They stop short of advocating for mental health care as a business priority. It’s time to change that mindset.