If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.
The board meeting ends at five. The investor update is due at nine the next morning. In between, a chief executive is supposed to have dinner with the family, help with homework and get some sleep. Instead, the numbers keep running through their head long after the house goes dark.
Pressure is part of leadership, and many leaders handle it well for years. But sustained scrutiny, especially when results disappoint, can wear a person down. For someone prone to depression, it can feed a steady stream of self-criticism that eventually turns into hopelessness.
How pressure can turn inward
Board members and investors are entitled to ask hard questions. The trouble begins when a leader starts to hear every question as a judgment on their worth. A missed target becomes proof of failure. A tense call becomes evidence that everyone has lost faith.
A composite example: a chief financial officer in her fifties preparing for a difficult earnings season might stop seeing friends, eat at her desk, and lie awake rehearsing worst cases. Over time she may begin to think that disappearing would be easier than facing another quarter. That is depression speaking, and it calls for care.
Physicians who chair departments and attorneys who manage firms feel versions of the same thing: budgets, partners, reviews and reputations, all pressing at once.
Across the St. Louis area, from family companies to regional firms to growing startups, the person at the top tends to absorb more than anyone sees. Pressure that cannot be spoken about at work often ends up carried alone, in the car, at the kitchen table or in the middle of the night.
Warning signs to take seriously
- Persistent hopelessness that does not lift after a good meeting or a strong result
- Describing oneself as a failure, a fraud or a burden
- Pulling away from family, friends and outside interests
- Major shifts in sleep, eating or alcohol use
- Reckless decisions, personally or professionally
- Any talk about death, dying or not wanting to be here
If you sit on the board or the leadership team
Directors and senior colleagues are often well placed to notice when a leader is struggling. A private conversation, away from the boardroom, can make it feel safer to answer honestly. Ask in plain language whether they are having thoughts of suicide. Keep the focus on the person rather than the performance, since this is not the moment to discuss the quarter.
If the answer is yes, keep them company, help them reach 988 or a clinician, and call 911 if there is immediate danger.
A supervised option within treatment
In some evaluations, a clinician may describe Spravato to a leader whose depression has brought suicidal thoughts. Spravato (esketamine) is a nasal spray the FDA has approved, taken along with an oral antidepressant, to treat depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. It is also approved for treatment-resistant depression. It is not a crisis treatment: it does not replace emergency care or a hospital stay when one is needed, and it has not been shown to prevent suicide or to reduce suicidal thoughts or behavior. It is given only in a certified clinic under a safety program called the Spravato REMS. The patient takes it there under supervision, stays at least two hours to be monitored, and does not drive until the next day after a full night of sleep. It is never dispensed for home use. Whether it fits is a clinician's decision after an evaluation.
Pressure does not have to win
Depression is a treatable illness, and recovery is possible with care and support. Asking for that support is not a sign that the pressure won.
One protected half hour can sit on the calendar like any other meeting. A free 30-minute consultation, available at some clinics that offer this treatment, is a confidential and unhurried chance to describe the pressure and ask whether an evaluation would help. Your spouse or a longtime mentor can attend with you.
If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.