Although “high-functioning depression” is not an official clinical diagnosis, it is a term commonly used to describe people whose depression is so well hidden that it does not affect their day-to-day functioning, explains Jennie Marie Battistin, a licensed marriage and family therapist in Burbank, California. For example, they may be socializing often with friends, meeting expectations at work, and not expressing hopelessness, yet inside they are struggling.
Why Is High-Functioning Depression So Hard to Recognize?
Persisting stereotypes about depression equate “real” depression with difficulty functioning. You can’t get out of bed, you’re always sad, and you can’t muster what it takes to do well at work. Those stereotypes don’t apply to someone with “high-functioning depression.” They don’t appear “sick,” which makes it difficult for loved ones — and even people who have the condition — to identify the internal feelings of inadequacy, self-doubt, and anxiety as signs of depression, says Joanne Frederick, a national certified counselor based in Washington, DC and the author of Copeology. Furthermore, “high functioning” implies (misleadingly) that since a person is able to function, there’s no clear need for intervention, says Mirela Loftus, MD, PhD, a psychiatrist and medical director at Newport Academy, an evidence-based treatment center for teens and families dealing with mental health issues in Connecticut.
What Are the Common Symptoms of ‘High-Functioning’ Depression?
Professionally, high-functioning depression is referred to as persistent depressive disorder (PDD) or dysthymia. Per Johns Hopkins Medicine, it is a milder but long-lasting form of depression that can include bouts of major depression at certain points. Although dysthymia usually is not as severe as major depression, those who have it can experience many of the same symptoms, ranging from mild to severe, at different times, Mayo Clinic experts explain. These symptoms may include:
Avoiding social activitiesChanges in appetite (increase or decrease)Difficulty concentrating or making decisionsExcessive anger or irritabilityFatigue and low energyFeeling hopelessFeeling empty, sad, or downFeeling guilty or worried about the pastLow self-esteemReduced productivity, activity, or effectivenessSelf-criticism or feeling incapable of certain thingsSleep issues
The difference between major depressive disorder (MDD) and dysthymia is that symptoms of dysthymia tend to ebb and flow depending on one’s personal situation, says Anisha Patel-Dunn, DO, a psychiatrist and chief medical officer at LifeStance Health in Bellevue, Washington. That’s why high-functioning depression can be so hard to notice — it doesn’t set off the same external red flags as MDD does, she explains. For instance, someone with dysthymia may be showing up for work or school, but act more reserved than usual, says Amanda Stretcher, a licensed professional counselor with Taylor Counseling Group in Dallas. Or they may seem fine when socializing but are not performing as well at work as usual. Furthermore, for someone to be diagnosed with MDD, they need to have five of the aforementioned symptoms for at least two weeks. For someone to be diagnosed with PDD, they need to have at least two of the aforementioned symptoms for more than two years.
If You’re ‘High-Functioning,’ Are You Sick Enough to Need Help?
People with dysthymia may assume they’re not sick enough to need help and therefore don’t seek it out. Nothing can be further from the truth, says Frederick, since depression, even if ‘high-functioning,’ still impedes your quality of life. “It’s important to remember that ‘high functioning’ does not mean fully functioning,” says Frederick. People with dysthymia still experience some level of impairment even if they’re able to perform most tasks on most days. Associating your depression with extreme cases or stereotypical symptoms that don’t match your experience doesn’t mean you wouldn’t qualify for or benefit from professional help, Dr. Patel-Dunn adds. And just as with physical illnesses, early intervention is important. Left untreated any symptoms of depression can cause impaired functioning and lead to MDD or complications like substance use, chronic pain, and suicidal thoughts or behaviors, per Mayo Clinic. “There is no symptom severity ‘limit’ for what you can and should seek help for,” Dr. Loftus says.
Is ‘High-Functioning Depression’ Treatable?
Yes. Although dysthymia may not appear to be as severe as major depression, it is very treatable, Frederick says. “There is no reason that anyone should live with a constant low mood when effective treatments are readily available,” she adds. “If you experience any of the aforementioned symptoms, the first step is to talk to your primary care physician or another healthcare provider,” Loftus notes. Dysthymia is often treated with a combination of talk therapy and sometimes medication, Mayo Clinic states. Cognitive behavioral therapy, one of the most common types of therapy used to treat depression, teaches people with dysthymia to turn unhelpful thinking and behavioral patterns into positive ones. “Talking to a therapist can help navigate the stress one is experiencing, and if the depression manifests with physical symptoms [such as sleep problems or changes in appetite], antidepressant medications may become a consideration,” says Loftus. The American Psychiatric Association and similar organizations offer directories to help you find a therapist in your area. Self-care is another important way to manage dysthymia. Lifestyle changes to consider, says Loftus, include:
Going to sleep and waking up around the same times every dayJournaling, meditating, or making artMaking time for physical activity each dayNourishing your body with a diet rich in fruits and vegetablesReaching out to loved ones for support and letting them know you’re struggling
If you have a family member, friend, or colleague with dysthymia and you want to offer support, Stretcher has this advice:
Be an active listener. “They may not want or need solutions, just someone to hear them and validate their experience. So instead of offering a ‘fix,’ try asking ‘What can I do to support you?’” says Stretcher.Highlight any strengths you see in the person, and share what you see. “Help cultivate hope where they may be experiencing hopelessness,” Stretcher explains. However, avoid directly telling someone with depression to “think positive” or naming the reasons why they shouldn’t be depressed.Know there will be ups and downs and continue to reach out even when they appear withdrawn. Just call or send a text to let them know you’re thinking about them and that you’re there whenever they want to talk.
If you are someone you know are feeling hopeless or having suicidal thoughts, you can talk confidentially to a trained counselor by calling the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). Even easier, starting on July 16, 2022, everyone across the country will be able to connect to the Lifeline by calling 988.
