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What is High-Functioning Depression?

High functioning depression is a mental health condition that is not apparent or obvious. From the outside, people who have high functioning depression appear as “having it all together”. They look good every day, they’re well-groomed and smile. They may have good families, satisfying careers and participate in church or club organizations. People suffering from high functioning depression socialize with their friends, and their friends consider them dependable.

High functioning depression sufferers have lives that look balanced. What people don’t see is that these sufferers are concealing a persistent depression.

Let’s first take a look at the form of depression that we’re more familiar with, known as classic depression or unipolar depression, which is the most common form. 1 Then we’ll examine high functioning depression to see how it compares and contrasts with classic depression.

What Is Classic Depression?

Mental health guidelines define depression as a disorder that is characterized by inactivity, low moods, and it also affects the individual’s behavior, thoughts and general well-being.

Signs of classic depression can include: 2

  • Sleeping too much or too little
  • Fatigue
  • Low energy levels
  • Appetite changes
  • Weight gain or loss
  • Feeling worthless
  • Self-hate
  • Guilty feelings
  • Concentration problems
  • Foggy thinking
  • Can’t make decisions
  • Agitation
  • Restlessness
  • Irritability
  • Withdrawing from activities
  • Hopelessness
  • Suicidal thoughts

Possible causes of depression may include : 2

  • Trauma
  • Stress
  • Chemical imbalances
  • Long-term illnesses
  • Loneliness
  • Loss of loved ones
  • Lack of sunlight

What Is High Functioning Depression?

People who have high functioning depression develop seemingly “normal” personas or facades they display to the world, but they are really going through the motions without much joy or satisfaction. The classic signs of depression aren’t apparent, such as inactivity, withdrawal, lack of energy and the paralysis that comes from feeling helpless. One word people who have high functioning depression frequently use is “numb” to describe how they’re feeling.

High functioning people with depression have a form of the disorder that’s low-grade but usually long-lasting – about five years on the average. 3 Also known as persistent depressive disorder (PDD) or dysthymia, this type of depressive disorder is less severe than classic depression but more chronic.

Signs of persistent depressive disorder are: 3

  • Feeling unsettled
  • Unhappiness
  • Feeling down
  • Feeling numb

The major difference between PDD and classic depression is that PDD doesn’t affect sufferers in their everyday lives as much as classic depression does. The symptoms change frequently (daily or weekly), where people with major depression tend to have the same symptoms that manifest steadily. 4

What Are the Characteristics of 
High Functioning Depression?

People living with high functioning depression may feel like they’re living a lie because they hide their depressive feelings well. A common theme is they are unable to enjoy life, or they’re feeling mentally numb. They feel very sad inside, and some may more readily quit relationships, jobs or projects. They may also want to quit life itself, and suicidal thoughts can then develop. 4

Suicide Dangers and High Functioning Depression

Because people who are suffering from high functioning depression hide it very well, for the most part, no one around them knows what’s going on. This well-hidden persona also prevents these types of depression sufferers from getting help.

Those dealing with high functioning depression struggle to seek out friends or family to talk about how they’re feeling because they don’t want anyone to know about their depression. They sometimes won’t seek professional help, because that would also be an admission that something is not right.

Attitudes like these that are common to people with high functioning depression leave them isolated, without a way to get help and feeling increasingly more sad and numb. These hidden struggles can dramatically raise the risks for suicide.

The suicide rate in the United States is sharply increasing, and studies show a relationship between depression and suicide.5

  • There are an average of 129 suicides a day.
  • Suicide is the 10th leading cause of death in the United States.
  • In 2017, more than 47,000 people died by suicide.
  • In 2017, there were approximately 1.4 million suicide attempts.

How Can You Spot Someone in Your Life That May Be a 
Highly Functioning Yet Depressed?

Most of the signs of persistent depressive disorder(PDD) are subtle. Be alert for the following characteristics:

  • An increase in alcohol consumption, especially very noticeable increases. Alcohol can worsen depression symptoms and/or thoughts of suicide.
  • The person is his or her own worst critic.
  • Dramatic changes in work or school performance or attitude.
  • People who seem overly concerned about productivity, because being overly productive may be used as a way to escape numb feelings.
  • People who feel like they are just wasting time, because their depression is making them feel that life is “just a waste of time”.

High Functioning Depression in Young Adults

Young adults can also suffer from PDD. Young people with high functioning depression have chronic feelings of sadness or worthlessness and are unable to experience pleasure. Young adults with dysthymia may have their symptoms of depression go unnoticed, as symptoms are less acute – but longer lasting – than in other forms of depression.

How Can You Spot a Young Adult in Your Life That May Be Highly Functioning Yet Depressed?

young adult with PDD comes across as moody, irritable, pessimistic or sad over an extended span of time. Other symptoms can include performing poorly at school, behavior problems, difficulties engaging with other young adults in social situations and low self-esteem. 6

The level of severity of specific symptoms may go up and down over long periods of time, but usually, symptoms don’t go away for more than two months at a time. Since dysthymia often happens in young adults along with other mental health conditions with similar symptoms (anxiety, eating disorders or substance abuse) these co-occurring disorders make PDD harder to diagnose.

Treatment for High Functioning Depression

The first step in getting the right treatment for depression is to visit a mental health professional, such as a psychologist or psychiatrist. It’s recommended to contact a substance abuse treatment center if drugs or alcohol are involved.

Your psychologist, psychiatrist or rehab facility can do an assessment to see if high functioning depression is present, or if it’s another condition with similar symptoms as depression. Once depression is diagnosed, it can be treated with medications, psychotherapy, or both. A combination of medications and therapy is regarded as the most effective treatment.

Psychotherapy teaches new ways of thinking and behaving to alleviate depression. Therapy helps people understand and work through difficulties that may be causing or worsening depression. Psychotherapy treatments for persistent depressive disorder include:6

  • Cognitive behavioral therapy (CBT): concentrates on thoughts, behaviors and feelings related to depression
  • Interpersonal psychotherapy (IPT): concentrates on working on relationships
  • Dialectical behavior therapy (DBT): used when depression is paired with either self-destructive or self-harming behaviors.
  • Substance abuse counseling: when appropriate.

Pharmacological (drug) treatments for persistent depressive disorder includes medications such as: 6

  • selective serotonin reuptake inhibitors (SSRIs)
  • serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • tricyclic antidepressants (TCAs)

Young adults should be closely monitored by their mental healthcare providers and their families when taking medications for depression. If a substance abuse disorder accompanies depression, parents and caregivers should consider an inpatient substance abuse treatment program. An inpatient drug rehab can help young adults stabilize their addictive behaviors, while safely treating their depression at the same time.

For many people, a long-term combination of medication and psychotherapy is the most effective course of treatment. Recovery from dysthymia can take time, and the symptoms can often ebb, flow and return. For these reasons, many clients are encouraged to continue doing what works for them: medications, therapy, or a combination of the two to stay on the journey of recovery and live revitalized and rewarding lives.


Resources

  1.  Informed Health Online
  2. National Institute of Mental Health
  3. PsychCentral
  4.  Psychiatry
  5. American Foundation for Sucicide Prevention
  6. National Institute of Mental Health
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