07.25.23
Is High-Functioning Depression for Real?
Getting shit done while dead inside? Welcome.
When you think about a person who has depression, it probably looks a lot like an antidepressant commercial. Staying in bed all day, crying, and seeming generally miserable 24/7, it’s all happening there. To be fair, depression does look like that for a lot of people. For others though, it’s totally different, and it’s sometimes described as high-functioning depression.
People who feel depression symptoms but hide them (whether they mean to or not) often look like they have their shit together. But internally, they’re seriously struggling like I was during my freshman year of college. I appeared to be thriving—I was getting straight As, had a good group of friends, and was joining clubs—but most days I’d walk around campus questioning my existence and feeling hopeless about the future. If you’ve been there, you know what I mean.
But high-functioning depression isn’t an actual diagnosis you can find in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), which makes it a little complicated. So, to find out what high-functioning depression really is and what to do if you think you might have it, I spoke with experts who know what’s up.
What is high-functioning depression?
Psychiatrist Susan J. Noonan, MD, MPH, says that, in her experience, the term high-functioning depression is typically used to describe people who meet the diagnostic criteria for clinical depression, also known as major depression or major depressive disorder, but they’re mostly able to keep those struggles hidden from others.
Now technically a diagnosis of major depressive disorder has to cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning,” per the DSM-5-TR. So, having high-functioning depression could mean that you check off a lot of the boxes for depression, but your day-to-day functioning isn’t super impaired (at least not at the moment). Or maybe things seem fine from an outsider’s perspective, but it’s tanking your functioning in an area of your life that most people don’t see, says Dr. Noonan. For example, she explains that you might seem like your normal self at work, but most nights you come home and break down.
Because high-functioning depression is basically just clinical depression that’s hidden well or not yet messing with your life in a major way, the symptoms can be exactly the same, explains Dr. Noonan, author of Take Control of Your Depression. According to the DSM-5-TR, in order to be diagnosed with major depressive disorder, you have to consistently experience either depressed mood or loss of interest or pleasure, along with a combination of at least four more symptoms like sleeping too much or too little, significant appetite changes, having super low energy, struggling to think or concentrate, or feeling worthless for at least two weeks.
It’s also possible that your high-functioning depression could be a different longer-lasting form of depression, called persistent depressive disorder (also known as dysthymia). Though, in order to be diagnosed with this condition, you’d need to feel depressed more days than not over the course of two years, according to the DSM-5-TR. In addition to that, you’d experience two or more symptoms like sleepiness, low self-esteem, feeling hopeless, and having a hard time making decisions or concentrating during the same time span.
So why are some people able to hide or power through when they’re experiencing the shitty symptoms above while others can’t? There are a few possible explanations. The first is that they might feel ashamed of having depression and mask their symptoms in order to avoid facing stigma, suggests clinical psychologist Margaret Robinson Rutherford, PhD, author of Perfectly Hidden Depression and host of The SelfWork Podcast. That’s often true in Black, Indigenous, and People of Color communities, which sometimes stigmatize people who have mental health struggles or who seek out mental health help, adds psychologist Jameca Woody Cooper, PhD.
Anyone who’s a perfectionist, high achiever, or a people pleaser is also more likely to try to push through their symptoms because they want to be seen as strong, capable, and competent, explains Dr. Noonan.
It’s also possible that some with high-functioning depression have less intense symptoms, says Dr. Woody Cooper. Maybe they’re experiencing fatigue, but they’re still able to get out of bed and go through the motions of their day. Or they could have trouble concentrating, but they’re still able to complete projects at work—it’s just taking them longer than it used to. They might even feel generally numb (see: anhedonia). These less intense symptoms, like the ones that come with persistent depressive disorder, are typically easier to hide since they don’t make it impossible to function.
But labeling your depression as the high-functioning kind might not make coping with the condition any easier. On one hand, having a name for high-functioning depression raises awareness about the fact that depression, like many mental health conditions, exists on a spectrum. No two people have the exact same experience, and the concept of high-functioning depression might help you find the words to describe what you’re experiencing. And this realization might propel you to get the help you need, even if you don’t feel completely debilitated by it, explains Dr. Rutherford.
That said, it’s also possible that the term high-functioning depression might give people the idea that it’s not that serious or worthy of treatment, which is very untrue. “Whether it’s high- or low-[functioning], it’s still depression and it still deserves attention,” says Dr. Woody Cooper. Not to mention that referring to some kinds of depression as high-functioning can also imply that folks who can’t function with depression just aren’t trying hard enough, which is obviously not the case at all.
Should you seek treatment for high-functioning depression?
Yep, definitely. Even if you’re able to work around your symptoms and keep your life looking normal, struggling to function in at least one area and not feeling like your usual self are signs that you should get help, says Dr. Woody Cooper.
If you’ve been experiencing some of those classic depression symptoms for a few weeks or more, that’s another clear indicator that it’s time to talk to a professional, says Dr. Noonan. She recommends turning to your primary care physician if you don’t know where to start. They’ll be able to refer you to a therapist or prescribe you medication if you’re open to it.
How is high-functioning depression treated?
The treatment process for high-functioning depression looks the same as it does for clinical depression. A mental health pro will try to get an idea of how severe your symptoms are, and from there they’ll decide whether you’d benefit from therapy, medication, some lifestyle changes, or some combo of the three.
Most of the time though, treatment for high-functioning depression often includes cognitive behavioral therapy because it can help you identify how your thoughts and ways of thinking are contributing to your symptoms, explains Dr. Woody Cooper. Mindfulness therapy can also be very helpful, adds Dr. Noonan.
Doctors or psychiatrists also often prescribe a selective serotonin reuptake inhibitor (SSRI) medication to increase serotonin levels in your brain, explains Dr. Woody Cooper. Things like upping how much you move or making sure that you have enough social connections can help too.
No matter what route you go, remember that you’re worthy of help and support—no matter how well you’re able to push through your symptoms.
Wondermind does not provide medical advice, diagnosis, or treatment. Any information published on this website or by this brand is not intended as a replacement for medical advice. Always consult a qualified health or mental health professional with any questions or concerns about your mental health.
