What is high functioning depression?

Depression is often depicted and described as a completely debilitating condition. We often picture people unable to rise out of bed in the morning, crying uncontrollably, and feeling a deep sadness. While these are common symptoms of the mental disorder, it is a misconception to think this is the only way the depression is manifested. In reality, depression takes many forms and can range greatly in severeness. Sometimes, people have what’s called “functional depression.” To accurately identify functioning depression, it’s important to get a diagnosis from a professional. Use the therapy matching service, Advekit, to get connected with accessible mental health professionals. 

High-functioning, or functional, depression is a term that has been popularized in the last few years and used to describe a condition formerly known as dysthymia, and now known as Persistent Depressive Disorder  –– a type of depression characterized by a depressed mood for most of the day, and on more days than not. Common depressive symptoms include overeating or poor appetite, insomnia or sleeping too much, low energy or fatigue, low self-esteem or low self-image, the inability to concentrate, difficulty making decisions, and general feelings of hopelessness. A person suffering from dysthymia may experience most of these symptoms or just a few, which is why it can be difficult to pinpoint.

People with high-functioning depression also are often pessimistic high achievers, which can mask the disease and be written off as general negativity, instead of something more serious. Someone with high-functioning depression is often negative or pessimistic in their outlook on their experiences as well as themselves, struggles with self-doubt, experiences irritability, deals with worry or guilt that seems excessive, and may generally be the person who is most likely to make a bigger deal of things than necessary. Perfectionists can often be a group of people with high-functioning depression.

High functioning anxiety disorder is perhaps a more commonly used term. This refers to people who struggle with anxiety, but are able to present as not anxious in public. While the difference between high functioning anxiety vs depression is definite, the two often coexist. Further, both high functioning anxiety and depression encompass the idea that you can have the symptoms and struggles of a mental health issue, while not exhibiting any signs to the outside world.  

Though a major contrast to Major Depressive Disorder, which is more acute, high functioning depression, (HFD) is also a chronic type of depression. With high functioning depression, any individual with depression appears somewhat fine to the outside world. They go to work, pay their bills, and talk to people normally. They may even appear to be happy at times, but their outward actions aren’t always an accurate reflection of how they are feeling. It doesn’t mean they don’t feel depressed. Some of these individuals may crawl into bed the minute they get home from work or collapse on the couch crying just moments after getting off the phone with a friend. You can have depression and still be very good at hiding it.

But, make no mistake, high functioning depression is just as difficult to cope with as any other forms of depression. In fact, it has its own unique challenges because it can appear so invisible. While people with an acute episode of major depression have a baseline of “normal” or “positive” feelings that erode while depressed, people with high functioning depression typically feel depressed most of the time, for years on end. In fact, they may not even remember what it felt like to feel good.

What are high functioning depression symptoms?

Generally speaking, signs and symptoms of high-functioning depression are similar to those caused by major depression but less severe. They may include changes in eating and sleeping habits, low self-esteem, fatigue, hopelessness, and difficulty concentrating. Symptoms persist on a low hum for most days, causing a nearly constant reduced mood that lasts for two years or more. Because the depression symptoms are operating at such a low grade, most functioning depression sufferers function almost normally outwardly but struggle internally. 

High-functioning depression is a recognized mental health condition that should be diagnosed by a psychiatrist or other mental health professional. Like any diagnosis, there are certain criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that need to be met for a professional to make a call either way. The first criterion for high functioning depression is that an individual experiences a depressed mood most days and, for most of the day, a minimum period of two years. The depressed feelings must include two or more of these symptoms:

  • Decreased appetite or overeating

  • Insomnia or oversleeping

  • Lack of energy and fatigue

  • Lowered self-esteem

  • Difficulty concentrating and making decisions

  • Feeling sad and hopeless

In addition to these symptoms that cause a depressed mood most of the time, there are a few other criteria that have to be met to make a diagnosis of PDD:

  • The depressed mood must occur on most days for at least two years without any relief from depression for longer than two months during that period.

  • The individual has never experienced a period of mania or hypomania, an unusually euphoric and energetic mood.

  • The depression symptoms cannot be better explained by another mental illness, medical condition, or substance abuse.

  • The symptoms and depressed mood must cause some impairment in one or more areas of normal functioning and significant distress in the individual.

What does it feel like to experience high functioning depression?

While the diagnostic criteria for high functioning depression outlines general symptoms and behaviors in clinical terms, it doesn’t necessarily describe what it feels like to go through it every day. It may be more useful to consider what it feels like to have this mental illness.

High functioning depression causes a person to feel a little down, most of the time with no relief. Others may describe a depressed person as being gloomy, cynical, or a downer, but not quite serious enough to label it as depression. The low mood is almost always present, and when there is a reprieve of happiness, it typically doesn’t last long. It’s possible to feel tired all the time, even if the person gets enough, or even too much sleep. This can make it seem like the person is lazy, when really, they just can’t summon the energy to do more than is necessary to function at a normal level.

Introspectively, high-functioning depression can make a person feel bad about themself, unworthy, and undeserving of happiness. Even though a person can do everything they’re supposed to do, like show up to work on time or keep the house clean, it always seems like a monumental effort.

Physically, there is unintentional weight gain or loss because of lack of appetite or compulsive eating. A persistent feeling of hopelessness can bring on a bout of uncontrollable crying without any real, concrete reason. And, social activities are extremely challenging because of the strong desire to withdraw. High functioning depression may also cause complications that seem unrelated, like substance abuse, chronic pain, relationship difficulties, and problems at work or school.

Signs of an Episode of Major Depression

Like all forms of depression, functional depression can stem from several different causes. It may be a combination of genetic, biological, or life experiences that lead to functional depression. Stress, illness, unresolved or anticipatory grief, substance abuse issues, trauma, relationship issues, and major life transitions are just a few reasons someone might grow depressed.

Anyone with high functioning depression is at risk of experiencing a major depressive episode, just as people with more acute diagnoses. In fact, most people with high functioning depression will have one such episode at least once in their lives. For some people, it may feel as if the persistent, low-level depression may take a turn into severe depression at any time.

While high functioning depression persists over a long period of time, major depression occurs in episodes that are shorter-lived, but still last at least two weeks long. The symptoms are similar but more severe during an episode of major depression for both cases.

Someone with high functioning depression operates at a typical level but, during an episode of major depression, that stability will slide. They may begin to perform more poorly at school or work, be unable to complete certain responsibilities, skip activities they normally participate in, become socially withdrawn, or even let self-care and personal hygiene slide. This is a marked difference in how the person normally behaves, but an episode for someone with high functioning depression is still not as severe as someone with major depression.

While major depression can also cause lack of interest in activities normally enjoyed, it also brings on extreme feelings of guilt, changes in emotional affect, and suicidal thoughts and behaviors. In rare cases, a depressive episode may even cause psychotic symptoms, such delusions and paranoia. This is not usually the case for high functioning depression cases.

What is depression therapy?

Talk therapy can be an extremely effective treatment for high functioning depression. What can be learned in therapy provides skills and insight to feel better and help prevent depression from coming back. Therapists can help a person identify the negative thoughts, beliefs, and habits that may be contributing to feeling depressed. It could also include things like medication, learning mindfulness skills, and doing activities linked to improving mood, such as exercise.

There are many types of therapy available. Three of the more common methods used in depression treatment include cognitive behavioral therapy (CBT), interpersonal therapy, and psychodynamic therapy. Often, a blended approach is used. Some types of therapy teach you practical techniques on how to reframe negative thinking and employ behavioral skills in combating depression. Therapy can also help you work through the root of your depression, helping you understand why you feel a certain way, identifying triggers are for depression, and teaching coping skills if low moods and other symptoms return.

One of the hallmarks of depression is feeling overwhelmed and having trouble focusing. Therapy helps a person step back and see what might be contributing to their depression and how they can make changes. The most common areas of focus are relationships, setting appropriate boundaries, and handling day to day challenges. 

Therapy can reveal patterns in relationships, and help improve current relationships that will reduce isolation and build social support, which are important in preventing depression from getting worse or returning. Additionally, feeling stressed and overwhelmed can cloud judgement on when and how to say no. Therapy can help set healthy boundaries and provide feedback on more positive ways to handle life’s challenges.  

The idea of therapy conjures images of one-on-one sessions with a therapist. However, group therapy can be very useful in depression treatment as well. Both group and individual therapy sessions usually last about an hour. Individual therapy can help build a strong relationship with one person, and may feel more comfortable sharing some sensitive information with one person than with a group. There is, of course, the added benefit of receiving individualized attention and care. However, in group therapy, listening to peers going through the same struggles can validate experiences and help build self-esteem. Often group members are at different points in their depression, so listening to varying perspectives can be extremely comforting. As well as offering inspiration and ideas, attending group therapy can also help increase your social activities and network.

Therapy isn’t easy, when you take apart things that haven’t worked well in your life, it often makes them seem worse before they get better. When therapy seems difficult or painful, it’s important not to give up. However, if the connection with the therapist consistently starts to feel forced or uncomfortable, it’s perfectly acceptable to explore other options for therapy. A strong trusting relationship is the foundation of good therapy.

This is why one of the most important things to consider when choosing a therapist is the connection with this person. The right therapist will be a caring and supportive partner in your depression treatment and recovery.

There are many ways to find a therapist including word of mouth from friends and family or a referral from a primary care doctor. National mental health organizations can also help with referral lists of licensed credentialed providers. If cost is an issue, check out local senior centers, religious organizations, and community mental health clinics. Such places often offer therapy on a sliding scale for payment.

Trusted therapist matching services like Advekit, can be a fast, effective way to get matched with great local therapists who specialize in high functioning depression. They can also help navigate insurance plans. 

Oftentimes people with high functioning depression feel like they’re getting by well enough and therefore don’t need therapy. However, therapy can help in every stage of life, but can be an especially critical tool in recovery that can lead to a vast improvement in quality of life.

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