What is High-Functioning Depression?

Are you a high achiever who inwardly struggles with feelings of worthlessness? Do you experience persistent low mood but still manage to show up for all of your responsibilities? Do you seem to be going through the motions of life, but no longer find pleasure in activities that used to bring you joy?

People with high-functioning depression may appear to be OK, but they are not. They silently, invisibly, and persistently struggle internally with depressive symptoms. Click To Tweet

If you answered yes to any of these questions, it’s possible you have high-functioning depression. Indeed, you can show up to life, achieve, and appear “normal” but still suffer from depressed moods, repressed emotions, and negative thought patterns.

Many of us have believed depression to be the one-dimensional depiction we see in the media. We imagine a depressed person being a sad, isolated individual, who may have trouble with hygiene, getting out of bed, and participating in activities.

The truth is depression takes many forms, and it can look vastly different from this pervasive stereotype. People with high-functioning depression may appear to be OK, but they are not. They silently, invisibly, and persistently struggle internally with depressive symptoms.

Here’s what you need to know about high-functioning depression, including symptoms, causes, and treatments.

WHAT IS HIGH-FUNCTIONING DEPRESSION?

High-functioning depression is a term used in some medical circles to describe depression that is hidden and allows people to perform daily, routine tasks.

It’s typically less debilitating than clinical depression, also called major depressive disorder. In addition, it allows a person to live what appears to be a normal life, including maintaining relationships, performing at work, and more.

Because individuals with high-functioning depression don’t appear “sick,” their depressive symptoms (ranging from mild to severe) can fly under the radar. Loved ones and even people who have the disorder may have a hard time identifying signs of depression. They may think some of their milder symptoms are simply character traits.

The symptoms can persist for a long time, even years. There’s a kind of slow daily emotional suffering with high-functioning depression, not unlike living with a low-grade fever. An individual can show up to life and push through or even do well with a low-grade fever, but they are always struggling internally.

It’s important to note that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not recognize high-functioning depression as a clinical mental health disorder.

But if it were to be classified as an official type of mood disorder, it most closely resembles the diagnostic criteria for persistent depressive disorder (PDD), formerly called dysthymia disorder.

People with PDD typically have depressed symptoms regularly for two years or more. In comparison, the symptoms for major depressive disorder (MDD) generally last for two weeks or more and can be more pronounced than with PDD. MDD is more episodic in nature, which makes symptoms easier to identify.

Some mental health professionals consider high-functioning depression and PDD to be the same thing, while others reject this notion. They argue PDD symptoms can negatively affect a person’s well-being, job, social interactions, or other important areas of their life, which does not indicate “high functioning.”

Other mental health professionals consider high-functioning depression to be episodes of depression that don’t rigidly fit into certain diagnostic signs and symptoms.

There’s no way to know exactly how many U.S. adults may be dealing with high-functioning depression, but we can look to MDD and PDD statistics to get an idea.

The National Alliance on Mental Illness reports that 8.3% of U.S. adults have a depressive episode annually. Statistics from the National Institute of Mental Health show that 1.5% of U.S. adults live with PDD (more than 3 million people).

 SIGNS OF HIGH-FUNCTIONING DEPRESSION

Although challenging to detect, the signs and symptoms of high-functioning depression are generally the same diagnostic symptoms of MDD and PDD, which include:

  • Feelings of sadness and low mood (or irritability in children)
  • Loss of interest or enjoyment in activities that once brought you pleasure
  • Feelings of hopelessness
  • Poor concentration/decision making
  • Lack of sleep or sleeping too much
  • Changes in appetite or excessive weight gain or loss
  • Loss of energy or fatigue
  • Feelings of worthlessness or intense guilt
  • Suicidality
  • Low self-esteem

Mental health professionals have observed these additional signs in many cases of high-functioning depression:

To cope with internal distress, people with high-functioning depression may also exhibit the following behaviors:

CAUSES AND CONTRIBUTING FACTORS OF HIGH-FUNCTIONING DEPRESSION

There’s no one cause of this form of depression, but rather an amalgam of many factors contributing to its development. It can be triggered by a life situation or develop spontaneously.

Common triggers include:

  • Death of a loved one
  • Loneliness
  • Major life changes
  • Financial problems
  • Extremely high levels of stress

There are a number of risk factors that increase the chances of developing this form of depression, including:

  • Genetics. If you have a parent or sibling with depression, it’s more likely you will develop it too.
  • Life circumstances. Your age, marital status, relationship changes, finances, and where your live can all figure into the development of depression.
  • Brain changes. Depressed brains work differently. Brain-imaging studies using SPECT scans at Amen Clinics show that overactivity in the limbic system is associated with low moods.
  • Substance abuse. Drug and/or alcohol abuse can significantly increase your risk of experiencing a major depressive episode.
  • Trauma. Experiencing trauma (emotional abuse, sexual abuse, or neglect) at an early age can cause long-term alterations in how your brain responds to fear and stress, which increases your risk of developing depression.
  • Medical conditions. Sleep problems, chronic pain, anxiety, attention-deficit hyperactivity disorder (ADHD), and other medical issues make it more likely that you will develop depression.

If you were raised with certain messages or if you have certain personality traits, they may predispose you to develop high-functioning depression. Some examples include:

  • You don’t feel comfortable showing vulnerability or perceived weakness.
  • You think that depression is something to be ashamed about.
  • You believe that your life will crumble to pieces and your friends will leave you if they find out you are depressed.
  • You come from a culture or family that does not talk about mental health.
  • You have the mistaken idea that if you can just power through, you’ll feel better and avoid any negative impact the depression may have on your job or relationships.

TREATMENT FOR HIGH-FUNCTIONING DEPRESSION

On a positive note, once depression is recognized in a high-functioning person, it can be addressed. Thankfully, depression is highly treatable.

Knowing which of the 7 types of depression you have is one of the keys to getting the most effective treatment.

Typically, a treatment plan includes a combination of strategies, such as:

  • Brain-healthy lifestyle habits, including regular exercise, stress reduction, healthy diet, nutritional supplements, social support, restful sleep, etc.
  • Cognitive behavioral therapy (CBT)
  • Antidepressant medication (if necessary)

The first step is getting a psychiatric evaluation from a qualified mental health professional.

High-functioning depression, depressive disorders, and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.

13 Comments »

  1. How can I schedule a brain scan?

    Comment by Deborah Colton — April 19, 2024 @ 12:55 PM

  2. The problem is it’s really hard to find a dr with any appt time.

    Comment by Jack. Botkin — April 19, 2024 @ 12:59 PM

  3. excellent post!

    Comment by Doug Morris — April 19, 2024 @ 2:49 PM

  4. Dr.Amen, this is a breath of a fresh air to read about the existence of high-performing depression .
    Thank you

    Comment by Diamante — April 19, 2024 @ 5:05 PM

  5. Very interesting, I m sitting here thinking about how this relates to me. Nice to know that there are things that I experience are most of my problems.

    Comment by Cynthia — April 19, 2024 @ 5:35 PM

  6. Impossible to be high functioning while depressed. We ignore any satisfactory

    Comment by Garth Miller — April 19, 2024 @ 7:19 PM

  7. Depression is a catchall phrase for doctors to use without dissecting the factors causing such enough. In my life and world, I choose to label it as frustration that goes up and down depending on health and life circumstances. When we don't have magic to make needed adjustments to feel happier, we opt to just manage as possible. Not everyone can have perfect lives and sometimes our lives don't even come close to being perfect. It took 64 years to find out about the genetic components that caused health problems. I am still dealing with MTHFR cellular damage internally despite looking healthy to any onlookers. I still have to be very cautious of my multiple chemical sensitivities that keeps me at home along with energy and mobility issues. It took until 2018 to get helpful genetic test results and still trying to apply solutions once I learned more. At the present time I wake up and have to check for clear brain or brain fog and deal with health and life situations. I am personally trying to make the best of various complicated situations. I donate to Operation Smile to feel more useful and give someone else the opportunity to smile as possible. I also am trying to get attention to the possible depletion of Social Security program to avoid less income and definitely avoid depression then. I can laugh sometimes but not consistently due to health and life circumstances. Such is life presently. EGN PS The health details are difficult for many regular doctors or people to understand at all.

    Comment by Elinor Nosker — April 19, 2024 @ 7:25 PM

  8. People that are high functioning are the ones that commonly commit suicide suddenly and catch those those around them completely off guard. Most recently the young female soccer player at Stanford, and a few years back Anthony Bourdain and Robin Williams.

    Comment by Nick — April 20, 2024 @ 7:31 AM

  9. This is me…finally, something that makes sense and explains the last 50 years of my life. Now to figure out next steps and find a therapist who gets it!

    Comment by myra dykes — April 21, 2024 @ 12:41 AM

  10. I've suffered with clinical depression my whole life!!? It has been life altering in the past!! But I still suffer from high functioning depression it's height or flight!! It's appearing normal or confused like you're always in you're own mind even though you still appear to have it all together if people ask are you ok??? You just say oh Iam a little distracted I must be tired??? Just so you can maintain ammoninity around others even though you feel sad or angry or disheartened!! Sometimes you just want yo escape be Free from it all but you can't run away from you're self!!? So you process or try to find answers for why you feel this way?? Or you try to achieve or over achieve get really busy an drown out the noise in you're head?? I used to suffer from agoraphobia OCD anxiety disorder really bad but theraphy medicine Lexapro 20 MG a day helps me tremendously to clear my head off distracting low mood thoughts!!! I have been in full time theraphy since 2020!! I've achieved much help processing why I feel this way??? But I grew up in a very dysphuntional home alcoholic Father Covert narssacist mother very destructive neglectful home 🏡 AN then I married a equally dysphuntional husband a Milignant Narssacist Phychopath Sociopath Stalker asshat that did further damage!!! But Iam out off that situationship now for almost 5yrs!! But still processing who I am what I want what I need!!? An it's hard because I was so Co-dependent an people pleaser that I was always taking the back seat!!! So to realize that I have needs that weren't getting met ever has been a journey an the guilt to say no or to not receive their critical thinking an attention like you can't assert yourself almost seems mean but it's not I am human an I have needs too!?? But it seems wrong??? So the journey for self identity goes on some bad days an some good!!! Iam 62 yrs young but sometimes I feel so old!!❤ Thank you for identifying high functioning depression!!!❤ Because alot off us go through this every day!!❤ I'd heard of high functioning adult an was irritated oh that's what Iam a high functioning mental case???? But I know the Truth!!❤ I've been neglected an abused an taken for granted for so long that now I need to find me!!❤ Thanks again Amen clinic's for the insight!!!❤

    Comment by Dawn McGill — April 21, 2024 @ 11:36 AM

  11. very helpful info for healthcare givers . esp. for those who work with aging, retirees who previously held supervisory positions at work. it doesn't hurt to read this and look in the mirror either.

    Comment by Ann — April 22, 2024 @ 7:00 AM

  12. Hello. You can schedule an appointment by calling 855-591-2590.

    Comment by Amen Clinics — April 22, 2024 @ 8:22 AM

  13. Hello! Amen Clinics has appointments available at all 11 locations. You can schedule an appointment with our care center representatives by calling 855-591-2590.

    Comment by Amen Clinics — April 22, 2024 @ 8:23 AM

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