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High Functioning Depression, Signs, Symptoms, & Treatment

High functioning depression is something that affects a wide range of people, but it is also something that is often pushed beneath the rug. Continue to read to learn more about high functioning depression.

By We Level Up FL Treatment Center | Editor Yamilla Francese | Clinically Reviewed By Lauren Barry, LMFT, MCAP, QS, Director of Quality Assurance | Editorial Policy | Research Policy | Last Updated: January 6, 2022

What is High Functioning Depression?

Is high functioning depression real? If I were to ask you to picture and describe a depressed person, what would you envision? Someone having trouble getting out of bed every day? Someone who can’t stop crying and who’s feeling hopeless? Or would you envision a popular, college-educated professional living it up in the big city with a great job?

According to The Mighty, high-functioning depression doesn’t look like the stereotype of depression most of us hold in our heads, this diagnosis nevertheless carries significant risks if left untreated. [1] But the uniquely tricky thing about high functioning depression is that it’s hard to spot precisely compared with severe clinical depression because the people dealing with it look, from the outside, like they’re holding it all together.

This can lead to a lack of ability to self-identify (or have those around you identify you) as depressed and, moreover, a possible resistance to seeking mental health treatment because of the stigma surrounding more “typical” depression. And this is a big problem.

5 Signs of High Functioning Depression

It can be difficult to describe depression to a person who has never struggled with this mental health disorder. Depression is a condition that is only really understood by those who have experienced it themselves.

People have different ways of coping with their depression. Some may use alcohol or drugs to self-medicate, some may turn to food and some may withdraw or isolate. Some people, however, have what is called “high-functioning” depression. This is a less severe form of depression that is easier to hide from others.

Do I have high functioning depression? Someone struggling with high functioning depressive disorder still experiences many of the classic signs of clinical depression. However, this form of persistent depression has some unique features, including:

  1. The symptoms of depression are less intense than major depressive disorders, therefore seeming more manageable.
  2. The individual is able to perform at work and maintain normal, healthy relationships, despite mild depression.
  3. In an effort to hide their true emotions from loved ones, they may struggle with chronic somatic symptoms, such as headaches and stomach distress.
  4. The person may self-medicate with a substance.
  5. Even though the individual is able to complete daily tasks, everything they tackle takes a tremendous effort.

Any form of depression, including high functioning anxiety and depression, is difficult to live with. A treatment regimen involving a combination of antidepressants and psychotherapy, as well as regular exercise and practicing mindfulness, may offer some relief.

High Functioning Depression Causes

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 grief, substance abuse issues, trauma, relationship issues, and major life transitions are just a few reasons someone might grow depressed.

There are several reasons why someone may develop functional depression. An individual with functional depression can often have mild enough symptoms that they’re able to continue functioning. Or they could be a perfectionist who is afraid to show that they’re struggling. [2]

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Depression Statistics

Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when recurrent and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school, and in the family. At its worst, depression can lead to suicide. Over 700 000 people die due to suicide every year. Suicide is the fourth leading cause of death in 15-29-year-olds.


3.8%

Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years.

Source: WHO

280 million

Approximately 280 million people in the world have depression.

Source: WHO

6.7%

More than 6.7% of all Americans will experience at least one major depressive episode a year. But chronic high-functioning depression only accounts for about 1.5% of the American population.

Source: NIMH


Depression Facts

DSM-5 Definition

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest.The American Psychiatric Association’s Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies the depressive disorders into:

Disruptive mood dysregulation disorder

Major depressive disorder

Persistent depressive disorder (dysthymia)

Premenstrual dysphoric disorder

Depressive disorder due to another medical condition

The common features of all the depressive disorders are sadness, emptiness, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function.

Because of false perceptions, nearly 60% of people with depression do not seek medical help. Many feel that the stigma of a mental health disorder is not acceptable in society and may hinder both personal and professional life. There is good evidence indicating that most antidepressants do work but the individual response to treatment may vary.

Etiology

The etiology of major depressive disorder is multifactorial with both genetic and environmental factors playing a role. First-degree relatives of depressed individuals are about 3 times as likely to develop depression as the general population; however, depression can occur in people without family histories of depression.

Epidemiology

Twelve-month prevalence of major depressive disorder is approximately 7%, with marked differences by age group.  The prevalence in 18- to 29-year-old individuals is threefold higher than the prevalence in individuals aged 60 years or older. Females experience 1.5- to 3-fold higher rates than males beginning in early adolescence.  In the US, depression affects nearly 17 million adults but these numbers are gross underestimates as many have not even come to medical attention.

Pathophysiology

The underlying pathophysiology of major depressive disorder has not been clearly defined. Current evidence points to a complex interaction between neurotransmitter availability and receptor regulation and sensitivity underlying the affective symptoms.

Clinical and preclinical trials suggest a disturbance in central nervous system serotonin (5-HT) activity as an important factor. Other neurotransmitters implicated include norepinephrine (NE), dopamine (DA), glutamate, and brain-derived neurotrophic factor (BDNF).

High Functioning Depression Symptoms

1. Difficulty experiencing joy.

What is high-functioning depression? With high-functioning depression, the things that used to bring you pleasure — whether this is a cherished yoga class or a monthly ritual of getting together with your girlfriends — these same things don’t bring you joy anymore. They may feel like burdens or events you want to avoid because it feels like more of an effort than support.

Most people function almost normally but struggle internally. Treatment is possible for high functioning depression through medications and therapy.
Most people function almost normally but struggle internally. Treatment is possible for high functioning depression through medications and therapy.

2. Relentless criticality — of self and others.

What does high functioning depression look like? You may have a relentless and invasive internal narrative that’s critical of yourself, of others, and of the world in general. You think you’re a failure, you think your boss is an idiot, your partner’s the most irritating person to have ever lived, and life’s just one big slog. This chronically negative thought pattern may feel like something you just can’t turn off.

3. Constant self-doubt. 

You may constantly doubt whether or not you’re on the right career path, whether you’re in the right relationship, doubt what you’re doing with your life and if you can even handle being an adult. This pattern of constant self-doubt may be situational or pervasive but it’s something that feels like you just can’t get over.

4. Diminished energy. 

If it feels like getting through each day is like walking up a mountain with a backpack of rocks, if you feel like you barely have the mental, emotional and physical energy to handle your life anymore, if your overall energy levels are greatly diminished, this could be a sign of high functioning depression.

5. Irritability or excessive anger.

 If you find yourself blowing up over small things — your partner says something wrong, your co-worker messed up a project, your kid just broke your favorite coffee mug, if you find yourself exploding in a way that feels disproportionate to the event, if irritability and excessive anger are something you’re wrestling with, this may be high functioning depression meaning.

6. Small things feel like huge things.

Similarly, if you find yourself feeling overwhelmed or greatly stressed by an event that happens that maybe wouldn’t have felt like such a huge deal in the past (a friend cancels weekend plans, the grocery bags break when you’re carrying them in, your darn trackpad stops working because you spilled some coffee on it) and it feels like the End Of The World instead of the annoyance that it is — if you find your stress responses disproportionate to the event itself, this may well be a sign of high functioning depression and anxiety.

7. Feelings of guilt and worry over the past and the future.

You worry that you chose the wrong career in college, you question whether you’re in the right grad school program, you worry about paying off all those student loans, you worry your biological clock is running out, you worry that you married the wrong partner, you worry about who’s going to care for your folks when they get older, etc. We all have these worries from time to time, but if feelings of guilt and worry over your past and future feel pervasive and dominant, this may be more than “normal” worry.

8. Relying on your coping strategies more and more.

If you find yourself needing extensive zone-out time after work and on the weekends, turning towards your coping mechanisms more often than not — such as substances or behaviors like using alcohol, substance abuse or using drugs, excessive gaming, constant Netflix, etc. — all in an effort to escape your life, this could speak to underlying depression.

9. Generalized sadness.

If you find yourself feeling a generalized sense of sadness you can’t seem to pinpoint the cause of, if you drop your mask and armors of smiling competency when you close your door behind you, if you feel a subtle sense of hopelessness, this could speak to high functioning depression definition.

10. Seeking perfection.

This one’s a tough one. In a way our society condones perfectionism — getting good grades, getting into the Ivies, landing that amazing tech job, striving, striving, striving. But perfectionism has a shadow side where striving turns into unrealistic demands of yourself and psychologically beats yourself up when you fall short of the bar you set for yourself. If you find yourself doing this and it’s causing you distress, be curious about whether this is a sign of high functional depression.

11. Inability to rest and slow down. 

If you need to clean up, tidy, and organize the house after you arrive home from an exhausting day of work before you even consider letting yourself rest, if you find yourself uncomfortable with slowness, stillness, and fallow periods of time because of the uncomfortable thoughts and feelings you come into contact with when you do actually slow down, this could be a sign of highly functioning depression.

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7 Tips for Managing High-Functioning Depression

Changes in lifestyle are very often helpful for people who are coping with any form of depressed mood. These lifestyle changes may include changes in diet, sleep routine, exercise, use of substances, and involvement with a social support network.

Since it is common for individuals with depression to have difficulty initiating new behaviors, a recommended first step is to seek the help of a mental health professional who will be supportive and help you make the changes that will be the most beneficial.

Here are seven lifestyle changes that have been shown to lessen depressive symptoms for most individuals:

  1. Contact a psychotherapist and schedule an initial meeting for a high functioning depression test as soon as possible.
  2. Add exercise of any kind (under physician’s advice) to your daily routine. Physical activity has been strongly linked to improved mental health and mood for all ages. This is particularly true for persons with chronic mild depression such as PDD, and for depression related to chronic anxiety.
  3. Set daily goals, preferably simple ones that are easily reached, in order to boost self-confidence and a sense of accomplishment.
  4. Begin to make improvements in diet which coincide with more energy, less sluggishness, and improved focus.
  5. Establish a routine for sleep and waking.
  6. Limit or omit the use of alcohol and other drugs depending on personal health risks. Seek support for recovery from substance abuse if needed.
  7. Reach out to family, friends, or members of the local and online community for emotional support.

How to help someone if you think they are hiding depression 

It can be hard to know how to help someone who seems to be dealing with depression. Here are some options to consider:

  • You can ask questions that show you care and open an opportunity to talk.
  • Listen without judging or giving too much advice.
  • Avoid clichés and cheery pep talks, which might not be helpful.
  • Offer to take walks together.
  • Make arrangements for low-pressure social activities, considering the other person’s interests.

Hidden depression is treatable. When people get help, symptoms often get better, although it can take some time for the effects to be noticeable. The most common and effective depression treatments are medications, psychotherapy, or a combination of the two.

In cases where therapy and medication haven’t fully relieved severe symptoms, brain-stimulating treatments may be an additional option.

It’s also possible to improve some depression symptoms with exercise, improvements to sleep, and a diet that limits sugary, processed foods (such as the Mediterranean diet).

Being cautious about disclosing a health condition is a matter of personal judgment and choice. Not every family member, friend, or workplace is safe and supportive, so protecting private health information can be a wise decision for some people depending on their situation. [3]

This type of depression can be difficult to detect in oneself, but especially in others. Contact us to get help.
This type of depression can be difficult to detect in oneself, but especially in others. Contact us to get help.

Untreated depression increases the risk of suicide. Researchers at the National Institutes of Mental Health point out that untreated depression can also raise your risk of developing illnesses, including:

  • Cardiovascular disease
  • Diabetes
  • Stroke
  • Osteoporosis
  • Alzheimer’s disease

Many people find that psychotherapy and changes to their diet, exercise, thinking patterns, and sleep habits are effective treatments, especially if symptoms are mild or moderate.

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Depression Treatment

Medication alone and brief psychotherapy (cognitive-behavioral therapy, interpersonal therapy) alone can relieve depressive symptoms. Combination therapy has also been associated with significantly higher rates of improvement in depressive symptoms; increased quality of life; and better treatment compliance. There is also empirical support for the ability of CBT to prevent relapse. Electroconvulsive therapy is useful for patients who are not responding well to medications or are suicidal.

Medications

  1. Selective serotonin reuptake inhibitors (SSRIs)
  2. Serotonin/norepinephrine reuptake inhibitors (SNRIs)     
  3. Atypical antidepressants
  4. Serotonin-Dopamine Activity Modulators (SDAMs)     
  5. Tricyclic antidepressants (TCAs)
  6. Monoamine oxidase inhibitors (MAOIs)  
  7. Selective serotonin reuptake inhibitors (SSRIs): SSRIs have the advantage of the ease of dosing and low toxicity in overdose. They are also the first-line medications for late-onset depression.
  8. SSRIs include Citalopram, escitalopram, fluoxetine,  fluvoxamine, paroxetine, sertraline, vilazodone, and vortioxetine.
  9. Serotonin/norepinephrine reuptake inhibitors (SNRIs): SNRIs, which include venlafaxine, desvenlafaxine, duloxetine, and levomilnacipran can be used as first-line agents, particularly in patients with significant fatigue or pain syndromes associated with the episode of depression. SNRIs also have an important role as second-line agents in patients who have not responded to SSRIs. 
  10. Atypical antidepressants: Atypical antidepressants include bupropion, mirtazapine, nefazodone, and trazodone. They have all been found to be effective in monotherapy in major depressive disorder and may be used in combination therapy for more difficult to treat depression.
  11. Serotonin-Dopamine Activity Modulators (SDAMs): SDAMs include brexpiprazole and aripiprazole. SDAMs act as a partial agonist at 5-HT1A and dopamine D2 receptors at similar potency, and as an antagonist at 5-HT2A and noradrenaline, alp Brexpiprazole is indicated as adjunctive therapy for major depressive disorder (MDD).
  12. Tricyclic antidepressants (TCAS): TCAs include the following: Amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, trimipramine. TCAs have a long record of efficacy in the treatment of depression. They are used less commonly because of their side-effect profile and their considerable toxicity in overdose.
  13. Monoamine oxidase inhibitors (MAOIs): MAOIs include isocarboxazid, phenelzine, selegiline, and tranylcypromine. These agents are widely effective in a broad range of affective and anxiety disorders. Because of the risk of hypertensive crisis, patients on these medications must follow a low-tyramine diet. Other adverse effects can include insomnia, anxiety, orthostasis, weight gain, and sexual dysfunction.

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Psychotherapy

Cognitive Behavior Therapy and Interpersonal Therapy are evidence-based psychotherapies that have been found to be effective in the treatment of depression.

Cognitive-Behavioral Therapy (CBT)

CBT is a structured, and didactic form of therapy that focuses on helping individuals identify and modify maladaptive thinking and behavior patterns (16 to 20 sessions). It is based on the premise that patients who are depressed exhibit the “cognitive triad” of depression, which includes a negative view of themselves, the world, and the future. Patients with depression also exhibit cognitive distortions that help to maintain their negative beliefs. CBT for depression typically includes behavioral strategies (i.e., activity scheduling), as well as cognitive restructuring to change negative automatic thoughts and address maladaptive schemas.

There is evidence supporting the use of CBT with individuals of all ages. It is also considered to be efficacious for the prevention of relapse. It is particularly valuable for elderly patients, who may be more prone to problems or side effects with medications.  

Mindfulness-based cognitive therapy (MBCT) was designed to reduce relapse among individuals who have been successfully treated for an episode of recurrent major depressive disorder. The primary treatment component is mindfulness training. MBCT specifically focuses on ruminative thought processes as being a risk factor for relapse. Research indicates that MBCT is effective in reducing the risk of relapse in patients with recurrent depression, especially in those with the most severe residual symptoms. Interpersonal therapy (IPT)

Interpersonal Therapy (IPT)

Interpersonal therapy (IPT) is a time-limited (typically 16 sessions) treatment for major depressive disorder. IPT draws from attachment theory and emphasizes the role of interpersonal relationships, focusing on current interpersonal difficulties. Specific areas of emphasis include grief, interpersonal disputes, role transitions, and interpersonal deficits.

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High functioning depression is a real thing, and it can have serious consequences if not addressed and treated.
High functioning depression is a real thing, and it can have serious consequences if not addressed and treated.

High Functioning Depression Treatment

While there is no single reason why someone develops high function depression and while there is not necessarily a way to prevent it, there are several evidence-based effective treatment modalities to help you manage and support yourself if you deal with it: Psychotherapy and/or medication. [4]

It’s important to recognize the symptoms of depression and get treatment so things don’t get worse. Untreated depression can lead to other health problems over time.

If you or someone you know is working hard to camouflage high functioning depression symptoms, know that good help is available. With treatment, depression can be managed, and a better quality of life can be restored.

Call today to speak with one of our treatment specialists.

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