Content reviewed and updated: 01/27/21
What Is High-Functioning Depression?
Clinicians and neurological researchers do not formally recognize high-functioning depression as a condition. Instead, “high-functioning depression” is a term popularized by the general public. The use of this term may have stemmed from social stigma surrounding depression and mental illness in general. Still, many clinicians disapprove of the use of this term because it can lessen the seriousness of depression as a condition.
In actuality, what is known as high-functioning depression is likely to be diagnosed as persistent depressive disorder (PDD), which is estimated to affect about 12% of people worldwide. Read on to learn more about high-functioning depression, how it is typically evaluated, and what treatment might look like.
Do I have high-functioning depression?
Picture this. You have a stable career, plenty of ambitions and aspirations, and a fairly large social circle. You also have a supportive partner who is always there for you. But, at the end of the day, you feel a lingering, persistent sadness.
Consider an alternate scenario. You are an entrepreneur, and to the outside world, it looks like you are crushing all of your metrics and goals each day. However, you consistently come home late from work. Your home is empty, and you feel a general sense of hopelessness or exhaustion most days. You might not know how to explain your feelings, or why you are feeling this way in the first place.
If you function well in both work and social settings but something still feels off, then it is possible that you have depression that is simply going unnoticed or unaddressed. It is not unusual for someone to overlook mild symptoms of depression for months or years. If this sounds like you, then it might surprise you that your symptoms can easily be diagnosed and treated.
Is high-functioning depression real?
High-functioning depression is not included as a clinical condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is a well-regarded reference that classifies mental health conditions. A person may function just fine throughout the day despite experiencing depressive symptoms, so some people call this type of depression functional depression or high-functioning depression. Most mental health clinicians, however, consider it a form of major depressive disorder (MDD), or PDD, formerly known as dysthymia or chronic major depression.
Specific symptoms and how long they last differentiate PDD from other forms of depression. For instance, a person with PDD may be able to function throughout the day while maintaining their work and social relationships, but they may also experience frequent bouts of low self-esteem and persistent feelings of sadness or emptiness. Such feelings may have clouded their outlook on life for years.
In contrast, someone with MDD may experience depressive episodes for weeks or months at a time. Someone with recurrent MDD may be depression-free for no more than 2 months before experiencing another depressive episode. In addition, the symptoms of MDD tend to be more severe than those of PDD. During MDD episodes, someone may feel completely worthless, sad, and even suicidal.
There are other differences between PDD and MDD, as defined by the DSM-5, and of these conditions, PDD is the one more commonly associated with high-functioning depression.
Symptoms of high-functioning depression
Clinicians are likely to identify symptoms of high-functioning depression as symptoms of PDD. Individuals with PDD are likely to experience irritability or low-grade, or mild, depression throughout the day. In addition, someone with PDD is likely to exhibit at least 2 of the following additional symptoms:
- Trouble sleeping or oversleeping
- Lack of appetite or overeating
- Low self-esteem
- Feelings of hopelessness or guilt
- Difficulty making decisions or staying focused
- Persistent fatigue
According to the DSM-5, adults with PDD have symptoms that have lasted for at least 2 years.
In some cases, symptoms of MDD may be identified in someone experiencing high-functioning depression. These include:
- Dietary changes, such as overeating or not eating enough
- Trouble sleeping or sleeping too much
- Feelings of hopelessness or guilt
- Fatigue or restlessness
- Recurring thoughts of death
- Little or no interest in activities that are normally enjoyed
While the symptoms of PDD and MDD are nearly identical, feelings of low self-esteem are often seen with PDD, and frequent suicidal thoughts are often seen with MDD.
Diagnosing high-functioning depression
Many people with high-functioning depression believe that nothing is really wrong, so they often go untreated. When someone experiences mild symptoms on a regular basis, it can begin to feel normal, making it hard for them to recognize that they might have depression.
A complete diagnosis is based on the presence of certain symptoms and how these symptoms affect a person’s ability to function in major areas of life. For example, a person with high-functioning depression may have less fun with activities they previously enjoyed, participate in fewer hobbies, feel less engaged with family, or do slightly less work during the week.
To make a diagnosis, providers will likely conduct a clinical interview and ask questions like:
- Have you been consistently depressed or down almost every day for the past 2 weeks?
- Have your feelings of depression been ongoing for long periods of time?
- How does feeling depressed or down affect your daily life and habits?
- What are your energy levels like lately?
- Have you been able to concentrate during work or school recently?
- Has your appetite increased, decreased, or stayed the same?
- How well have you been sleeping?
Depending on the symptoms experienced, an individual could be diagnosed with PDD, MDD, or premenstrual dysphoric disorder (PMDD). Those who have been functioning with depressive symptoms for more than 2 years, however, are often diagnosed with PDD.
Risk factors for high-functioning depression
Certain factors may increase someone’s risk of developing depression, including:
- A history of mental illness
- High levels of anxiety
- A diagnosis of ADHD
- Traumatic experiences
- Stressful life events
- Previous substance abuse
- A history of low self-esteem
- Poor psychological health
In addition, some physical illnesses may be associated with an increased risk of developing depression, such as:
- Autoimmune diseases, like lupus or multiple sclerosis
- Chronic pain
Treating high-functioning depression
While depression is very treatable, there are no distinct treatment options for high-functioning depression since it is not a formally recognized clinical disorder. However, those seeking treatment for high-functioning depression are often treated with the same therapy and medication options used to treat different types of depression.
Psychotherapy vs. medication
Depression is usually treated with a combination of psychotherapy and antidepressant medications.
Psychotherapy may include cognitive behavioral therapy or other strategies to identify and resolve certain thought patterns that tend to develop when someone has depression. Different methods of psychotherapy can be effective for adults with mild to moderate depression.
Antidepressant therapy often involves using a selective serotonin reuptake inhibitor (SSRI) as the first-line treatment. Other antidepressants, such as tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors (SNRIs) may also be used.
Treatments for depressive symptoms work differently for different people. For this reason, mental health providers thoroughly evaluate how medications are likely to work for each particular individual and the potential side effects they might experience. Treatments are tailored to a person’s unique condition. And if one treatment option ends up not working, a patient and their provider can decide to switch treatments in order to find the most suitable option.
Seeking help for high-functioning depression
While high-functioning depression is an unofficial term, there is no doubt that it is a legitimate concern for many people. The term “high-functioning depression” often resonates with career-driven individuals and professionals who feel that there is a stigma surrounding a diagnosis of depression.
Some people might think that their friends and family will not understand what they are feeling. After all, in every practical sense, they can still function throughout the day! But all depressive feelings are valid, and treatment may be just a click or phone call away.
If you experience symptoms of depression at any time, know that you are not alone. Consider speaking to a specialist. You do not have to feel ashamed for getting professional clarifications about how you are feeling, especially if how you are feeling is affecting your daily life. A mental health provider can help guide you through your depression with effective treatment options.
Mental health providers like the ones at Ahead are experts in personalized treatment options for those who are feeling depressed. During your consultation with an Ahead provider, you will be able to express your concerns in an open, judgement-free space and get the treatment you need.
*** If you or someone you know is currently experiencing suicidal ideation, please call 1-800-273-8255 or visit SuicidePreventionLifeline.org.