What Is High-Functioning Depression?

When you imagine a person with depression, you might picture someone who has difficulty keeping a job, has withdrawn from their friends and family, or has difficulty maintaining their hygiene. But this is a mistaken view of what depression looks like.

People with depression come in all shapes and sizes. Many of them function very well in everyday life. If you lead a successful life by day, only to come home and feel empty, sad, or numb every evening, then you could be living with high-functioning depression.

In this article, we’ll go over what high-functioning depression is as well as what to do if you think you have it.

What does high-functioning depression mean, and is it a real diagnosis?

The term “high-functioning depression” usually refers to when people with depression are able to cope with their symptoms enough to function in everyday life.

For example, someone with depression could call in sick from work so often that they lose their job. They could become hospitalized after a suicide attempt or even die by suicide. Another person who also has depression could experience symptoms, but continue to go to work. They may hide their symptoms from the people around them in order to maintain relationships.

This second person could be said to have high-functioning depression. They function at a generally higher level than other people with depression.

“High-functioning” can be used to describe any person with a health condition who functions at a higher level than other people with the same condition. For example, someone could have high-functioning autism, or high-functioning substance use disorder.

High-functioning depression is a colloquial term, and is not used by medical professionals. It also isn’t included as an official diagnosis in the Diagnostic Statistical Manual. Someone who has high-functioning depression would likely be diagnosed with a depressive disorder like:

• Major depressive disorder
• Persistent depressive disorder
• Seasonal affective disorder

The catch is that to meet the diagnostic criteria for a diagnosis of depression, your symptoms must negatively impact your functioning in at least one area: work, home, or social life. But even if you’re “high-functioning”, it doesn’t mean your daily life isn’t affected at all.

For example, you could hide your symptoms, but have a hard time getting truly close to people in your relationships. You may not attempt suicide, but suicidal thoughts and feelings could make it hard to get out of bed in the morning.

These are all things that mental health professionals consider when completing a diagnostic assessment.

But whether or not you fully meet the official criteria for depression may not be the most important thing. If you have symptoms of depression, then you deserve support no matter how well you function.

Are high-functioning depression and persistent depressive disorder the same thing?

Sometimes, when people talk about high-functioning depression, they could be referring to a mental health condition called persistent depressive disorder. ^[1] Persistent depressive disorder is a relatively new diagnosis that combines the previous diagnoses of dysthymic disorder and chronic depression.

The symptoms of persistent depressive disorder are similar to those of major depressive disorder. One difference is that symptoms of depression often aren’t as acute for people with persistent depressive disorder. However, they last longer, and often stick around for years.

Because symptoms of persistent depressive disorder are often less severe and debilitating, it could be easier for someone with this condition to continue functioning in their everyday life. For example, they could be able to maintain their job for years while living with persistent depressive disorder. This is an example of high-functioning depression.

But keep in mind, there’s no clinical agreement about what “high-functioning depression” is. This means that some people who have high-functioning depression could have persistent depressive disorder, while others could meet the criteria for major depressive disorder or another condition entirely.

High-functioning depression is not a clinical term and is not used in diagnosis, while persistent depressive disorder is.

What does high-functioning depression feel like?

People with high-functioning depression feel depressed, just the same as their lower-functioning peers. The symptoms of depression include:

• A sad or empty mood that doesn’t go away
• Feelings of hopelessness
• Feelings of guilt or worthlessness
• Low energy or fatigue
• Difficulty concentrating
• Sleep troubles
• Aches or pains that can’t be explained by a physical illness
• Changes in eating habits that could lead to weight loss or gain
• Recurrent thoughts of death or suicide

On top of these symptoms, people with high-functioning depression often feel the pressure of having to cope with life’s daily challenges.

People with high-functioning depression typically:

• Maintain employment
• Get good grades at school
• Maintain housing
• Have good hygiene
• Keep close relationships
• Avoid hospitalization

However, underneath their outward success, they may be struggling with depression symptoms. Their depression might feel like a secret they need to keep from those around them. They may have family and other responsibilities that feel like they take precedence over addressing their depression symptoms.

People with high-functioning depression could also struggle with perfectionism.

In our experience, people with high-functioning depression often say things like:

• “At the end of the day, I feel so profoundly sad. Sometimes I think about ending my life.”
• “Everyone thinks I’m okay, but I self-harm in secret.”
• “Nobody would love me if they knew I was depressed.”
• “I don’t have time for treatment. I need to go to work.”
• “I’m fine. There are other people who have it so much worse.”
• “Even though I have friends, I feel lonely all the time.”
• “It’s hard to want to live another day, but what choice do I have?”
• “When I’m out in the world, I feel like I’m on auto-pilot. The real me is totally numb.”

If you recognize yourself in these statements, then it may be time to seek needed support for depression.

Risks of high-functioning depression

On the surface, it could seem like it’s preferable to have high-functioning depression. But all types of depression are painful, and there’s no one type that’s “better” to have than another.

Additionally, there could be some unique challenges that come along with depression if you’re high-functioning.

Being undiagnosed

Many people with high-functioning depression could be undiagnosed. They could be too busy, or too ashamed, to seek out an assessment and diagnosis for their mental health concerns. This is a major issue because high-functioning depression requires treatment, just like any other type of depression. A depression diagnosis can help healthcare providers understand what’s going on and provide the right treatment.

Not seeking support

In a similar vein, people with high-functioning depression could be reluctant to seek treatment for their mental health concerns. This could include both professional mental health support as well as support from their friends and family. Since people with high-functioning depression often don’t look like what we imagine “depression” to look like, loved ones could also be less likely to notice something is wrong.

We often hear about successful people in the media dying by suicide due to depression. This could be because they lived with high-functioning depression, but no one realized they needed help.

Feeling misunderstood

People with high-functioning depression could also be misunderstood by the people around them when their depression symptoms inevitably show up in their lives. For example, their colleagues may label them as “lazy” when they’re unable to come to work, even if this is a result of their depression. This could lead people with high-functioning depression to feel even more ashamed or be more likely to blame themselves.

Signs of high-functioning depression in children and adults

Children and adolescents can live with high-functioning depression, too. This can be worrying for parents, especially if your child refuses to talk about what’s going on. Parents may also miss the signs of high-functioning depression because they may not look like what they expect.

A child or adolescent with high-functioning depression could:

• Become more withdrawn
• Continue to get good grades but express no interest in school
• Be too eager to please those around them
• Make negative comments about themselves
• Have perfectionistic tendencies and be overly hard on themselves
• Appear to be fatigued all the time
• Tell you that they feel empty or numb
• Be more irritable than usual
• Have friends, but express to you that they feel lonely

Treatment for high-functioning depression

Even if you’ve been able to function with depression thus far, that doesn’t mean you don’t need treatment. All types of depression are serious mood disorders. Even high-functioning depression isn’t likely to go away without treatment. In fact, it may become worse over time.

The main types of treatment for depression are psychotherapy and medication. But holistic lifestyle changes, like physical exercise, a healthy diet, and mindfulness practice, can be very effective as well.

If you have high-functioning depression, you could feel like you don’t deserve treatment. You might feel like other people with depression have it worse, or that you’ve been living with these feelings for so long you’re used to it.

Our team is here to tell you that you deserve support as much as anyone else. Just because you’re used to something doesn’t mean you need to live with it forever. Mental health treatment can help you start thriving, instead of merely surviving every day with high-functioning depression.

At The Center • A Place of HOPE, we use a unique Whole Person Care approach to help you recover from depression and start truly living your life.

Are you ready to make a commitment to your healing? Get in touch with us to learn more about our admissions process.

[1] https://www.nimh.nih.gov/health/statistics/persistent-depressive-disorder-dysthymic-disorder