Can You Have 'High-Functioning' Depression?

Depression is a mental health condition that affects one in six people at some point during their lifetime. It can take many different shapes and forms, and affect people in different ways.

High-functioning depression or functional depression is a lay term that is sometimes used to describe experiencing symptoms of a depressive disorder, but to outside appearances, you look fine, says Aimee Daramus, PsyD, a licensed clinical psychologist.

'High-functioning' depression is not a term used in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR), the tool that clinicians use to diagnose mental health conditions. Instead, it is a colloquial term that has gained popularity in recent years to describe hidden symptoms of depression that often go unnoticed by others and don't appear to impair day-to-day functioning.

While it isn't a specifically-recognized condition, in some cases it may represent an actual clinical diagnosis of depression. You may seem fine because you can go about your day and be productive. Other people may not even realize that you are experiencing depression unless you tell them, says Dr. Daramus. However, you may not be alright.

About the Term 'High-Functioning Depression'

Despite the growing use of the term "high-functioning depression," some experts suggest that its use can be problematic or even harmful.

While the use of the term demonstrates how depression can often be an invisible illness, causing distressing symptoms without being outwardly visible, its use may also play a part in perpetuating stigma about mental illness. It may cause some people to feel that they should be able to function at a high level even while struggling with serious symptoms of depression.

It's also important to emphasize that describing it as 'high-functioning' often makes it seems like the symptoms are less serious or less severe. This might increase the likelihood that people will dismiss their symptoms, feel like others won't take them seriously, or fail to seek treatment.

Symptoms of 'High-Functioning' Depression

Depression can cause emotional and physical symptoms, which can include:

• Having a persistent feeling of sadness or emptiness
• Feeling hopeless or pessimistic
• Feeling guilty or worthless
• Feeling irritable or anxious
• Losing interest in everything
• Withdrawing from others around you
• Feeling tired and fatigued
• Talking or moving slowly
• Having trouble focusing, remembering, or making decisions
• Experiencing sleep changes and difficulties
• Experiencing changes in appetite and weight
• Thinking about death, self-harm, or suicide
• Experiencing physical symptoms such as headaches, cramps, aches and pains, and digestive issues that don’t have a clear cause and don’t get better with treatment

Someone who lives with you may notice the fatigue, irritability, isolation, sadness, and other signs of depression, says Dr. Daramus. “A lot of the time, though, people can’t really tell unless you choose to be open about it.”

Causes of 'High-Functioning' Depression

Depression is usually caused by a combination of several factors, such as:

• Brain chemistry: Imbalances of certain neurotransmitters (brain chemicals) that regulate mood, among other things, can lead to depression.
• Genetics: Depression often has a genetic contribution and can run in families, so having a relative with depression can make you more likely to develop depression.
• Life events: Upsetting or stressful life events, such as the end of a relationship, the loss of a job, or the death of a loved one can trigger depression.
• Trauma: Experiencing trauma or stressful conditions can contribute to the development of mental health conditions such as depression, anxiety, and post-traumatic stress disorder.
• Medical conditions: If you have a health condition such as heart disease, diabetes, cancer, Parkinson’s disease, or chronic pain, you may be more likely to develop depression simultaneously. It’s important to report the symptoms of depression to your healthcare provider and seek treatment for it, as depression can worsen other health conditions.
• Medication: Certain medications may also cause depression as a side effect.
• Substances: Alcohol and recreational drugs can also cause or exacerbate depression.
• Personality: Certain personality traits may make you more prone to experiencing depression.

Diagnosing 'High-Functioning' Depression

It’s important to note that 'high-functioning' depression isn’t an official diagnosis in itself, says Dr. Daramus. It is sometimes used to describe dysthymia, but it can happen with any type of depressive disorder.

According to Dr. Daramus, there are several types of depressive disorders and specifiers, including:

• Major depressive disorder (MDD): Also known as clinical depression, major depressive disorder is a form of significant depression that persists for over two weeks. 
• Persistent depressive disorder (PDD): Also known as dysthymia, persistent depressive disorder persists for over two years, with periods of more and less severe symptoms.
• Seasonal affective disorder (SAD): Formerly known as major depressive disorder with seasonal pattern. This is a form of depression people often experience in winter, when there is less sunlight. Seasonal affective disorder tends to recede in summer and reappear in winter.
• Perinatal depression: Known as major depressive disorder with peripartum onset in the DSM-5. This is a form of depression that some pregnant people may experience. It encompasses antepartum depression (depression during pregnancy) and postpartum depression (depression after pregnancy).
• Premenstrual dysphoric disorder (PMDD): PMDD is a more severe form of premenstrual disorder (PMS) with prominent mood symptoms, that people typically experience in the days leading up to their menstrual period.
• Bipolar depression: People who have bipolar disorder may alternate between periods of elevated moods and high-energy, known as mania, and periods of significant depression. 
• Psychotic depression: People who have psychotic depression (known as major depressive disorder with psychotic features) also experience symptoms of psychosis, such as hallucinations (seeing or hearing things that are not real) and delusions (believing things that are not true).

A mental healthcare provider can determine whether your symptoms meet the diagnostic criteria for these depressive and other psychiatric disorders listed in the "Diagnostic and Statistical Manual of Mental Disorders," a guide published by the American Psychiatric Association.

If you have symptoms of these depressive disorders, you may still be functioning on some level as though everything’s fine, but it may not be. If you are able to hide it or still do very well in life, that might be considered 'high-functioning' depression, says Dr. Daramus.

Hiding the Fact That You Have Depression

According to Dr. Daramus, these are some reasons why you may feel like you have to hide your depressive symptoms from others:

• You might have come from a family or culture that teaches people not to talk about mental illness.
• You think you’ll feel better by powering through on your own.
• You’re trying to avoid any impact on your job and relationships hoping the depression lifts.
• You are someone who isn’t comfortable showing vulnerability or perceived weakness. 
• You think having depression is something to be ashamed of.
• You feel that your life will fall apart and people will abandon you if they find out about the depression.

Treating 'High-Functioning' Depression

While a person who has depression may be described as 'high functioning,' this does not mean that they do not need treatment. Treatments for depression can include:

• Therapy: Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and mindfulness techniques can help you work on the shame or fear of having depression, in addition to the depression itself. Therapy can help you take a step back from the urge to hide the depression from everyone. A therapist would work with you within the boundaries of your work life, family, cultural background, or other factors that are influencing you to hide your depression.
• Medication: Antidepressant medication will likely be prescribed for moderate to severe depression. These medications work by improving the balance of neurotransmitters in the brain. There are many different types of antidepressants, so it may take some time for you to find the one that works best for you.
• Support groups: Support groups can be helpful in providing a safe space for you to discuss your depression with people who have similar experiences if you’re not comfortable talking to others in your life about it.

Final Thoughts

People can sometimes find it hard to believe that someone who is highly functional may have depression. However, it’s important to remember that depression can affect anyone, even those who are rich, famous, or successful, or those who seem to be living in comparatively ideal circumstances.

Depression is neither a character flaw nor a weakness, and it is not something to be ashamed of. In fact, some people with high-functioning depression choose to be very open about it and advocate for others with depression, says Dr. Daramus.

If you are experiencing depression, it’s important to get help for it so you can start feeling better. Depression is among the most treatable of mental health conditions and treatment has a highly significant likelihood of success.

Treatment can also be helpful with difficulty accepting that you have depression or felt the need to hide the fact that you have depression from others.