What is Low-Functioning Depression? It’s Signs and Symptoms

What is Low Functioning Depression

As the name suggests, low- functioning depression is a type of depression wherein the ability to perform day to day tasks gets diminished. It is marked by significant difficulty in doing daily tasks, undertaking responsibility and maintaining relationships. However, the intensity and severity of symptoms varies from person to person. 

For example, person X might start to feel exhausted after 2 hours of work, whereas it may be difficult for person Y to maintain basic hygiene. Despite the difference, person X and Y have a decreased amount of functioning than their normal. 

Hallmark characteristics of low functioning depression are:

• Difficulty concentrating
• Common causes of depression
• Decreased amounts of energy
• Inability to accomplish day to day tasks
• Poor self care and hygiene
• Loss of interest in activities
• Demotivation towards work 
• Sleep disturbances

As basic activities start to feel overwhelming and difficult as a whole, low- functioning depression has dynamic effects on daily life. 

Here are some specific ways that LFD effects an individual’s life:

Inability to work due to:

1. Excessive procrastination
2. Lack of motivation 
3. Low levels of energy
4. Decreased productivity
5. Decline of quality of work

Neglect of personal Hygiene in response to:

1. Neglect of basic self care activities like showering, brushing, cleaning surroundings, etc.
2. Changes in appetite
3. Insomnia or hypersomnia

Problematic interpersonal relationships due to: (Dolan, 2010)

1. Not participating in activities affecting social life
2. Communication starts to feel like a difficult task
3. Isolating oneself

Poor physical well-being as a consequence of:

1. Extreme fatigue and exhaustion
2. Lack of physical activity
3. Excessive stress
4. Not eating nutritional food

Emotional health as an outcome of:

1. Fall in self-esteem
2. Worrying about the tasks
3. Stress
4. Continuous sadness

High Functioning Depression Vs Low Functioning Depression

Apart from the differences between high-functioning depression and low-functioning depression, there are a few similarities too. These are as follows:

1. Both of these conditions have persistent feelings of sadness, hopelessness and low self esteem
2. Negative thoughts
3. Strain on relationships and social life
4. Risk of suicidal ideation (however the intensity of risk may vary)
5. Impairment in daily functioning
6. Symptoms like insomnia or hypersomnia 

Why is Low Functioning Depression Hard to Recognise?

Low functioning depression, often known as Major Depressive Disorder (MDD) has profound effects on an individual’s day to day life. However, it can be hard to recognise. 

One of the prime reasons is misinterpretation of symptoms. Some hallmark symptoms of LFD like fatigue, changes in appetite, etc. can often overlap with physical illnesses rather than depression. 

Apart from this, stigma around mental health has always revolved. As a result, individuals either don’t seek professional help or hide the severity of their symptoms. 

Furthermore, if we notice the nature of low functioning depression, it has gradual onset which makes it difficult to notice change. 

As lack of communication is one of the symptoms of LSD, individuals often internalise the distress and avoid expressing it to professional and loved ones.  Along with all these symptoms, lack of awareness is focal. Due to lack of psychoeducation, individuals can not recognise the problematic patterns in the first place.

Thus, it is advised to reach out to a mental health professional to receive a holistic intervention plan and aid the symptoms.

Causes of Low Functioning Depression

Low functioning depression can be caused due to various reasons that can be identified after proper methodology from professionals. Some primary causes of LFD include genetic, biological, social, psychological, environmental factors, etc. 

Biological Factors:

In depression, neurotransmitters like dopamine and serotonin have a huge role. Imbalances in these leads to dysregulation of mood and motivation. Furthermore, other imbalances in hormones like thyroid and menopause can cause depression (depending on severity cause low functioning depression).

Psychological Factors:

Negative thought patterns lead to overall pessimism, low self esteem and lack of motivation. Additionally, certain personality types are more susceptible to depression. In a study, it was indicated that individuals with higher levels of neuroticism have more possibility of depression. (Costa, 1992).

Environmental Factors:

Individuals who have gone through childhood trauma like neglects, sexual abuse or physical abuse are predisposed to depression if not dealt properly. Additionally, if there is the presence of excessive stress, hassles and worrisome events in day to day life, it can trigger depression.

Genetic Predisposition:

In cases where there is a family history of depression, it can increase the risk for future generations too. Also, few genetic variations impact the chemical functioning of the brain that contribute to the possibility of developing depression.

Do I Have Low Functioning Depression? Signs and Symptoms

Physical Symptoms:

• Excessive fatigue
• Loss of appetite
• Changes in sleep
• Slowing down of thought and physical movement
• Frequent body aches

Emotional Symptoms:

• Feelings of sadness
• Hopelessness
• Irritability 
• Loneliness 
• Loss of interest from activities

Behavioural Symptoms:

• Social isolation
• Inability to keep up with tasks
• Not maintaining self care and personal hygiene
• Avoidance of previous routine
• Possible substance abuse

Cognitive Symptoms:

• Agitation
• Difficulty remembering things
• Poor decision making
• Negative thought patterns
• Suicidal thought

Diagnosis of Low- Functioning Depression

Low functioning depression (or major depressive disorder) demands a comprehensive assessment from a mental health professional that includes clinical testing, self report questionnaires, interviewing and examination of physical symptoms. However, there are a few challenges faced while diagnosing LFD.

As discussed before, there are overlapping symptoms with anxiety, bipolar disorder and PTSD making it difficult to distinguish between comorbidities. Furthermore, many physical illnesses also involve changes in appetite, sleep disturbances and fatigue which complicates the diagnosing process more. 

Along with these, lack of information about symptoms and mental health conditions play a pivotal role in inability to diagnose symptoms and seek professional help. Individuals often underestimate their condition and not seek help. There is still a lot of stigma around mental health that enables them to discuss these symptoms. 

However, getting an accurate assessment is very important to control and manage the symptoms from severing further. Effective treatment plans help in understanding nature and provide a holistic treatment plan that includes psychotherapy, medication and daily life changes. Early intervention promotes curing the condition before the symptoms exacerbate. Thus, proper evaluation and multidimensional treatment plan help in enhancing the quality of life. 

Is Low- Functioning Depression Treatable?

Yes, low functioning depression is treatable and has several effective intervention options. Most commonly, the treatment plan includes psychotherapy, pharmacotherapy, lifestyle changes and support groups.

Therapies like cognitive behavioural therapy (CBT) help in identifying and changing the negative thought patterns and Mindfulness based therapy promotes staying in the present and exploring the thoughts that arise. Additionally, medications are often used to manage the neurotransmitters like dopamine and serotonin and alleviate depression symptoms.

Changes in mood and irritability are common in depression, mood stabilisers help in relieving these symptoms. In low functioning depression, there is a significant decline in ability to do daily functioning. Lifestyle changes like regular exercise, sleep hygiene and stress management techniques like yoga, meditation, etc help in reaching a healthy routine.

Treating Low- Functioning Depression

In order to manage the symptoms, it is crucial to reach out to a mental health professional. The treatment plan includes:

• Psychotherapies:
• Cognitive Behavioural Therapy (CBT)

It is one of the most widely used and an effective therapy that is used in the treatment of mood disorder. CBT helps people with depression by giving them tools and techniques to challenge their negative thoughts and replace them with more accurate and realistic thoughts. Main purpose of CBT is to help an individual identify the cognitive triangle and reciprocal relationship between situations, thoughts and feelings. 

• Interpersonal Therapy (IPT)

This is another effective form of psychotherapy used widely with people suffering from depression. Due to lack of communication and isolation there is a huge effect on interpersonal relationships in LFD, interpersonal therapy helps in strengthening and improving these. IPT helps individuals focus on improving relationships and communication. It focuses on conflict, role transition, grief and social deficit skills.

• Psychodynamic Therapy (PT)

This therapy delves into the unconscious mind to uncover unresolved conflicts and past experiences that might be leading to symptoms of Low Functioning Depression. PT helps in understanding the root cause of the symptoms, addressing them and treating emotional conflicts. Psychodynamic therapy can be a long-term process, but it can be very effective in helping individuals.

• Medication:

Various pharmacological medications are used to impact the neurotransmitters and mood regulation in depression. These include antidepressants like SSRIs, mood stabilisers and other medications that are closely monitored by mental health professionals. 

• Transcranial Direct Stimulation Device :

 It is a non-invasive brain stimulation technique that is used to treat major mood disorders effectively. Research has shown that it reduces the symptoms of depression significantly both in hospital administered and self administered devices. Mave arc is one such device which has promising results and is ongoingly showing results in individuals who are using the device to reduce their symptoms of depression.

• Lifestyle Changes: 
• Regular exercise - Regular exercise is potent for treatment of depression. Workout or exercise of any form for at least 30 minutes a day can significantly enhance the levels of desired neurotransmitters in the body. 
• Sleep hygiene -  Regular, sound sleep is the backbone of one’s overall health. Good sleep and mental health go hand in hand.  Poor sleep can lead to depression and depression can lead to poor sleep. Thus maintaining sleep hygiene, or a routine before you go to bed can enhance one’s quality of sleep as well as mental health.
•  Nutritious food intake - A good diet is a healthy weapon to fight the ills of depression. Intake of the right kind of food and multivitamin helps improve multiple conditions, leaves you with better skin and also fights depression.
• Meditation
• Yoga
• Changes in routine
• Other strategies
• Support groups
• Journaling
• Talking to trust ones
• Goal setting, etc.

Triggers of Low Functioning Depression

Identifying and addressing triggers plays a pivotal role in treatment of low functioning depression. Triggers can vary in severity and its impact from individual to individual. Moreover, these triggers could be traumatic events, abuse, bereavement, chronic stress, or life changes. For instance, when an individual changes country, their whole life is impacted. This can start causing feelings like hopelessness, loneliness and lack of motivation. 

Significant life changes like losing a loved one or job loss can trigger depressive episodes. Along with this, presence of stress for longer duration can increase the amounts of cortisol and can be detrimental. Apart from these, traumatic experiences like physical, emotional or sexual abuse lead to negative thought patterns, maladaptive behaviour and impaired social relationship which are all causes of depression. 

In order to avoid these effects on an individual’s mind and body, it is crucial to put in use various techniques to manage triggers. Few are as follows:

• Stress Management

Deep breathing, meditation,  yoga, routine setting.

• Seeking Professional Help

Reaching out to a mental health professional.

• Support Network

To avoid social isolation, expressing emotions to family, friends or even support groups can be fruitful.

• Lifestyle Changes

Exercising, nutritional food, sleep hygiene.

• Understanding Triggers

Recognising and acknowledging the triggers is the first step to healing from them.

Risk Factors of Low- Functioning Depression

Risk factors are characteristics or variables that make an individual more susceptible to develop a disorder (Werner and Smith, 1992). Identifying these risk factors of low functioning depression can help in understanding who is more vulnerable to the condition. In a research conducted by Constance Hammen, he stated some consistent risk factors that include cognitive processes, stressors, certain sociodemographic factors like being a female, parental depression and personality traits. (Hammen, 2018).

• Personality Traits

Few individuals with personalities like neuroticism and pessimism for example experience emotions more intensely and tend to have a negative outlook towards life events. As a result, there are feelings of hopelessness and difficulty coping from stress.

•  Life Events

Individuals who like in more consistently stressful situations can feel exhausted and have negative coping mechanisms. Furthermore, traumatic experiences increases the possibility of developing depression. 

• Biological Factors

Females have a genetic predicament to having depression due to a combination of biological, psychological and social factors. Also, if one of the parents have a history of depression, the offspring are affected and have an increased possibility. 

Coping Strategies of Low Functioning Depression

Coping with low functioning depression can be undertaken on a professional level as well as individual level. An amalgamation of both is beneficial. Few strategies include:

• Seeking Professional Help: 
• Reaching out to a mental health professional
• Undertaking psychotherapy
• Use of Medications to alleviate symptoms
• Self- Care Techniques
• Physical activity and regular exercises
• Relaxation techniques
• Journaling
• Sleep hygiene
• Setting small achievable goals
• Social Strategies
• Support groups
• Strengthening support system from family and friends

How to Help Someone with Low Functioning Depression

The first step of helping someone with low functioning depression is psychoeducation. Educating oneself and the individual who is suffering can help in firstly destigmatising the condition and have a better understanding of the situation. Showing empathy through active listening and acknowledging their feelings can be helpful. Oftenly, individuals feel that there might not be a way out of this. Promoting professional help and encouraging them to see a therapist or a psychiatrist can help in providing practical support.

Henceforth, being emotionally present can sometimes show significant effects to relieve feelings of loneliness and hopelessness. Regular check-ins and staying connected helps in reducing feelings of isolation. However, it is important to keep boundaries and focus on one’s own mental health too while being a caregiver for others. It is okay to say no and take a step back.

If You’re ‘Low- Functioning’, Are You Sick Enough to Need Help?

Low functioning depression is a critical condition that impacts daily life and needs focus and assistance from a mental health professional. Various misconceptions revolve around mental health disorders. One is “maybe it’s not serious enough”. In the case of LFD, if the symptoms are severe and impact daily functioning, it is important to take necessary support. Support will help in receiving effective treatment that will improve the overall well- being of an individual and alleviate the current and comorbid conditions. 

However, support does not only mean professional. It is okay to take small steps. This could involve reaching out to someone from family or maybe a friend first. It is not that, sometimes support groups can be beneficial while maintaining personal confidentiality of identity. Talking to individuals with similar experiences lessens the feeling of loneliness and provides a community for emotional support.

References:

Bell-Dolan, D. J., Reaven, N. M., & Peterson, L. (1993). Depression and social functioning: A multidimensional study of the linkages. Journal of Clinical Child Psychology, 22(3), 306-315.

Costa, P. T., & McCrae, R. R. (1992). Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual. Psychological Assessment Resources.

Kupferberg, A., Bicks, L., & Hasler, G. (2016). Social functioning in major depressive disorder. Neuroscience & Biobehavioral Reviews, 69, 313-332.

Hammen, C. (2018). Risk factors for depression: an autobiographical review. Annual review of clinical psychology, 14(1), 1-28.

Oh, J., Jang, I., Jeon, S., & Chae, H. (2022). Effect of Self-administered Transcranial Direct Stimulation in Patients with Major Depressive Disorder: A Randomized, Single-blinded Clinical Trial. Clinical Psychopharmacology and Neuroscience, 20(1), 87-96. https://doi.org/10.9758/cpn.2022.20.1.87