What is High-Functioning Depression? Signs and Symptoms

What Is High-Functioning Depression?

While high-functioning depression is not a formal clinical diagnosis, the term is important to understand. High-functioning depression refers to the functionality of the individual with depression, and not a separate diagnosis. 

It refers to someone who is able to continues to function and engage with life’s responsibilities like relationships, work and self-care despite living with depression. 

However, maintaining high functionality is not always a sign of helpful adjustment or coping. It simply is something some people with depression are able to do, and others, not so much. 

The key characteristics of the so-called high-functioning depression are the same as any form of depression - low mood, feelings of hopelessness and helplessness, loss of pleasure in activities. 

The difference here is that some of the behavioural signs or symptoms associated with depression (like changes in sleep and appetite or social withdrawal) may be absent. Like any other form of depression, high-functioning depression, too, may take a toll on relationships, work and other areas of life. 

One may be physically present and engaging, but emotionally low or flattened. One may feel like they don’t have the capacity to feel joy or pleasure from these activities, or even have a nihilistic view of things. 

We’ve also covered Low-Functioning Depression.

Major Depression Vs. High-Functioning Depression

Differences Between High Function Depression And Major Depression 

Similarities Between High Function Depression And Major Depression 

The symptoms of both, high functioning depression and major depression are similar - low mood, feelings of hopelessness and helplessness, loss of interest or pleasure in activities, irritability, low energy, isolation and so on. 

Remember that there is no consensus between mental health professionals on high functioning depression. Nonetheless, most professionals do tend to agree that this is a form of depression in which the individual maintains functionality. 

Considering this nuance, high functioning depression may be best understood as depression without significant impairment. 

Why Is High-Functioning Depression So Hard to Recognize?

The Mask Of High-Functioning

The “high-functioning” in high-functioning depression can often be a way for individuals to mask their depression. In a later section, we will look deeper into why individuals may mask their depression, but for the moment, allow me to share an anecdote. 

A friend of mine works in the entertainment industry. Their job requires them to not only perform in front of a camera and a crew on a regular basis, but also show up at social and networking events in order to remain “visible”. 

This friend is often the life of the party. But, what very few people know is that a few years ago, they were diagnosed with depression - a condition that, if spoken about openly in their professional network might backfire and rob them of opportunities. 

They have learnt to mask, and when things begin feeling too overwhelming, they take a vacation. They continue to remain “high-functioning” by masking symptoms of depression in professional settings, which only a handful of people in her life know about. 

Misconceptions About Depression

Another reason why high-functioning depression is difficult to recognize is because of common misconceptions about depression. 

Most of us associate depression with someone who is low and gloomy all the time.

Common myths about depression that may prevent us from recognising high-functioning depression include expecting the depressed individual to be pessimistic or sad all the time, not expecting them to be able to perform tasks or laugh at a joke, or dismissing depression as everyday sadness.   

Causes of 'High-Functioning' Depression

Biological factors

Certain regions of the brain like amygdala, thalamus and hippocampus are involved in mood regulation. Research shows changes in these brain areas among patients who have depression. 

However, the relationship between biology and psychological conditions is often bidirectional, and it’s hard to say if depression is caused by a smaller hippocampus, or it shrinks this part of the brain. 

Other biological factors associated with depression include hormonal fluctuations or changes, in particular, changes in thyroid. Having an injury or physical illness may also make us more vulnerable to experiencing depression. 

In women, depression may be associated with their menstrual health, including menopause, and postnatal health. Studies also show that there is a genetic component to depression. Changes in gut microbiome and chronic inflammation are two more biological conditions associated with depression. 

Psychological factors

Individuals who are more likely to negatively evaluate themselves, score high on neuroticism, are prone to brooding and rumination, or have a negativity bias when responding to things around them are seen to be more prone to depression. 

Social factors

Social factors such as trauma or stressful events, interpersonal conflicts, prolonged isolation, and economic instability are some of the social factors associated with depression. 

Do I Have High Functioning Depression? 

Signs And Symptoms Of High-Functioning Depression

Symptoms of high-functioning depression are essentially the same as any other form of depression, but in the context of high funcionality may show up in different ways. 

Physical symptoms

1. Fatigue or lethargy 
2. Bouts of insomnia or oversleeping 
3. Changes in appetite 

Emotional symptoms

1. Not feeling good about oneself 
2. Not able to enjoy your accomplishments or experiences 
3. Lack of motivation to do more 
4. Feeling nihilistic about things 

Behavioural symptoms

1. Irritability or easily losing patience 
2. Social withdrawal or isolation 
3. Anger outbursts 
4. Indecisiveness or passivity in decision-making 

Cognitive symptoms

1. Forgetfulness 
2. Brain fog 
3. Difficulty concentrating 
4. Confusion or feelings of overwhelm 

Hiding the Fact That You Have Depression

Masking: How High-Functioning Depression Can be Hidden

Masking is the process of hiding one’s symptoms in order to fit in, or feel like you fit in. Individuals with depression may mask their feelings of hopelessness or helplessness by deliberately putting a positive spin on things. 

They may mask their low energy by taking on more activities. Sometimes, masking may be useful for a certain context (like for my friend who had to mask their depression in professional settings).

However, if the individual has no space where they can take the mask of and sit with and process their feelings, it may point to a hidden dysfunction or an underlying issue.  

Hidden dysfunction: Underlying issues

For example, keeping oneself busy all the time may also be a way of not facing the painful feelings they one be holding on to. Masking one’s depression may also be a way to deal with the shame and stigma associated with mental health. 

Many times, we internalize shame around mental distress, and may try to mask depression because we feel shameful about it. We may fear judgment from others, especially if people around us are not aware of mental health or have a tendency to dismiss or judge emotional distress. 

In this context, masking depression and maintaining high functionality may be a coping mechanism, albeit an unhelpful one in the long run. This is because in close relationships, the impact of depression can be felt sooner or later. 

High functioning depression impacts close relationships because one may tend to withdraw emotionally, if not physically, or one may become increasingly irritable around loved ones. 

Diagnosis of High-Functioning Depression

High functioning depression can be difficult to diagnose correctly because individuals tend to downplay their symptoms. 

For example, in cases of high functioning depression in women, one may see a woman dismissing her feelings of sadness as being oversensitive. 

High functioning depression in men may sometimes show up as a general pessimistic view of the world and the idea that everyone gets sad and there’s no point moping. 

The downplaying of symptoms is a challenge in the diagnosis of high functioning depression. However, when diagnosed accurately, it is treated as ‘pervasive depressive disorder’ or ‘dysthymia’ - a type of depression in which low mood persists for two or more years. 

It is important to diagnose high functioning depression accurately because this informs the treatment that the patient will receive. 

Is ‘High-Functioning Depression’ Treatable?

Like other forms of depression, high functioning depression is also treatable. Depending on the severity of symptoms, treatment of high functioning depression may involve therapy or a combination of therapy and medication. Lifestyle changes also play an important role in the management of depression. 

Treating high-functioning depression

1. Therapy options 

Psychotherapy is an essential part of managing depression, regardless of whether one is taking medication or not. Therapy helps the individual gain insight about themselves and learn coping strategies, challenge thought and emotional patterns, improve interpersonal relationships, build confidence and boost self-esteem. CBT and psychodynamic therapy are useful therapy modalities used for depression. 

2. Medication

In moderate to severe cases of depression, one may experience brain fog or overwhelm which can make it difficult to utilize and engage with the therapy process. In cases like this, medication can be useful. A thorough evaluation by a psychiatrist can help determine which type of medication would work for the individual, and in what dose. 

3. Lifestyle changes

Our lifestyle habits can deeply impact both, our physical and mental wellbeing. Lifestyle changes like regular exercise, a balanced and nutritious diet, adequate sleep, and relaxation and meditation practices can be helpful in managing the symptoms of depression. 

Easy Coping Strategies for High-Functioning Depression 

1. Acknowledge what you’re feeling - In order to cope with something, we have to first acknowledge it. While staying busy may offer temporary relief, if we don’t sit with and unpack what we’re feeling, eventually, it takes a toll on us. 
2. Avoid minimising or downplaying your experience - Everyone feels sad and low once in a while, and feeling this way in response to an event may even be healthy and appropriate. However, if the feelings of sadness you’re experiencing tend to linger and more positive emotions feel inaccessible, this is not a matter to downplay.  
3. Reach out to a trusted friend or family member - Talk to someone you trust and feel safe with about what you’re feeling. If you don’t feel comfortable or ready to share, just reach out and spend some quality time with a loved one who lifts your spirit.  
4. Seek professional help - If the thought, ‘do I have high functioning depression?’ comes to mind after reading this article, reach out to a mental health professional. Talking to a therapist can help you gain clarity about what you’re feeling, and from there, you can start thinking about how to create healthy change for your mental wellbeing. 

How to help someone with high functioning depression

If you are concerned about the wellbeing of a loved one and are finding yourself wondering how to help someone with high functioning depression, keep the following tips in mind: 

1. Listen without judging, dismissing or trying to “fix” them - All too often, we’re quick to judge or dismiss a loved one’s distress because it’s uncomfortable for us. We may even be quick to jump in and try to problem-solve or fix their distress. But remember that sometimes, simply being heard can be helpful. 
2. Try to do fun activities with them - If they want to keep things light, honour that and find fun activities both of you could enjoy together. 
3. Don’t take things personally - If they are withdrawing, or being snappy, you can point that out to them with kindness and compassion, but don’t take it personally. Keep in mind that they are doing so probably because they are feeling depleted, and it’s not an attack on you. 
4. Avoid saying the following - ‘I know you how feel’, ‘You just have to snap out of this’, ‘Try to think positive’, ‘Be grateful for what you have’. 
5. Encourage them to seek professional help - A mental health professional offers a safe, objective and confidential space to explore one’s inner life. They are trained to listen to thought patterns and identify maladaptive ways of functioning.

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

It is a pervasive myth that people who seek help from a mental health professional are “crazy” or “mad”. It is also not true that you have to be a certain amount of “sick” before you can reach out to someone. 

Emotional or psychological distress can often feel subtle or vague, and show up as this feeling that something’s off, but we don’t know what. You don’t have to let it escalate and impact your behaviour or how you show up in your life before you reach out to a therapist. 

If you’re ready to start your journey, you can book a consultation with one of our brilliant mental health professionals. 

Conclusion

High functioning depression is not a formal clinical diagnosis. It is best understood as depression wherein one remains high functioning. Individuals with high functioning depression tend to downplay their symptoms, and for this reason, it can be easily missed. However, it is important to recognize it so that appropriate treatment can be provided. 

Citations

Afeefa Rafath. (2024, July 25). How to Treat Depression Without Medications: Alternative Depression Treatments in 2024. Mavehealth.com; MAVE HEALTH PRIVATE LIMITED. https://www.mavehealth.com/blogs/how-can-you-beat-depression-without-medication 

‌Amenabar, T. (2024, May 15). What are 7 signs of “high-functioning” depression? A viral video explains.. Washington Post. https://www.washingtonpost.com/wellness/2024/03/05/high-functioning-depression-signs/

Campana, J. (2022, December 7). Thyroid disease: How does it affect your mood? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/expert-answers/thyroid-disease/faq-20058228 

‌Clinic, C. (2024). What Is High-Functioning Depression? Signs and Symptoms. Cleveland Clinic; Cleveland Clinic. https://health.clevelandclinic.org/high-functioning-depression 

Gangwani, P. (2024). Best 10 Beginners Meditation Techniques for Depression: How to Start & Why It Works. Mavehealth.com; MAVE HEALTH PRIVATE LIMITED. https://www.mavehealth.com/blogs/meditation-for-depression 

Gangwani, P. (2024). Depression: Signs & Symptoms, Types, Causes, and Treatment. Mavehealth.com; MAVE HEALTH PRIVATE LIMITED.  https://www.mavehealth.com/blogs/depression-signs-symptoms-types-causes-treatment 

‌Harvard Health Publishing. (2022, January 10). What Causes depression? Harvard Health; Harvard Health Publishing. https://www.health.harvard.edu/mind-and-mood/what-causes-depression 

High-functioning depression: Definition and symptoms. (2020, June 9). Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/high-functioning-depression 

‌Israel, Sonia, and others, 'Environmental and Social Risk Factors in Depression', in Madhukar H. Trivedi, and Steven M. Strakowski (eds), Depression (New York, 2019; online edn, Oxford Academic, 1 Nov. 2019), https://doi.org/10.1093/med/9780190929565.003.0004

Mave. (2024, July 29). Diet and Depression: Fight Depression with Nutritious Foods. Mavehealth.com; MAVE HEALTH PRIVATE LIMITED. https://www.mavehealth.com/blogs/foods-that-reduce-depression-quickly 

‌Recovery, R. O. (2022, June 5). 7 Signs You’re Dealing with High-Functioning Depression. Red Oak Recovery. https://www.redoakrecovery.com/addiction-blog/7-signs-youre-dealing-with-high-functioning-depression/ 

‌Remes, O., Mendes, J. F., & Templeton, P. (2021). Biological, psychological, and social determinants of depression: A review of recent literature. Brain Sciences, 11(12), 1–33. https://doi.org/10.3390/brainsci11121633 

What Is “High-Functioning” Depression? (n.d.). Verywell Mind. https://www.verywellmind.com/high-functioning-depression-causes-symptoms-and-treatment-5324550