A common stereotype with depression is how it looks from the outside.
Often these stereotypes are perpetuated by the media. For example, images of head in hands despair have long been linked with stories on depression or suicide, inspiring a campaign, Time to Change, to challenge these portrayals in the media.
Their campaign’s mission highlighted an important truth: “People with mental health problems don’t look depressed all the time.” So while yes, depression often is debilitating and stops people from functioning at a day-to-day level, it doesn’t always look this way.
In fact, there’s a term for it: high-functioning depression.
What is high functioning depression?
Firstly, high functioning depression isn’t an official diagnosis. It’s a term given to people who are experiencing symptoms of depression while performing at a certain level of functionality. The difficulty with this type of depression is that it often goes undetected by friends and family, or even the person experiencing it themselves.
The closest diagnosis in the DSM-5 (the diagnostic and statistical manual of mental illnesses and mental disorders, published by the American Psychiatric Association) is persistent depressive disorder. This is also known as dysthymia or chronic depression. Rather than acute and severe, this way this type of depression affects people is long-lasting.
According to Mayo Clinic, “though persistent depressive disorder is not as severe as major depression, your current depressed mood may be mild, moderate or severe.” Those with high functioning depression might maintain relationships, careers, pay the bills, build a family. But subtle feelings of disinterest, low mood, anxiety, apathy, or meaninglessness follow them around like a dark cloud.
Symptoms of high functioning depression
Because many people have internalized the misconception that depression has to look a certain way, those who experience high functioning depression might not be aware of it.
A mental health professional might tell you that it could be that something simply “feels off,” or that happy moments in life, from big celebrations to simple joys, aren’t fully enjoyed or appreciated.
Persistent Depressive Disorder
In the U.S., it’s estimated that around 1.5 percent of the population, close to 3 million people, feel depressed and experience persistent depressive disorder. When it comes to this type of disorder, a sign of depression is low mood that has persisted for over two years.
Other symptoms of high functioning depression include:
- Chronic sadness or feeling down, without an obvious cause
- Self-esteem difficulty
- Feelings of emptiness
- Low energy or motivation
- Irritability and anger
- Reduced social activity
- Lack of or decreased appetite.
- Poor sleep or insomnia
It’s common for people to think “I’ve got no reason to be depressed,” and to ignore chronic low mood when there’s no apparent cause. Because high functioning depression is present over a long period of time, many people even get used to, or adjust to, the symptoms, without knowing exactly when it started.
Some people may feel that it’s just the way they are, and that they don’t need to seek treatment for a clinical diagnosis or emotional support.
How do I manage high functioning depression and boost my mental health?
I want to offer an unconventional view, one I stand by with every cell of my being. I believe depression is a great teacher, and if approached with curiosity and humility, it contains its own solutions.
In the words of M. Scott Peck in The Road Less Travelled:
“Rather than being the illness, the symptoms are the beginning of its cure. The fact that they are unwanted makes them all the more a phenomenon of grace—a gift of God, a message from the unconscious, if you will, to initiate self-examination and repair.”
I grappled with depression for the majority of my life. At times it was more intense than others. In some peculiar way, the times when it was more intense, and really got in the way of life, were the most important, because they made me fully aware that I had to self-examine and repair. This is a catch with high functioning depression — it might not reach that tipping point, or it might take years of struggle to really begin to explore.
With that in mind, I’d like you to approach these steps with an open mind, and be willing to consider that high functioning depression has its own form of intelligence. In other words, to have faith that actually, you can learn to understand it, to grow, and heal through it.
1. Accept its presence
Something called you to read this article. Maybe it was because you are concerned about a loved one. Or maybe there’s a part of you that suspects you’re experiencing functional depression and would like to dig a little deeper.
That’s an incredible first step, as it shows a willingness to acknowledge where you’re at, a powerful first step in all change. By accepting that you are experiencing high functioning depression, you might feel grief, anxiety, or even relief. Start by being totally self-honest.
The “persistent” in this version of depressive disorder is often due to the symptoms not being intrusive enough to seek immediate action. If you can acknowledge where you’re at, right now, you can take action before the symptoms increase.
2. Be honest about how high functioning depression impacts your life
The more subtle the symptoms, the more subtle the impact. Once you’ve accepted the reality of depression, the next step is to explore all the ways your life adjusts around it. Do you socialize less than you’d like to? Is your creative expression stifled? Are you unable to find joy in life’s simple pleasures? Do you lean on substance abuse to get through the days? Do you experience overeating, insomnia?
This process won’t be easy. But it will give you a clear idea of the way your life is affected and, on the flip side, the way your life will be improved once the healing process takes place. This can be used as motivation by the person struggling to get support or to place more attention and focus on doing the necessary work.
3. Consider your steps for support
The next step is to start to piece together a plan of action.
It can be difficult to know where to begin, or what steps to take, once you acknowledge that high functioning depression is a problem. Consider getting professional support, whether through treatment programs, through talking therapy, or getting in touch with someone that can provide medical advice. Consider talking to a close friend about your experience. As the saying goes, a problem shared is a problem halved.
This process really depends on how much you feel you’re able to work through the symptoms. Often people with severe depression need support because they’re at such a low point, daily functioning is impossible. If you feel able to do the work, then a good starting point is to look at your life from a wide perspective, to identify what could be causing it.
4. Deconstruct the experience
An issue with stigma is that it can make a diagnosis feel overwhelming, or like a life sentence. I’d encourage you to view this kind of depression as one part of a greater whole. Don’t worry about having to pinpoint exactly why persistent low mood is there, but instead, look at different life areas, such as:
Do you have a healthy diet and avoid overconsumption of alcohol? Are you getting regular exercise? Do you monitor your screen and social media use?
Are your relationships nourishing and mutually supportive? Do you have healthy boundaries, or are you overextending due to people-pleasing? Are you expressing your needs?
Are you spending time connecting to yourself, and to nature? Are you aware of your values and guiding principles? Do you know what’s most meaningful to you in life?
Is your work fulfilling? Do you have a healthy work and life balance, or are you overworked? Do you feel supported by your team?
Are you able to identify and process your emotions? Do you fully feel your emotions? Have you resolved grief or trauma?
This process is worthwhile for anyone. But if you’re experiencing high functioning depression, it can highlight where you need extra support from others, either through people you know, or through a professional.
The awareness levels around mental illness and mental health awareness is improving all the time. But there’s a long way to go, especially when it comes to misconceptions and stereotypes.
And as important as it is for people to be aware of symptoms to understand and support others who are suffering, it’s just as important for people to be fully informed in order to make sense of their own experience.
I’m a big believer that there are always, always positive steps forward, no matter where you’re at. The basis from this “Ground Zero” is one of acceptance and compassion. But in acknowledging your experience of high functioning depression, there’s an opportunity for deeper understanding and exploration of all the factors in your life that could be contributing to this mental health condition.
Even if there’s a one percent boost by making one change, that’s a success. Even if you learn a small lesson about yourself by looking into your inner world, that’s a success. Acknowledging that you could be experiencing high functioning depression validates years of struggle, and is also a success.
Start from ground zero
Start from Ground Zero. Know that change is always possible.
And, most importantly, know that YOU deserve happiness and fulfillment in this life. It is possible to learn how to beat depression. Acknowledgment is the first step in moving towards that.