High Functioning Depression: This Is What It Looks Like

By Caitlin Bray

High Functioning Depression: This Is What It Looks Like

Depression doesn’t always have to mean that you can’t get out of bed, go to work, or hang out with your family and friends. 

For those with high functioning depression, it looks a little different. If you’re one of those people, you may struggle with getting others to understand that you are still dealing with depression. 

To help, we’d like to tackle exactly what high functioning depression is so that we can help more people to understand this important, yet invisible, mental health condition.

What is High Functioning Depression?

High functioning depression, medically known as dysthymia, is also frequently referred to as “smiling depression.” This is part of what makes it such a difficult condition to discuss and diagnose--most people who suffer from this type of depression are very skilled at being able to put on a happy face. 

It can help to think of high functioning depression as living with a mask on, and more people than you’d think suffer from it. 

People who have this condition can get up, go to work, and interact with others without showing many of the stereotypical signs of depression. Essentially, they’re good fakers, not because they want to, but because they feel like they have to. 

On the inside, people who have high functioning depression have to cope with the same feelings that those with other forms of depression must deal with. They may appear to have it together, but the internal process that it takes to get there is much harder than it is for other people. 

Many people with this condition use all of their energy keeping up that mask when they’re outside of the home, and will fall asleep as soon as they get home because they are so exhausted. Some even deal with “passive” suicidal ideation - they don’t want to actively end their lives, but the thought of their lives ending doesn’t distress them either.

What Causes High Functioning Depression?

Like most types of depression, the exact cause of high functioning depression is still unclear. 

What we do know is that there are a few different factors that may come into play.

  • Brain chemistry - The balance of chemicals that keeps our mood stable can lead to depression if that balance is thrown off. This often happens as a result of exposure to severe and/or long-lasting stress.
  • Heredity - There is some evidence that shows that depression can be inherited from either one or both parents.
  • Environment - Depression can be triggered by major, negative life events like loss, trauma, or hardship. This is especially true for those who may have a genetic predisposition to depression.

High functioning depression can begin at any point in life, from childhood through adulthood. When diagnosed before the age of 21, it is referred to as “early onset” high functioning depression. Diagnosis after the age of 21 is called “late onset” high functioning depression. Females do tend to be more likely to develop this condition than men, but the exact reason why that is is still unclear.

Signs and Symptoms of High Functioning Depression

While many of the signs and symptoms of high functioning depression may vary between the people dealing with the condition, there is one symptom that is considered a “primary feature.” 

To be diagnosed with high functioning depression, there must be a depressed mood present most days of the week for at least 2 years (1 year in children or adolescents). There may be periods with depressive symptoms, but those periods can’t last longer than two months at a time. 

Other signs and symptoms include (there must be at least two of these to receive a diagnosis of high functioning depression):

  • Feeling hopeless
  • Low energy/fatigue
  • Low self-esteem
  • A change in appetite - either overeating or not eating enough
  • Difficulty with decision-making and concentration
  • Trouble falling/staying asleep (insomnia) or sleeping in excess (hypersomnia)

In general, people with high functioning depression tend to look and act normal, while also maintaining a negative view of not only themselves, but also life in general.

How is High Functioning Depression Diagnosed?

Before making a diagnosis of depression or any other mental health issue, most doctors want to rule out potential physical causes like hypothyroidism, nutritional deficiencies, or neurological issues. 

Once receiving a clean bill of physical health, individuals will be referred to either a psychologist or a psychiatrist (psychologists cannot prescribe meds, while psychiatrists can) for further evaluation.

An official diagnosis is made by looking at the above symptoms combined with clinical interviews. 

During those interviews, the doctor will be looking for general attitude, duration and intensity of symptoms, and the ways in which daily life is impacted by dealing with depression. 

However, high functioning depression is not officially in the Diagnostic and Statistical Manual of Mental Disorders, so some doctors may not feel comfortable officially calling it that. It does, however, have a very close diagnosis called Persistent Depressive Disorder. 

What Does Treatment Look Like?

While there is no cure for high functioning depression, treatment generally involves a combination of two methods: medication and therapy. 

Medication is prescribed less often for high functioning depression than it is for major depressive disorder, though the reason for this is unclear. When medication is prescribed, it is usually an SSRI (selective serotonin reuptake inhibitor), like Prozac, Lexapro, or Zoloft. 

This can also be combined with supplemental mental health therapy that can provide important nutrients that support mental and emotional wellness, such as L-theanine, GABA, and Rhodiola.*

Therapy in and of itself is also generally very beneficial (for anyone, really!). Therapy normally focuses on developing healthy coping strategies and dealing with any triggers. CBT (or cognitive behavioral therapy) is most commonly used to help with high functioning depression. 

With CBT, patients work with their therapist to specifically identify negative patterns of thinking that may be plaguing them. Once identified, they work together to change those thought patterns into something more healthy and helpful. It’s one of the most popular forms of therapy used in the United States, for a variety of different mental health conditions.

Treatment for high functioning depression is usually very effective.

What Can I Do?

If you’re dealing with high functioning depression, in addition to seeking professional help, there are some other ways that you can maintain your best physical and mental health on your own.

  • Maintain a healthy diet, especially one rich in foods that can help promote mental health. Supplement as needed to make sure you’re getting mood-conducive nutrients. 
  • Get plenty of sleep! Lack of sleep can make depression symptoms worse, even though we know it can be tempting to stay up late, especially if work is causing you stress.
  • Exercise regularly. It releases endorphins and can naturally improve mood.
  • Try to continue doing things that you love and that make you happy.
  • Surround yourself with supportive people, and know who you can talk to if you need to vent.
  • Avoid alcohol and caffeine, if at all possible. While each has a different effect on the body, they can all worsen symptoms of anxiety and depression. If you must use either, remember to use them in moderation.

Supporting your body can not only give you something else to focus on, but it can also help your body go on to support your brain. Chronic stress and depression can affect not only our mental health, but our physical health as well. Take care of both.

Why the Stigma Around High Functioning Depression?

The issue of the stigmatization of all mental health conditions is something that is a continuing struggle. Because the symptoms of poor mental health aren’t as physically obvious as someone with diabetes or cancer, some people may not believe that mental health issues are “real.” 

That couldn’t be any further from the truth.

This is even more clear when it comes to the issue of high functioning depression. It can sometimes feel like, for your depression to be taken seriously, you have to exhibit all the stereotypical signs. 

If you’re still able to live a fairly normal life (at least, as it appears from the outside), that may subject you to blame and judgement. People may not believe you when you say you’re depressed, they may tease you, etc. It may even make you question it yourself.

In fact, many people with high functioning depression feel a significant amount of guilt about being able to function normally. They feel like they’re not as depressed as they think they are because they can still “do” normal life. But that just makes them a larger victim of the condition, because they are judging and stigmatizing themselves before others even have the chance to do it. That also leads to delaying treatment, because they don’t think that they qualify for help. It really is an insidious condition.

In Closing  

High functioning depression is tricky, and often not taken as seriously by the people who aren’t dealing with it. It can still be just as devastating as all other forms of depression, though. 

If you suffer from this condition, talk about it.

Putting a face on “smiling depression” can help normalize not only this diagnosis but mental health conditions in general. And don’t forget to support your own health by maintaining a healthy diet and continuing to do things you love. 

Depression, even high functioning depression, doesn’t have to control your life. Remember—you control your life, no matter what. 

*FDA Disclaimer: These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.