What Is High-Functioning Depression?

depressed person in a support group

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What Is High-Functioning Depression?

Depression is a mental health condition that affects 1 in 6 people at some point during their lifetime. It can take many different shapes and forms, and affect people in different ways. 

High-Functioning Depression

High-functioning depression is when you're experiencing symptoms of a depressive disorder, but to outside appearances you look fine, says Aimee Daramus, PsyD, a licensed clinical psychologist and author of “Understanding Bipolar Disorder.”

If you have high-functioning depression, you may seem fine because you may be able to 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 all right.

This article explores the symptoms, causes, and diagnosis of high-functioning depression, as well as some treatment and coping strategies that may be helpful.

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

Aimee Daramus, PsyD

High functioning depression can happen at any severity, from mild to so severe that the person is self-harming or at risk of suicide. The scary thing is that they are often hiding their symptoms from other people.

— Aimee Daramus, PsyD

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.”

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

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 can be genetic and 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 cause depression.
  • Trauma: Experiencing trauma or stressful conditions can cause you to develop 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: If you tend to get overwhelmed easily and have difficulty coping, you may be 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. Rather, it can happen with any type of depressive disorder.

According to Dr. Daramus, these are the different types of depressive disorders:

  • Major depressive disorder (MDD): Also known as clinical depression, major depressive disorder is a form of 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): This is a form of depression people experience in winter, when there is less sunlight. Seasonal affective disorder tends to recede in summer and reappear in winter.
  • Perinatal depression: 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), 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 high-energy, known as mania, and periods of depression, where they experience sadness and fatigue. 
  • Psychotic depression: People who have psychotic depression also experience symptoms of psychosis, such as hallucinations (seeing 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 disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, a guiding manual published by American Psychiatric Association.

If you have any of these depressive disorders, you may still be functioning as though everything’s fine, but it may not be. For instance, if you have major depressive disorder but are able to hide it or still do very well in life, that would be considered high-functioning major depressive disorder, 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 the fact that you have depression from others and try to go about your life:

  • You might have come from a family or culture that teaches people not to talk about mental illness.
  • You may have built an outwardly great life for yourself and don’t want to risk losing everything.
  • You think you’ll feel better by powering through.
  • You’re trying to protect your job and relationships until the depression lifts.
  • You are someone who isn’t comfortable showing weakness. 
  • You think having depression is something to be ashamed of and don’t believe you can have depression.
  • You feel that your life will fall apart and people will abandon you if they find out about the depression. (Sometimes that does happen in reality).

Treating High-Functioning Depression

Treatment for high-functioning depression is a lot like treatment for other forms of depression, says Dr. Daramus. According to Dr. Daramus, treatment 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 may 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 about it.

A Word From Verywell

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 an 80% to 90% success rate.

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

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7 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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