Depression Is It Possible to Have Functional Depression? By Amy Morin, LCSW, Editor-in-Chief Updated on November 06, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Verywell / Madelyn Goodnight Table of Contents View All Table of Contents What Is Functional Depression? Persistent Depressive Disorder How Depression May Impact Functioning Causes Risks Treatment There are many misconceptions about what depression looks like. You might envision someone who is too distraught to get out of bed. Or you may imagine someone who isn’t able to work or do activities due to their low mood. But, in reality, depression takes many forms and can range greatly in severeness. Sometimes, people have what’s called “functional depression.” What Is Functional Depression? Functional depression, or high-functioning depression, isn’t a clinical diagnosis. It’s more of a buzzword. But that doesn’t mean it isn’t real. After all, some individuals with depression appear somewhat fine to the outside world. They go to work, pay their bills, and talk to people. They might even smile regularly. But this doesn’t mean they don’t feel depressed. Some of these individuals may crawl into bed the minute they get home from work. Or they might sit on the couch every evening and cry all night. They could just be good at hiding their depression from others. What Is Smiling Depression? Persistent Depressive Disorder The DSM-5 (the newest version of the manual clinicians use to see if patients meet the criteria for a specific mental illnesses) includes a condition called persistent depressive disorder. While there are several different kinds of depression, individuals who appear to be high-functioning may have persistent depressive disorder. Here are some of the common symptoms: Low self-esteem Changes in sleep habits (sleeping too much or too little) Changes in appetite (overeating or decreased appetite) Difficulty concentrating Trouble making decisions Feelings of hopelessness In order to qualify for a diagnosis, the symptoms must be present for two or more years. Consequently, many individuals who have these symptoms have learned to function despite them. How Depression May Impact Functioning To meet the criteria for a diagnosis of depression, an individual must experience social, occupational, or educational impairments. This means that their low mood must somehow interfere with their daily lives. But it doesn’t mean that they won’t still function well in some of those areas. Here are some examples of how an individual with functional depression might still experience impairments in one area of their lives or another: A woman shows up to work on time every day and performs her job well. She rarely engages in any social activities, however, because she doesn’t feel like being around people.A man continues to enjoy a rich social life with friends in the evenings and on the weekends. Yet he struggles to get through the workday at times because he’s depressed. Since he works from home, he’s able to show up late or put off certain tasks without anyone knowing.A woman is a stay-at-home parent. She manages to take care of her parenting duties, but she feels lonely and depressed during the day. She quits taking college classes because she feels overwhelmed.A college student continues to take online classes and work toward his degree. But he quits his part-time job because he lacks the energy and motivation to work. Causes Like all forms of depression, functional depression can stem from several different causes. It may be a combination of genetic, biological, or life experiences that lead to functional depression. Stress, illness, unresolved grief, substance abuse issues, trauma, relationship issues, and major life transitions are just a few reasons someone might grow depressed. There are several reasons why someone may develop functional depression. An individual with functional depression can often have mild enough symptoms that they’re able to continue functioning. Or they could be a perfectionist who is afraid to show that they’re struggling. Risks Individuals who can still function while depressed might convince themselves their depression isn’t that bad. Some People Minimize Their Issues Some people with high-functioning depression may minimize the seriousness of their condition and be less likely to seek treatment. They could also be less likely to gain emotional support from others if their depression goes undetected. Friends, family members, and colleagues may have no idea that the individual is even depressed. Additionally, someone with high-functioning depression might feel guilty about getting help (guilt often goes hand-in-hand with depression). They may think that people who have worse depression are more deserving of help. Some People Feel They Shouldn't Be Depressed They might also tell themselves they have no reason to be depressed. They may think that since they can still function, they should be happier. Or they may believe someone who has a job and a family shouldn’t be depressed. These thoughts may prevent them from asking for help as well. All types of depression can lead to an increased risk of suicide, including functional depression. Someone who has functional depression may experience increased thoughts about death, and they might consider ending their lives. Other people could misunderstand high-functioning depression. They may think an individual who is withdrawing socially isn’t interested in being friends. Or they might label an individual’s struggle with motivation as laziness. These misconceptions tend to create even bigger problems for someone who is already struggling with depression. They might increase their social isolation or cause them to try to overcompensate by acting as if they’re OK when they’re truly sinking further into depression. Treatment Functional depression may be treated with medication, therapy, or a combination of the two. If you suspect you might have functional depression, talk to your physician. Your doctor can rule out medical issues that could be contributing to your emotional state. Sometimes, physical health issues (like thyroid problems) can contribute to depression. If your physician feels treatment is warranted, you may be prescribed medication. You might also be referred to a psychiatrist who specializes in mental health medications. Additionally, your physician could recommend talk therapy. There are several types of therapy that can be effective in treating depression, including cognitive behavioral therapy (CBT). CBT can help you break free from the thoughts and behaviors that reinforce depressive feelings. A Word From Verywell Sometimes it’s helpful to check in with those around you to ensure they’re doing OK. Even if they look OK on the outside, and they seem to be functioning just fine, they may be battling issues you know nothing about. If you suspect someone in your life may have high-functioning depression, talk to them. Make it clear that it’s OK to ask for help if they need it and that depression isn’t a sign of weakness—anyone can develop depression. 1 Source 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. American Psychiatric Association. “Other Mental Disorders.” Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. doi:10.1176/appi.books.9780890425596.529303. By Amy Morin, LCSW, Editor-in-Chief Amy Morin, LCSW, is the Editor-in-Chief of Verywell Mind. She's also a licensed clinical social worker, psychotherapist, and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk, "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time. 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