Depression impacts more than 18% of Americans, according to the Centers for Disease Control and Prevention (CDC), making it a common illness people struggle with. But, like all health conditions, there is a spectrum with depression. Some people with depression have difficulty doing even the most basic tasks, while others may appear fine to outsiders in what’s known as high-functioning depression.
People with high-functioning depression can usually do important things like show up to work and pay their bills on time, but feel empty and sad inside. Basically, you may not know from looking or talking to someone with high-functioning depression that they’re not doing well, but they’re dealing with a lot of the same issues as those with “regular” depression.
It’s important to point out that there is some controversy around this term (more on that in a moment). But plenty of people still identify with high-functioning depression. Here’s what it means, plus how it’s treated.
Experts Featured in This Article:
Gail Saltz, MD, is an associate professor of psychiatry at the NY Presbyterian Hospital Weill-Cornell School of Medicine.
Steven D. Hollon, PhD, is a researcher and professor of psychiatry at Vanderbilt University.
What Is High-Functioning Depression?
Let’s get this out of the way now: “High-functioning depression” is not a medical term. Meaning, it’s not used in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is a tool that mental health providers use to diagnose conditions. With that, many experts don’t use this term.
Gail Saltz, MD, associate professor of psychiatry at the NY Presbyterian Hospital Weill-Cornell School of Medicine, describes it as a term that “lay people use to describe someone who feels depressed but doesn’t have all the symptoms of a clinical major depression and is able to function externally well enough.”
Steven D. Hollon, PhD, a researcher and professor of psychiatry at Vanderbilt University, agrees, stressing that having depression doesn’t mean you can’t do things. “People who are depressed can do anything they can do when they are not depressed, but often do not believe they can, so they do not start,” he tells PS.
While high-functioning depression may mean that someone has depression but hides the symptoms well, “it may be a misnomer for someone experiencing clinical dysthymia, which is a diagnosis of more mild depression for longer periods off and on in their lives,” Dr. Saltz says. (Unlike high-functioning depression, dysthymia is an official diagnosis.)
What Causes High-Functioning Depression?
Both major depression – which is a term mental health providers often use to refer to depression – and dysthymia have similar causes, Dr. Saltz says. Those can include:
- A genetic predisposition
- Environmental stressors
- Experiencing a trauma
- Taking certain drugs, alcohol, or medications
Symptoms of High-Functioning Depression
Symptoms of high-functioning depression can vary from person to person. However, the National Institute of Mental Health (NIMH) says these are the most common symptoms of depression as a whole:
- Persistent sad, anxious, or “empty” mood
- Anger or irritability
- Feelings of hopelessness or pessimism
- Becoming withdrawn
- Feelings of irritability, frustration, or restlessness
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Fatigue, lack of energy, or feeling slowed down
- Trouble concentrating, remembering, or making decisions
- Trouble sleeping, waking too early in the morning, or oversleeping
- Changes in appetite or unplanned weight changes
- Physical aches or pains, headaches, cramps, or digestive problems that don’t have a clear physical cause or go away with treatment
- Thoughts of death or suicide or suicide attempts
- Doing more high-risk activities than usual
- Being impulsive
- Using more alcohol or drugs
- Isolating from family and friends
- Problems with sexual desire and performance
“Clinical major depression includes ‘neurovegetative symptoms’ of difficulty sleeping, loss of appetite, also loss of libido, loss of finding anything pleasurable, sometimes thoughts of suicide,” Dr. Saltz says. “These things tend to make it difficult to be high-functioning. But a mild form may allow someone to still do well at work, and with others, and therefore go undetected.”
People with dysthymia (also known as persistent depressive disorder) may have these symptoms, per Harvard Health:
- low mood
- increased or decreased appetite or weight
- lack of sleep or sleeping too much
- fatigue or low energy
- low self-esteem
- trouble concentrating
- difficulty making a decision
- hopelessness or pessimism
How Is High-Functioning Depression Treated?
The best treatment for high-functioning depression ultimately depends on the person. But people who are struggling may benefit from these treatments, according to NIMH:
- Talk therapy. Also known as psychotherapy, this can help teach people with depression new ways of thinking and behaving to try to counteract habits that contribute to their condition. It includes cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT).
- Medications. Antidepressants are typically used to treat more severe forms of depression. These help to change how the brain makes or uses certain chemicals that are involved in mood or stress.
“If you are struggling with low mood – no matter your functioning – you can benefit from psychotherapy,” Dr. Saltz says. “If your symptoms are more severe, you can also benefit from medication plus therapy.”
If you are feeling anxious or depressed and need help finding help or resources, the Anxiety and Depression Association of America (1-240-485-1001) and the National Alliance on Mental Illness (1-800-950-6264) have resources available.
Korin Miller is a writer specializing in general wellness, health, and lifestyle trends. Her work has appeared in Women’s Health, Self, Health, Forbes, and more.
