What is high functioning depression?

You can’t always tell when someone is depressed.

Many individuals suffering with depression actually seem pretty happy. They have powerful careers, happy families, active social lives, and seem to have it all pretty well together. Their positive, successful exteriors hide the real truth; that inside they are struggling with a daily battle against fatigue, low mood, frustration, and that self-critical little voice constantly telling them they are no good and dragging them down.

Success and depression are not mutually exclusive. In fact, millions of Americans living with depression are successful at work, school, and in their personal lives. Not all suffers are incapacitated by the illness; there are actually several different types of depression officially recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and each one can range from mild to moderate to severe. Increasingly, mental health practitioners are using the term ‘high functioning depression’ to refer to those sufferers that, despite experiencing symptoms of depression, are able to function in their daily lives.

Let us be clear: ‘high functioning’ is not the same as ‘fully functioning’. While you may be able to push on in your career or home life and make it work, as a high functioning depressive you are unlikely to be achieving at anywhere near your full potential. Over time, high functioning depression can deteriorate into increasingly severe depressive symptoms and, without help, ultimately become deadly.

“It’s like dressing up for Halloween every day and staying ‘in character’ no matter what”

How would you describe high functioning depression? What is it like? I posed these questions to my group and heard it described as putting on a ‘constant performance’ to hide it from the world. One group member described their experience as “putting on your happy face, selling that everything is good, (and) counting down the minutes until you can get in your car and breathe again”. Another said it felt like “putting on a brave face when actually you’re dying inside”. High functioning depressives seem to have two aspects to their experience: the depressive symptoms themselves, and the experience of trying cope and hide their illness from the world.

Seven characteristic of high functioning depression

There are seven characteristics associated with high-functioning depression:

1.You feel sad and numb all the time, even when doing something fun

Your low mood seems to be a constant companion and you’ve lost interest in activities that you used to enjoy. Going out, socializing, and participating in enjoyable hobbies have become a chore and you struggle to feel enthusiastic or excited anymore.

2. You constantly criticize yourself

Beating yourself up mentally and emotionally has become a daily occurrence. You constantly put yourself down, berating yourself for not trying harder, not achieving everything you should, and for making mistakes. Your inner monologue constantly attacks you, making you feel worthless.

3. You overthink everything

Your constant self-criticism and attempts to appear ‘normal’ lead you to overthink and overanalyze everything, creating more stress, pressure, and likelihood of a breakdown.

4. You are constantly concerned with time

Despite making progress, you question whether you are making the best use of your time. You may be successfully working through your to-do list, achieving at work, or engaging in positive activities, yet in the back of your mind you question whether this is really the best use of your time. You worry you are in the wrong job, chasing the wrong goals, or are wasting time on meaningless activities when there are more important things you should be focusing on.

5. You have excessive pastimes

While binging on Netflix, gaming online, or mindlessly scrolling on social media are common ways to pass the time, you find yourself spending hours and hours at a time engaged in these kinds of activities. You tell yourself you’re relaxing, but what you’re really doing is trying to escape from the constant self-criticism, overthinking, and negative stream of thoughts running through your mind.

6. You have unhealthy coping strategies

Excessive pastimes aren’t the only way you try to escape. You may find yourself turning to overworking, alcohol, drugs, or other unhealthy coping strategies to escape from yourself.

7. You feel misunderstood

You go to work every day, manage your home, family, and social life successfully, and generally come across as a relatively well-adjusted person. Talking about how you really feel seems futile; you don’t act like a typical depressed person and you seem to be doing fine, so others don’t take your struggles seriously. Often they’ll simply minimize your feelings, telling you to ‘cheer up’ or ‘not to worry about it, you’ll be fine’.

Persistent Depressive Disorder

High functioning depression is most commonly associated with persistent depressive disorder (one of the types of depression in DSM-5), a mild to moderate ongoing depression lasting at least two years. Approximately half of Americans with PDD do not seek treatment; this figure is likely much higher for high functioning depressives, who many not consider themselves as in need of help. Sufferers often do not recognize that they have the condition, believing that it is just ‘normal’ for them to feel low all the time. Seeking help seems self-indulgent, and besides, it can’t be that bad if you can still function right?

Wrong. This is one of the most damaging myths surrounding high functioning depression. It is not true that if you can still function pretty well, hold down your job, and keep your head above water that you are not really suffering with depression. Left untreated your depression symptoms may increase over time, depleting your ability to function and ‘perform’ for the world. While you might be able to fool the outside for now that you have it all together, over time the daily battle against fatigue, self-criticism, and numbness could become harder and harder to win.

High functioning is not the same as fully functioning

The sad reality for many high functioning depressives is that we accept it as our fate to struggle daily in our misery and live a mediocre but ‘okay’ life. Perhaps you’ve dabbled in personal growth before; tried to set yourself some goals and motivate yourself to make some positive life changes. Unfortunately, the majority of personal development books and success strategies aren’t designed for the additional challenges depression adds to making progress. The commonly held belief that ‘depression needs therapy, not personal growth coaching’ has led to coaches typically steering clear of the needs of depression sufferers. Yes, therapy is an effective treatment for depression in many cases, but what good is improved functioning if your life is still just mediocre? You deserve to feel better AND create the life you’ve always dreamed of.

This article is for educational and informational purposes only. Always consult a qualified physician or mental health professional if you have concerns regarding your own mental health.