Now, more than ever, many of us are finding ourselves feeling in a funk, out of our element, and at struggling to have enough energy to push through the day. Life in self-quarantine has quickly brought on a whole new set of challenges for all of us, especially those already struggling with mental health concerns on our best days. The challenges many are expressing in the difficult times has got me thinking about mental health stigma, and societies’ perception of what mental illness is “supposed to” look like. Specifically, how depression manifests itself and the impact it can have on an individuals’ life.

The American Psychiatric Association (2013) refers to depression as a “common and serious medical illness that negatively affects how you feel, the way you think and how you act.” Depression brings on feelings of sadness and anhedonia (loss of interest in activities one typically enjoys). It can create a variety of emotional or physical problems and have a significant impact on all areas of functioning. This can become a barrier in some people being able to work, have relationships, take care of their physical and emotional needs. In severe cases, depression can trigger feelings of hopelessness, helplessness, and even thoughts of suicide or suicidal actions/gestures. However, because depression can range from mild to severe in severity, at times, depression is not as obvious. Individuals may be very good at masking their symptoms and be generally highly productive in all areas of functioning. Due to their ability to appear “okay” from an outside perspective, sometimes those with high functioning depression can be made to feel like they aren’t entitled to struggle. Others may unknowingly be dismissive of what they are going through, or not even recognize it at all. This does not mean, however, that it is any less of a concern or undeserving of validation and treatment.

Defining “High Functioning” Depression

Bearing in mind that depression occurs on a severity scale, mental health clinicians have to be careful in their strategies for screening for symptoms. For many reasons, individuals may even present to counseling for other concerns (grief, relationship/marital concerns, job stress, etc.) and not recognize depression as an underlying condition. Mental health clinicians are able to more accurately measure what’s happening for someone by conducting formal and informal assessments, which allow for a deeper exploration of thoughts, feelings, and functioning. It is through these measures that we’re able to recognize what may easily be missed. This allows for improved opportunities for effective treatment and coping strategies that can help clients to understand what they’ve been struggling with.

Some clinicians are looking at “high-functioning” depression as similar to a form of depression called dysthymia or, persistent depressive disorder. This disorder is characterized by depression which may not be intense enough to noticeably affect one’s ability to perform daily tasks at work and home. Nonetheless, the symptoms observed are the same as those found in individuals struggling with major depressive disorder, including:
• Persistent feelings of sadness, emptiness, and anxiety
• Feelings of hopelessness, or overall pessimism
• Bouts of unexplained irritability
• Feelings of guilt, worthlessness, or helplessness
• Anhedonia
• Low energy, fatigued
• Restlessness
• Decreased/increased appetite and weight changes
• Suicidal thoughts or gestures
• Somatic symptoms, such as unexplained headaches, body pains, or digestive issues

It is also important to note that for some people with “high-functioning depression” or dysthymia, they may also find that they experience periods of major depression episodes. During these times, there may be a greater severity in symptoms which can result in impairments in areas of functioning, or even thoughts of suicide. For example, someone struggling with dysthymia may generally always make it to work consistently and on time and be able to come home with enough energy to take care of their home and family. However, during a major depressive episode, they may find themselves calling in sick to work due to feeling exhausted and unable to get out of bed, or unable to complete tasks such as personal and home hygiene.

Who’s at Risk of “High-Functioning” Depression?

The label of “high-functioning depression” does not stipulate a thriving career or additional mental health issues. People with this type of depression, however, are likely to be successful, ambitious, perfectionistic, lonely, or anxious. These traits are often related to depressive thinking and behavior. Wright offered some examples in her piece about high-functioning depression:
• Relentless self-criticism and doubt
• Feelings of guilt and worry over the past and future
• Seeking perfection in work and life
• Inability to rest and slow down
• Upset by small issues

When people are ambitious and expect a great deal from themselves, they can feel depressed when they fall short of unreasonable goals. Such is the nature of perfectionism. Nothing feels like enough. There is an anxiety about whether they will be able to obtain everything they want — or if they are good enough to deserve their desires. Career-driven lifestyles can breed loneliness and frustration.

Anyone may be susceptible to this form of depression, given their family and personal genetic history and other factors. However, individuals struggling with this type of depression are often those whom are successful, ambitious, perfectionistic, or generally anxious. These types of personality traits, often found in Type A individuals, can be related to depressive patterns in thoughts and behavior due to high levels of stress and feelings of pressure to continually achieve. Some individuals with these personal traits may exhibit:
• Patterns of self-criticism
• Easily reactive or frustrated by small stressors
• Chronic feelings of anxiety and worry, related to both past and future
• Difficulty with rest and relaxation—never slowing down

What Can I Do?

While those with a “high-functioning” form of depression may be better able to function as a whole, they are also less likely to receive treatment or support. Given that they are able to remain productive, social, and maintain relationships it’s easy for friends and family to fail to recognize the warning signs. As a result, it is unfortunately common for affected individuals to make the incorrect assumption that struggling is just a necessary part of life. If you find yourself having symptoms of depression and feel unsure of how to reach out for fear of being misunderstood, invalidated, or supported—don’t lose hope. Please contact Life Enhancement Counseling Services today at 407-443-8862 to schedule an appointment with one of our experienced Orlando mental health counselors. You deserve to feel balanced and able to enjoy your life, especially during this difficult time where stress and isolation have added to life’s typical challenges.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013.

Rausch, J. (2017). The Talkspace Voice. What is high functioning depression? Retrieved from https://www.talkspace.com/blog/what-is-high-functioning-depression/