What Does It Mean to Have High Functioning Depression

When most of us think about depression, we picture someone unable to get out of bed, overwhelmed by sadness or isolated from the world. While this is a reality for many, there’s another side of depression that often goes unnoticed – high-functioning depression. 

This quieter form of the condition allows people to keep up with daily responsibilities, such as going to work, taking care of their families or maintaining social relationships, all while privately battling feelings of emptiness, fatigue and self-doubt. Understanding high-functioning depression is crucial, as it sheds light on the hidden struggles of those who seem to have it all together on the surface. This blog will explore how it works, what it looks like and why awareness matters.

What is high functioning depression?

A closer look: High-functioning depression is a colloquial term, often associated with Persistent Depressive Disorder (PDD), also known as dysthymia. It refers to individuals who manage to maintain their work, relationships and daily routines despite experiencing depressive symptoms.

Depression isn’t always visible, and that’s an important truth to understand. 

• Some people may be deeply struggling internally while maintaining an outward appearance of stability and control.
• This ability to “mask” symptoms or appear high functioning is why depression can go unnoticed, even by close loved ones.

Unlike major depressive disorder, which can be debilitating, high-functioning depression allows people to "function" in society, though they may struggle internally.

• That said, the term "high functioning" can downplay the severity of the condition, leading people to dismiss their symptoms or avoid seeking help.
• Because they continue to meet societal expectations, the depression is often invisible and goes unnoticed by others.

Characteristics and traits

Persistent low mood is defined by a constant sense of sadness, emptiness or hopelessness that lasts for years.

• This low mood is less intense than major depression but is chronic and pervasive.

Fatigue and low energy is common.

• Chronic tiredness and lack of motivation is common, even if the person appears productive.

Difficulty concentrating at work or school typically shows up.

• Some people struggle with focus, decision-making and memory.

Changes in sleep and appetite are frequent symptoms.

• Some people either don’t sleep or oversleep, while others eat too much or too little.

Feelings of guilt or worthlessness tend to hover.

• A persistent sense of inadequacy or self-criticism is common, even when achievements are evident.

Social withdrawal can coexist even if people still maintain relationships.

• They may hang out in group settings, big or small, but often feel disconnected or isolate themselves emotionally.

Masking symptoms

• They may appear outwardly successful, cheerful or "put together," masking their internal struggles.

Physical symptoms can accompany the emotional side of depression.

• Some people experience headaches, digestive issues, aches and pains, inflammation or sexual health problems.

Treating high-functioning depression

Key points: Living with high-functioning depression can feel like walking a tightrope – you fulfill daily responsibilities while privately grappling with an ongoing sense of sadness, fatigue and disconnection. While it's tempting to try to “fix” things on your own, professional help is key for managing any type of depression.

Therapy (either in person or online) is often the first and most effective step for managing high-functioning depression. 

• Cognitive behavioral therapy (CBT) is one of the most common therapies for depression, as it focuses on identifying and changing negative thought patterns and behaviors that contribute to depressive symptoms.
• Interpersonal therapy (IPT) focuses on improving communication and relationships, which can help alleviate feelings of isolation or disconnection.
• Psychodynamic therapy involves exploring past experiences, unresolved conflicts or deeper emotions that may be contributing to depression.
• Behavioral activation focuses on encouraging re-engagement with activities people used to enjoy to combat lethargy and disinterest caused by depression.

Medications can work in conjunction with therapy to address symptoms.

• Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants such as sertraline (Zoloft) and fluoxetine (Prozac) that work by increasing serotonin levels in the brain.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) or venlafaxine (Effexor) help regulate both serotonin and norepinephrine.
• Bupropion (Wellbutrin) targets dopamine and norepinephrine, which can be particularly effective for individuals who experience low energy and motivation.

Further reading: Neurotransmitters are brain chemicals that work together every second of your day to regulate your mood, perception and view on life. Learn more about the four types of “happy chemicals.”

Tips to stay productive while managing depression

Why it matters: Living with depression can make even the simplest tasks feel overwhelming. However, with the right strategies and mindset, you can take steps to be productive each day while caring for your mental health. 

Start with small, manageable goals.

• Large tasks can feel burdensome, so divide them into smaller, achievable actions.
• Begin with tasks that take two minutes or less, as completing simple actions often builds momentum for bigger tasks.
• Focus on a few key things you want to accomplish each day and label them as "essential" to cut down on decision fatigue.

Create gentle routines that are easy to achieve.

• Start with a wake-up and wind-down routine to bring structure to your day – routines reduce the pressure of decision-making when you’re feeling low.
• Dedicate specific time slots for prioritized activities and set realistic durations.
• Allow wiggle room in your schedule so that it doesn’t feel rigid or overwhelming. 

Practice self-compassion even if you don’t achieve everything on your list.

• Remind yourself that progress is more important than perfection.
• Acknowledge small victories, like making a meal or answering a phone call.
• Challenge the inner critic by focusing on what you can do instead of lingering on what you didn’t do.

Prioritize self-care by taking care of what you put into your body and how you look after yourself.

• Depression often impacts appetite, so aim for balanced, simple meals that contain whole grains, lean proteins, omega-3 fatty acids and leafy greens.
• Move your body, whether that’s a walk around the block or yoga, to boost endorphins without overwhelming you.
• Create a calming bedtime routine, limit screen time before bed and practice relaxation techniques like deep breathing.

Stay organized by writing goals down or setting reminders.

• Use a planner, smartphone app or sticky notes to jot down your tasks for the day.
• Use phone alarms to prompt breaks, meals or specific tasks so you can stay on track even if your focus dips.

Gradually incorporate positive habits and focus on one change per week.

• Pair small habits with things you already do.
• For example, practice deep breathing while your morning coffee brews or stretch after brushing your teeth.

Next steps: Your primary care physician is a trusted partner in your path toward better mental health. They can provide guidance, discuss treatment options and connect you with additional resources to support healing.

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Contact your primary care physician for more information or to refer you to a mental health provider. Don't have one? Find the right doctor for you in the link below.

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