The term "high functioning depression" has made its way into mainstream vernacular over recent years. It is not an actual clinical diagnosis; instead, it is a lay term that in most cases describes individuals who, based on external markers of success appear to be functioning well, but internally are battling symptoms associated with milder forms of clinical depression.
I do not fully subscribe to this term for a number of reasons, one of which is the incorrect assumption that high functioning depression is synonymous with the clinical diagnoses Persistent Depressive Disorder (defined in the DSM 5) or Dysthymia (defined in the DSM-4)
both of which are mild, longer-lasting forms of depression. I've seen this correlation made in dozens of online resources, from clinicians and non-clinicians alike.
Defining high functioning depression as mild is misleading. It assumes incorrectly that if a person is depressed and continues to function well enough in their career and relationships, that they must not be that depressed, and therefore not deserving of serious attention or treatment.
Defining high functioning depression as a mild form of depression is misleading. It assumes incorrectly that if a person is depressed and continues to function well enough in their careers and relationships, that they must not be that depressed, and therefore not deserving of serious attention or treatment.
In reality, depression in a high functioning individual is not necessarily mild at all. Many high functioning people possess such excellent coping and compensatory strategies that they are able to perform the duties expected of a well-adjusted adult even while they are suffering significantly with their depression. Examples include Dr. Lorna Breen, MD who went to work everyday serving as an emergency medicine physician and medical director at a New York hospital. She worked on the frontlines of the Coronavirus pandemic, returned to work after contracting and recovering from the virus herself, only to tragically succumb to a more insidious and silent killer, depression, when she committed suicide in April 2020.
In reality, depression in a high functioning individual is not necessarily mild at all. Many high functioning people possess such excellent coping and compensatory strategies that they are able to perform the duties expected of a well-adjusted adult even while they are suffering significantly with their depression.
Depression in high functioning individuals is an important topic that is often overlooked for reasons we have already reviewed. Even the individuals suffering themselves sometimes struggle to identify their own depression, and instead relate their issues to non-mental health explanations that they (or society) may find more acceptable. There is also the assumption, driven by movie portrayals and general misinformation, that depression always looks like someone sitting in the corner of a dark room, isolating and not taking care of themselves, unable to work or function, crying all day, and contemplating suicide. In reality, depression can take many different forms and be difficult to spot, especially in high functioning people. Getting help starts with recognizing the symptoms of depression. Here are some signs that you may be depressed, even though you are high functioning:
1. You often wake up sad, or angry, or both. Even before the day has begun, you are filled with dread about what lies ahead. You may have moments when you temporarily feel better, but most of the time you struggle with negative thoughts and emotions.
2. You drag yourself through your day. You go to work. You take care of your
family. You do all the things. But everything just feels so hard to do, like you're wading through a pool of molasses. You push through because that is what is expected of you, not because you want to. You may feel you are going through the motions, without experiencing much pleasure.
3. You’re always exhausted. You may sleep too much or not sleep enough. Either way, you're always drained. You view sleep as a welcomed escape from your reality. You sometimes secretly think that you wouldn’t mind if you never woke up.
4. You spend weekends isolating yourself. Yes, during the work week you do what is expected of you. The pressure of your job pushes you, your fear of failure and disappointing others drives you. Your work maybe a welcomed distraction for you. But as soon as those external pressures are lifted, you struggle to find any internal motivation to do anything else. You bury yourself in as much mindless inactivity as you can stand.
5. You struggle with feeling guilty, inadequate, hopeless or like a failure. You blame yourself when things go wrong. You are unyieldingly tough on yourself, believing you deserve harsh treatment when you don't live up to your high standards. Friends say you're perfectionist. When you fall short of your ideal outcome, you are filled with feelings of self-blame, hopelessness and failure.
6. You’re easily irritated. Everything and everyone gets under your skin. You snap at the people you love the most. You then tell yourself you’re a bad person because you snapped. You feel worse.
7. You struggle to make decisions. You feel distracted and unfocused. Your mind spins with confusion and indecision leading to inaction, overwhelm and guilt. You're certain you have ADHD.
8. You eat (or drink alcohol) to feel better, not because you’re hungry. Food and alcohol are your friends. They soothe your emotions, or help you avoid them altogether. You may gain weight as a result, and feel badly about it, leading to more emotional overeating.
9. You’re really good at hiding. You smile, joke, tell yourself and others you're fine. You are afraid to let anyone know how you're really feeling because they wouldn't believe someone who is so put-together may be suffering inside. Or you worry about the ramifications on your job or reputation if you admit to or seek help for depression.
10. You have a perfectly good explanation for all of these symptoms; and none of your explanations include depression. You tell yourself that your irritation is because people are annoying. You convince yourself that the only reason you wake up frustrated is because your job stinks, you haven’t achieved your goals because you’re lazy and need to "get it together", you drink too much because you deserve to treat yourself after a hard day. All of these explanations feel more acceptable to you than a mental health struggle like depression.
If these signs resonate with you or someone you care about, please don't ignore them or explain them away. Share this article. Seek out a mental health provider (therapist, psychiatrist) for help and support. You don't have to travel this road alone.
You've got this!
Dr. Jeannie
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