What Is High-Functioning Depression?
Photo by Serena Burroughs via Stocksy
Like many other therapists, I’ve had clients who come to therapy and describe themselves as having high-functioning depression. These clients are usually excelling at work, maintaining relationships, and handling daily responsibilities, but internally battling feelings of worthlessness, fatigue, and disconnection from life.
While it might seem harmless to label this as high-functioning depression, it can actually make addressing depression more challenging because it downplays the severity of what often fits the diagnostic criteria for a depressive disorder. It implies that because the person doesn't seem like they’re depressed, their problem can’t be that bad.
The reality is that no one should believe they need to ‘be strong’ or mask their feelings when struggling with depression.
What is High-Functioning Depression?
Depression doesn’t present in the same way for every person. While high-functioning depression is not its own diagnosable form of depression, I’ve found that it usually falls into two schools of thought:
Doesn’t Everyone Feel This Way?
Some people assume they have high-functioning depression because of their perceptions of what is normal. I have had clients with depressive disorders ask, ‘Doesn’t everyone feel this way?’
Depression can distort a person’s thinking, to the extent that it seems perfectly logical to fixate on everything that is and could go wrong. With that mindset, it makes sense to believe everyone else is dealing with thoughts and feelings of meaninglessness and despair.
It can begin to seem like other people are simply handling things better without the understanding that they’re not dealing with the same issues.
The Picture of Success
High-functioning depression is often used as a label for someone who doesn't act the way they expect of people with depression. For many people, the symptoms of depression make it difficult to even get out of bed. But others may seem to represent the picture of success.
Some people struggling with depression manage to maintain high-profile jobs, engage in multiple hobbies, exercise regularly, and spend time with friends.
They may be masking the symptoms of depression which lie beneath the surface. They may just be going through the motions, acting as if everything is fine. The ‘picture of success’ is just that – merely a picture.
For people masking depression, the symptoms might be strongest when they are home alone. With nothing to distract them from the numbness of depression, they become very distressed.
Where Does the Term High-Functioning Depression Come From?
If there is no medical diagnosis for high-functioning depression, where did it originate?
People have likely used these words for decades to describe themselves or others. However, more recently it’s become popular on social media, especially on TikTok. While the intention behind high-functioning depression content isn’t harmful, the spread of the term has certainly fueled stigma.
The concept of high-functioning depression can cause harm by:
Increasing the stigma by implying that depression is not serious if you appear high-functioning
Preventing people from getting help for depression due to the belief that their problem is not severe enough
Making loved ones less likely to become aware of the person’s problem by perpetuating the myth that only one expression of depression is valid
Downplaying the importance of professional mental health care, with the false narrative that depression can be overcome through willpower
Types of Depression
High-functioning depression is not an accurate diagnosis. Typically, it is used to refer to one of two types of depression:
Major Depressive Disorder
Dysthymia (Persistent Depressive Disorder)
Major Depressive Disorder
A person meets the criteria for Major Depressive Disorder (MDD) according to the DSM-5 if they indicate the presence of five or more of the following symptoms during the same two-week period:
Depressed mood most of the day, nearly every day (feeling sad, empty, or hopeless)
Markedly diminished interest or pleasure in almost all activities most of the day, nearly every day
Significant weight loss or gain, or changes in appetite nearly every day
Insomnia or excessive sleeping nearly every day
Observable restlessness or slowed movements
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive guilt nearly every day
Diminished ability to think or concentrate, or indecisiveness nearly every day
Recurrent thoughts of death, suicidal thoughts, or suicide attempts
At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure.
Someone described as having high-functioning depression may be masking the effects of major depressive disorder.
Dysthymia (Persistent Depressive Disorder)
Dysthymia refers to a depressive disorder that is lower in intensity but is persistent. To be diagnosed as dysthymia, it has to have been present for at least two years.
The criteria for Persistent Depressive Disorder (Dysthymia) according to the DSM-5 are as follows:
Depressed mood for most of the day
Poor appetite or overeating
Insomnia or excessive sleeping
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness
Someone who is described as having high-functioning depression may have dysthymia. It may seem less severe, but its persistence makes it an extremely distressing and dangerous disorder.
Can I Diagnose Myself With Depression?
You can find many diagnostic tests online, including the Patient Health Questionnaire (PHQ-9) used by therapists and physicians. This can give you an indication of whether you have a diagnosable disorder. However, there are limitations to self-diagnoses.
Many people who do their own PHQ-9 and come up short of the criteria for a diagnosis find they meet the criteria when they are assisted by a professional. This is because the clinician can offer more context to the questions and get more accurate answers.
This is also why people may read through the symptoms of depression and believe they don’t apply. If you think that what you are feeling is normal, for example, you would not characterize it as a ‘depressed mood.’
While information can give you more insight into a mental health issue, you need to see a licensed mental health professional for a diagnosis. If they do diagnose you with depression, they will be able to guide you to find the best treatment.
How to Treat High-Functioning Depression
The treatment for depression differs according to the circumstances, but usually includes medication or therapy, or a combination of both.
Someone who is looking for treatment for high-functioning depression may be resistant to taking medication off the bat. The belief that depression needs to be debilitating to be taken seriously leads people to hope they can ‘just get over it.’
Therapy can be the perfect starting point, as it gives the person the opportunity to explore what they are going through. The non-judgmental stance of the therapist provides them space to view their experience more objectively.
Octave has hundreds of therapists who specialize in treating depression.
While high-functioning depression is not an official diagnosis, the term can be problematic, as it gives the impression that depression is not as bad as long as the person appears to be doing okay. The reality is that someone who seems to be high-functioning may simply be masking their symptoms.
If you or a loved one has what seems to be high-functioning depression, seek professional help.
Where to Get Help
If you or someone you know is in crisis, here are resources for 24/7, free and confidential support, suicide prevention resources, and education around mental health illnesses.
Suicide & Crisis Lifeline
The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.
Call 988
The Trevor Project
The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people under 25.
Call 1-866-488-7386
Veterans Crisis Hotline
Connect with the Veterans Crisis Line to reach caring, qualified responders with the Department of Veterans Affairs. Many of them are Veterans themselves.
Call 800-273-8255 and press 1
Crisis Text Line
Text from anywhere in the USA to text with a trained Crisis Counselor. Every texter is connected with a Crisis Counselor, a real-life human being trained to bring texters from a hot moment to a cool calm through active listening and collaborative problem solving.
Text TALK to 741741 to text with a trained crisis counselor.
Full List of Suicide Prevention Resources provided by American Foundation for Suicide Prevention