Understanding & Healing From High Functioning Depression​

Going through life with major depression can be an isolating experience, especially when it doesn’t show up in the ways we expect. With high-functioning depression, it can feel like you’re doing everything right and still suffering. That’s because, generally, the symptoms don’t become so debilitating that they manifest externally.

You may find yourself still going to work, completing tasks, and even participating in social activities. And yet the negative effects are still there. From a lack of energy to feelings of hopelessness, depressive symptoms can escalate when ignored. Conversely, acknowledging and addressing a high functioning depressive disorder is how we can start to take back control of our lives.Understanding high functioning depression is the first step towards:

• Coping with internal and external symptoms
• Treating the underlying mental health condition
• Healing in a way that creates freedom in your life

In this post, we’re going to break down everything you need to know about high-functioning depression.

Let’s jump right in.

Understanding high-functioning depression

To understand high-functioning depression it helps to isolate the first half of the term. Contrary to a lot of online discourse, “high-functioning” doesn’t mean living at an optimal level. The term describes a much broader spectrum.

From an outside perspective, people with high-functioning depression can be perceived as happy and “successful”, but the condition typically conceals an internal suffering, including symptoms ranging from chronic sadness to concentration difficulties to suicidal thoughts.

The Demographics of High functioning depression

High functioning depression is a mental health issue that tends to rick its sufferers into believing they have no need for help. It affects people of all age groups and nationalities, but it is more common in women than men.

The National Institute of Mental Health (NIMH) reports that major depression affects 6.7% of American adults. Those who are most at risk are people who report having multiple (two or more) races.

People with high-functioning depression may share the psycho-demographic traits of finding it difficult to recognise their own condition. They may believe that they are just feeling sad, but not depressed. Since their symptoms typically aren’t as self-limiting as those in other types of depression, people with high-functioning depression are less likely to seek help on their own.

What does it feel like?

As we’ve seen a useful way to view “high-functioning” is as a mental health condition that’s difficult to detect. That’s because our ability to function is based on the severity of the symptoms, not our internal will or motivation. When depressive symptoms are present, but not visible, it’s harder to be aware of what’s affecting you.

As for the second half of the term, here’s a helpful definition from our post on how depression feels:

Like “high-functioning”, the term describes a spectrum. How we experience depression is unique to everyone. High-functioning depression manifests in a range of unique depressive experiences of varying severity.

As psychiatry and neurology professor Dr Carol A. Bernstein notes:

“The question with depression is for how long, and how much does it interfere with our capacity to go on with life?”

So, in terms of high-functioning depression what does that interference look like internally and externally?

The answer to this can be extremely complex. Let me share a personal story to help explain:

A while back I was struggling mentally. Yet at the same time, I thought I was managing life. I didn’t realise this is what it meant to be high-functioning. I knew the lack of energy and feelings of sadness throughout the day were a form of depression. However, I also thought just doing things was a sign I was getting better.

I only labelled the depressive symptoms that stopped me from functioning. This created a lot of confusion which I could mask in public. Privately, internally, my mood and energy were still low, and it led to chronic unhappiness.

Enjoying things became hard, even when I wasn’t expected to “function” because hiding depression is exhausting. There were personal, emotional, and social reasons for doing it, but they only made it worse. It’s a slippery slope similar to how social pressure to hide signs escalates.

What high-functioning depression looks like on the outside

As chaotic as high-functioning depression feels inside, the outside picture can present very differently. The signs people associate with chronic depression usually aren’t visible. People may assume you’re fine, when, really, you’re not.

This can make you doubt your struggles or feel isolated. Externalising that pain can sometimes seem like inappropriate or “over-emotional” expressions of anger or irritation. Such outbursts can be misunderstood by others and stir feelings of guilt because it can seem like you’re randomly lashing out, but it’s not random.

It’s important to note that while depression can trigger angry outbursts and emotional displays, neither anger not emotional displays are integral symptoms of high-functioning depression. It can manifest in many ways.

So, what signs should you watch for?

High-functioning depression is hard to spot unless people look for it. Knowing the symptoms is vital. It’s best to deal with them while feelings are still manageable.

But how do these symptoms usually present?

There are a few key symptoms that people with high functioning depression show that may be either overlooked or misunderstood as they do not fit with stereotypical images of depression.

These include:

• Inability to concentrate
• Lack of enjoyment in things you used to enjoy
• Decreased interest in socialising or doing anything fun
• Sleep disturbance
• Decreased motivation
• Concentration difficulties
• Irritability or feelings of anger when there’s no apparent cause
• Feelings of guilt, hopelessness and worthlessness, even if you have achieved a lot in life
• Racing thoughts
• Feeling like there’s no point in carrying on and that nothing you do is effective
• Difficulty working out what you need to do or how to spend your time

What causes high-functioning depression?

There are various causes of depression. Prolonged emotional distress is a common cause, as is the experience of a traumatic event such as the death of a friend or family member. Trouble coping with anxiety, PTSD, pre-existing mental illnesses, a poor diet or just too much exposure to social media can all trigger depression.

Family history can play a role. The Stanford School of Medicine researched the heritability of major depression and estimated that up to 50% of cases could be genetic. However as the research concludes, “no one simply “inherits” depression from their mother or father. Each person inherits a unique combination of genes from their mother and father, and certain combinations can predispose to a particular illness.”

Other risk factors of developing depression in adulthood are the loss of a parent in childhood or being abused as a child. Giving birth (postpartum depression), seasonal changes (Seasonal Affective Disorder), alcohol abuse and medical problems can also cause depression. 

Knowing what contributes to and exacerbates feelings of hopelessness or chronic sadness helps us identify and hopefully minimise exposure to the external factors that trigger us. It can be all too easy to miss certain triggers especially the ones we engage with daily. 

The bottom line is: neuroscientists still don’t fully understand what happens in the brain when we become depressed or exactly what causes depression. And of all the several known risk factors for developing depression usually, more than one is involved when a person becomes depressed. 

Whatever the cause, anyone struggling with a high-functioning depressive episode deserves a great deal of self-care and genuine social support.

How to treat high functioning depression?

There are many ways to treat depression. Some people prefer medication, some look to tDCS. For others lifestyle changes or talk therapy are more effective options. What is certain is that most treatments work better in combination. Working with a licensed psychologist or psychotherapist, can help you understand the root of your depression and provide support as you find the complimentary treatment or combination of treatments that works best for you.

Overcoming the mental health stigma

Do you ever feel as if you’re faking it until you make it throughout the day? Well, you aren’t alone.

In a 2021 study, 22% of US college students reported severe depressive symptoms during the 2020-2021 academic year. A further 19% reported experiencing moderate depressive symptoms. Almost half the respondents reported as struggling with some form of depression, ranging from feelings of sadness to thoughts of suicide.

The truth is that depressive disorders affect more people, who on the outside seem to be doing well, than we realise. Unfortunately, stigmas around mental disorders in general shame people into hiding their struggles. 

According to a team of researchers from King’s College London, Harvard Medical School and the World Health Organisation, in the world’s richest countries, only one in five people received minimally adequate treatment during a 12-month period.

But avoiding help and missing out on treatment only invites further risk.

Risks of untreated high-functioning depression

Disclosing that you’re struggling with depression isn’t easy, and that’s understandable. Even among family, colleagues, and friends, reaching out can feel difficult. The support of a mental health professional, meanwhile, is not always accessible. 

Yet not reaching out, and delaying treatment options can prolong and elevate symptoms. A recent study found that the length of time depression went untreated was the strongest indicator of how severe future symptoms would be. 

In simple terms, untreated depression only gets worse with time. High functioning depression, almost by definition, can tend to continue on a long time.

Challenges of living with high-functioning depression

Because untreated symptoms worsen with time, the trouble with high-functioning depression is that you eventually lose function over time. This loss can come so gradually that you don’t notice until you’re left in an impossible position. 

This escalation makes managing your emotions and relationships more stressful and can warp your sense of reality. You may end up seeing yourself as a burden, but you’re not. You’re simply dealing with a mental health condition that’s both complex, stigmatised, and untreated. 

Ok, you’ve read the signs and are ready to look for help…so, what kind of tools and support are available?

Coping tools

Coping with high-functioning or any kind of depression means finding healthy ways to reduce its impact on you. This differs from hiding it, which buries symptoms. Instead finding methods that make daily life easier will move us towards long-term healing. Here are the methods we recommend.

Practice meeting small goals daily. This can seem counterintuitive because high-functioning depression affects you without being debilitating, but the goal here isn’t simply to function. Depression impacts our motivation and self-worth. Small goal-based activities give you a sense of achievement without taxing your energy reserves. 

Rest when you need to. Your ability to function wanes the longer depression persists, so sometimes the best thing to do is just rest. Pushing through depressive symptoms might get something done now, but the cost can carry over into the next day and create a spiral. 

Add exercise to your daily routine. It doesn’t have to be a strenuous activity. In fact, it should be something you enjoy that you can do every day, even if it’s just for a few minutes. Physical exercise offers mood-boosting effects and helps with regulating sleep. 

Practice mindfulness. Mindfulness is the process of regaining control of your thoughts and emotions to better care for your mental wellbeing. For help incorporating mindfulness, try our 10-minute meditation guide.

Treatment options

Most experts agree that the best approach to clinical depression is to find the right treatment combination that tackles both the biological and behavioural aspects for each individual. Where coping methods are things you can do on your own, treatment often requires a professional. Starting your journey to recovery from depression can be scary, but mental health professionals spend their lives learning how to help you. They’re on your side, ready to support. 

In terms of combined approach, efficacious options include:

Cognitive Behavioural Therapy (CBT). CBT helps you break cycles of negative thought and establish healthier behavioural routines. It’s a psychotherapy treatment that, with the support of a mental health professional, encourages us to be more aware of our thoughts, emotions, and beliefs, and reshape how we process them to support the healing journey. We made a free app based on Behavioural Therapy which you can download here (It’s 100% free forever!)

Transcranial Direct Current Stimulation (tDCS). tDCS is a non-invasive brain stimulation technique that treats depression via a gentle current that stimulates activity in the brain. In the treatment of depression, this is usually to stimulate an underactive dorsolateral prefrontal cortex. Validated across the past decade, you can now access the technique easily with our portable tDCS headset; medically approved for home use.

Antidepressant medication. With the help of a psychiatrist, depression can be treated with antidepressants. Both CBT and tDCS can be combined with antidepressant medication. Before choosing this treatment option, make sure to discuss side effects and withdrawal symptoms with your doctor.

Supporting a loved one with high-functioning depression

If you have a loved one struggling with high-functioning depression, here are some ways to support them. 

Keep in mind that depression changes the way people think. Psychologists refer to this phenomena as cognitive distortion. A depressed person may interpret neutral events as negative. For example, someone says you look good, you think they don’t mean it. Or your boss tells you how great your work was, you tell yourself anyone could have done it. You have a disagreement with a loved one, you tell yourself it’s because you are a failure. Depressed people inherently read ambiguous cues in a negative way. 

Separate the person from the symptom. When supporting a loved one, try not to attach blame to either of you. This helps reduce stigma because it avoids conflating symptoms with character.

Ask for help. Helping a loved one cope with depression can be a complex puzzle, but you don’t need to solve it alone. It is important to ask for help for you when you need. It is not always an easy step, but it can be an immensely important one. Here’s some of the best advice from our psychologists on how to help someone with depression.

What now?

High-functioning depression is a real issue for many people. If you are one of these people, know that there’s always a reason to hope. There are coping tools, treatments and people out there ready to support your recovery. It’s never too late to acknowledge the signs and reach out. 

Managing and healing from high-functioning depression is a journey, but it need not be a lonely one.

Need help now? Try our free depression app and access over 50 virtual therapy sessions, a comprehensive treatment program, and symptom tracker to guide you to better mental health.