What Does High Functioning Depression Look Like: An Invisible Illness

Asma Rehman, LPC
Latest posts by Asma Rehman, LPC (see all)

When you think of someone with depression, what do you imagine?

A stock photo that shows a Black woman sitting hugging her knees to her chest under a work desk, looking stressed. Most of us probably think of someone who is frequently sad or down and who isn’t able to go about their day to day life without serious impairment. That is indeed many people’s experience of depression. Not everyone experiences depression in the same way, however.

One mental health disorder that is often overlooked is high functioning depression. Some people even call high functioning depression an invisible illness, because it’s so tough to spot when someone is struggling.

Is high functioning depression a diagnosis?

Persistent Depressive Disorder (PDD), is the diagnosis that most closely aligns with high functioning depression. PDD is basically chronic depression, whereas major depressive disorder tends to have periods of intense depression between periods of normal functioning.

To be diagnosed with Persistent Depressive Disorder, a person must experience multiple symptoms of depression for at least two years. The National Institute of Mental Health’s research shows that around 1.5% of adults in the US experience PDD each year.

Generally PDD isn’t thought to be as debilitating as a major depressive episode, but the severity can actually range from mild to severe. High functioning depression, like Persistent Depressive Disorder, is often hard to spot because the people who live with it are often skilled at masking their symptoms.

Symptoms of PDD are similar to Major Depressive Disorder (what you might think of as “classic” depression), except that they occur for at least two years persistently instead of lasting for periodic episodes.

Some of the symptoms of high functioning depression are:

  • Feeling sad or hopeless
  • Changes in eating
  • Changes in sleep
  • Mood swings
  • Irritability
  • Self-esteem issues
  • Withdrawing socially
  • Crying
  • Lack of energy
  • Difficulty focusing and getting things done

Why do some people function differently with depression?

In mental health diagnoses, a person’s functioning is often considered. When a person is able to get things done and meet expectations in most or all areas of their life (job, school, social life, relationships, etc), they are considered to be more high functioning than someone who is severely impaired in several spheres of life. A stock photo that shows a Black man in sitting at a work desk with his head in his hands like he's overwhelmed.

There is a difference between high functioning and fully functioning though. Even if you’re able to do everything you need to do and meet all of your responsibilities, you might not be able to do things well. You might feel drained or like you’re going through the motions.

Why is it hard to recognize high functioning depression?

There are a few reasons why it’s tricky to recognize when someone is dealing with high functioning depression.

Unfortunately, part of why it’s hard to recognize PDD is because of stigma. There are common stereotypes about how depressed people behave, and often we expect someone with depression to be unable to function. People with PDD are often forced to find ways to go about their daily lives while managing their symptoms, so they appear to be functioning to others while on the inside, they’re suffering.

As with any chronic illness, chronically depressed people have to find ways to keep going with their lives.

People develop skills to cope with their Persistent Depressive Disorder because they usually don’t have other options. Even if you don’t feel great a lot of the time, there are still bills to pay and responsibilities to take care of.

PDD isn’t static. The symptoms and severity of high functioning depression often ebb and flow. The intensity of a person’s PDD isn’t always disruptive to the point where it would show up on a traditional depression screening.

A stock photo that shows a white woman sitting on a bed with her computer on her lap, sitting next to a small dog with its ears perked up. The woman looks stressed. The stigma and shame around being someone with depression who can function in some ways keeps people from seeking treatment. They may feel that things aren’t “bad enough” to warrant treatment even though treatment can be helpful and improve quality of life.

If your quality of life is impacted by PDD you deserve treatment. Just because you can function doesn’t mean you’re functioning at a level that works for you. You don’t have to suffer through it.

If I have high functioning depression, or Persistent Depressive Disorder, what can I do?

If left untreated, high functioning depression like PDD can develop into Major Depressive Disorder, which is often more disruptive to daily life and more severe. Untreated Persistent Depressive Disorder can also lead to substance use, and cause suicidal thoughts or behaviors.

Treatment for high functioning depression is very similar to treatment for classic depression – talk therapy, medication, self-care, and community support all play a role. Finding the right medication can take some trial and error, but can really help with the symptoms of depression. Talk therapy can help you explore your patterns and thoughts to find what is working for you and what isn’t. Working with a therapist can teach you new ways to cope that feel more supportive and help validate your experience with high functioning depression, which often goes unnoticed.

Self care is important when you’re dealing with any mental health issue, especially one that is chronic like high functioning depression.

Make sure you get plenty of quality sleep each night. Try to stick to a bedtime routine like avoiding screens before bed, limiting caffeine, and going to bed and waking up at the same time each day. Take time regularly to move your body in ways that feel good and nourishing to you. Exercise has many benefits, but it doesn’t have to be punishing or miserable to be worthwhile. Find something that you look forward to so you’ll want to do it often. Connecting with your body during movement can help you assess how you’re feeling and what you need to feel better. A stock photo of a man with brown skin leaning back in a chair at a conference room table, running his hand over his face.

Finally, we all need community. We are social creatures, and we need connection with others to heal. Even if you don’t feel ready for depression treatment, don’t hesitate to reach out for support from loved ones and your community. It’s okay to ask for help and seek comfort from those around you.

If you’re struggling with high functioning depression, reaching out to a depression support group can also be beneficial. Depression treatment like talk therapy can help unravel unhelpful thinking patterns and develop coping strategies. Our Houston therapists can guide you through this journey. Contact us today to begin.

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