High Functioning Depression: The Hidden Struggle

It’s a question that often bewilders people: How can someone seem to be functioning well, excelling at work, and maintaining relationships while simultaneously grappling with depression? The term “high functioning depression” has been coined to capture this very phenomenon. This is not an officially recognized medical diagnosis but is rather a colloquial term for what experts call Persistent Depressive Disorder (PDD), also known as dysthymia. This form of depression is marked by a chronic but less severe mood disturbance that lasts for at least two years. What makes it particularly perplexing is that people with high functioning depression are often successful in their professional and personal lives, but are internally suffering.

Persistent Depressive Disorder: A Chronic, Lower-Intensity Mood Disturbance

Unlike major depressive disorder, which might incapacitate a person to the point where getting out of bed or engaging in daily activities becomes a monumental struggle, those with persistent depressive disorder often continue to meet work obligations and maintain relationships. However, this doesn’t mean they’re not suffering; the psychological pain is still there, but it’s often overshadowed by their ability to continue with daily life. This form of depression is insidious because it doesn’t necessarily bring life to a grinding halt. Instead, it casts a lingering shadow over it.

The symptoms are often less intense than those of major depression but can include feelings of hopelessness, low self-esteem, lack of joy, and a constant low mood. Because the symptoms are less severe but more chronic, individuals might not even recognize that they are suffering from a treatable mental health condition. This is particularly dangerous because, over time, untreated PDD can severely affect quality of life and even lead to the development of more severe mental health conditions.

Functioning Well, Yet Suffering in Silence

A significant number of people with persistent depressive disorder go undiagnosed because they appear to be functioning well. The stereotype that a person with depression is unable to work, go to school, or maintain relationships often causes those with high functioning depression to go unnoticed. In a society that places a premium on productivity, there is often a perception that if you’re performing well in your job, you must be emotionally and mentally “fine.”

This is a dangerous misconception. Being productive should not be considered synonymous with being mentally healthy. You can be the CEO of a successful company, a straight-A student, or a loving parent and still struggle with mental health. The outer facade of success and competence can often mask a deep-seated struggle with persistent depressive disorder. This facade makes it easy to dismiss one’s own symptoms or for others to overlook the signs that something is amiss.

The Impact on Daily Life: It’s More Than Just “Feeling Down”

Living with high functioning depression affects daily life in subtle yet impactful ways. A constant low mood might make everyday activities seem pointless or less enjoyable. Lack of motivation can result in feeling unfulfilled despite career or academic accomplishments. Relationships can suffer, as emotional withdrawal becomes a coping mechanism to navigate through the chronic feelings of sadness or hopelessness.

The cost of not addressing this form of depression extends beyond the individual and can have a ripple effect on family, friends, and colleagues. From reduced performance at work due to lack of concentration to strained relationships stemming from emotional withdrawal, the repercussions can be broad and deeply damaging.

Why It Often Goes Undiagnosed and the Need for Early Intervention

One of the major barriers to diagnosis and treatment is the social stigma surrounding mental health. Many people fear that admitting to having a mental health issue will cause them to be viewed as weak or unstable. This is even more pronounced in individuals who are successful and fear that a diagnosis will tarnish their achievements.

Additionally, the medical community itself might overlook symptoms in individuals who seem to be functioning well. Standard diagnostic procedures often focus on how much a person’s symptoms interfere with their ability to function, leading healthcare providers to sometimes miss the diagnosis in high-functioning individuals.

Early intervention is crucial. The longer persistent depressive disorder goes untreated, the more difficult it becomes to manage the symptoms and the higher the risk for additional mental health conditions to develop. Treatment often involves a combination of medication, such as antidepressants, and psychotherapy to provide coping mechanisms and tools for managing symptoms. While persistent depressive disorder is chronic and may require long-term treatment, proper management can substantially improve quality of life.

How Do People with Undiagnosed Depression Understand Their Distress? Insights from Research

Understanding the complex experiences of individuals with undiagnosed depression has been a focus of several studies. A particularly enlightening research article titled “I Didn’t Know What Was Wrong:” How People With Undiagnosed Depression Recognize, Name and Explain Their Distress sheds light on this issue. This study emphasizes how people often don’t have the language or awareness to properly identify their symptoms as a mental health issue, specifically depression. It echoes some of the challenges associated with high functioning depression and persistent depressive disorder, as these conditions often go undiagnosed for similar reasons.

The research finds that individuals commonly experience a disconnect between their emotional state and the realization that they may have a medical condition requiring treatment. This is particularly noteworthy as it can lengthen the time between symptom onset and receiving proper diagnosis and treatment. The delay is not merely an inconvenience; it can have severe consequences on one’s overall well-being and may contribute to the development of additional mental health problems.

Contrastingly, another body of research, such as that presented in the American Journal of Psychiatry, has traditionally explored depression through the lens of its more overt symptoms, often associated with the inability to function effectively in daily life. These studies have frequently been the basis for the diagnostic criteria used by healthcare providers. However, the focus on overt symptoms can lead to the underdiagnosis of forms of depression where the individual appears to be functioning well, like persistent depressive disorder or high functioning depression.

The Springer study is significant because it highlights the subjective experiences of people grappling with their undiagnosed condition. Recognizing that many people may not understand their symptoms as indicative of a mental health issue provides valuable information for medical professionals and educators alike. It underscores the need for public awareness campaigns that break down the stereotypes surrounding mental health conditions, in order to reach those who might not even be aware that their struggle has a name, a treatment, and a community of others sharing similar experiences.

Defining Functionality During Recovery from Depression: A Research Perspective

Understanding what constitutes “being functional” during recovery from depression is a critical aspect of both diagnosis and treatment. The research article “Defining and Measuring Functional” explores this topic, emphasizing that functionality is not merely the absence of symptoms but involves a range of abilities that allow a person to effectively manage daily life. 

This could include handling job responsibilities, maintaining interpersonal relationships, and fulfilling household tasks. Traditional indicators of recovery might focus on symptom reduction, like lower levels of sadness or irritability, but this perspective can overlook the broader goal of improving quality of life. 

Measuring functionality often incorporates standardized assessment tools that look at a person’s ability to participate in social activities, complete work, and achieve personal goals. In the context of high functioning depression or persistent depressive disorder, these assessments can be particularly useful to gauge recovery progress, as individuals with these conditions may already be accomplishing basic tasks but still experience an undercurrent of emotional distress. 

The integration of functionality measures into treatment plans can provide a more comprehensive picture of an individual’s mental health state and guide more effective treatment strategies.

Your Struggle is Valid, Even if Unseen

It’s important to remember that mental health is not a one-size-fits-all experience. The absence of severe symptoms does not mean the absence of a legitimate problem. If you or someone you know seems to be functioning well but displays signs of persistent sadness, low energy, or lack of interest in activities once enjoyed, consult a healthcare provider for a proper diagnosis and treatment plan. Your struggle is valid, even if it’s not readily visible to the world.

Authors: Doctor Ashok Bharucha and David Dardashti