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How is high-functioning depression diagnosed?
The signs and symptoms of high-functioning depression
What happens during a major depression episode?
What is high-functioning depression?
High-functioning depression is a lay term sometimes used in clinical psychiatry, but unlike major depressive disorder (MDD), the name for the most common form of clinical depression, it does not denote a formal disorder. People with so-called high-functioning depression are clinically assessed as “depressed” but function relatively normally. They are typically diagnosed with persistent depressive disorder (PDD), which was previously known as dysthymia.
Although not as severe as MDD, high-functioning depression can have serious consequences if not correctly diagnosed and professionally treated. For example, those with high-functioning depression can suffer many MDD symptoms.
PDD should be diagnosed by a qualified psychiatrist or other mental health professional. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the specific symptom criteria that must be met for a formal diagnosis. One notable feature is that the condition lasts at least two years.
How is high-functioning depression diagnosed?
The first criterion for PDD is experiencing depressed mood on most days and for most of each day. The depressed mood must include two or more of the following symptoms:
- Decreased appetite or overeating
- Irregular sleeping patterns, such as insomnia or oversleeping
- Fatigue or lack of energy
- Low self-esteem
- Difficulty concentrating and making decisions
- Feeling sad and hopeless
There are several other criteria that also must be met for a formal diagnosis of PDD:
- The depressed mood characterized by the above symptoms must occur on most days for at least two years, without relief lasting longer than two months during that period.
- The individual must have never experienced a period of mania or hypomania, which are characterized by an unusually euphoric and energetic mood.
- The depression symptoms cannot be better explained by another mental illness, by a medical condition, or by substance abuse.
- The symptoms and depressed mood must cause impairment in one or more areas of normal daily functioning and must cause the individual significant distress.
Notably, a person diagnosed with PDD can also meet the criteria for MDD.
What is the difference between PDD and MDD?
According to the National Institute on Mental Health (NIMH), PDD affects around 1.5% of adults in the US, with women more likely to experience the disorder than men.
MDD, on the other hand, is far more common. In fact, it is one of the most common mental health disorders in the US, affecting around 7.1% of adults across the nation.
A primary difference between the PDD and MDD is duration. For a psychiatrist or other qualified mental health professional to diagnose PDD in an adult, symptoms must have lasted for at least two years, whereas a diagnosis of MDD requires only a major depressive episode lasting two weeks. Such episodes may be separated by gaps of two months or more.
With regard to symptoms, the disorders are similar, so an individual can meet the criteria for both disorders simultaneously.
The signs and symptoms of high-functioning depression
As mentioned above, the symptoms of PDD are similar to those of MDD but generally less severe.
Although they vary across individuals, symptoms often include changes in both eating and sleeping habits, fatigue, hopelessness, low self-esteem, and difficulty concentrating
These symptoms persist on most days, causing a nearly constant depressed mood that lasts for two years or more. While many people with PDD appear to function almost normally, their internal struggle is also nearly constant.
Known the symptoms of high-functioning depression
- Loss of interest in daily activities
- Sadness, emptiness, or feeling down
- Hopelessness
- Difficulty concentrating and making decisions
- Irritability or excessive anger
- Sleep problems
- Tiredness and a lack of energy
- Low self-esteem and high self-criticism
- Avoidance of social activities
- Decreased activity, effectiveness, and productivity
- Feelings of guilt and worry over the past
- Poor appetite or overeating
Causes, risk factors, and complications of PDD
Possible causes
As with many mental health disorders, the exact cause of high-functioning depression is not yet known and it is likely determined by multiple contributing factors. The following are the most common of the known likely causes of PDD:
- Inherited/genetic: High-functioning depression appears to be more common in people with a family history of the condition. However, researchers are still trying to identify the specific genes that may be involved.
- Trauma/stressful life events: As with major depression, traumatic events, such as the loss of a loved one, family conflicts, financial problems, or other experiences that cause overwhelming stress, may cause PDD in some people.
- Biological/changes in brain structure: People with high-functioning depression may have experienced physical or structural brain changes. The significance of these changes remains unclear, but further research may help pinpoint their role.
- Brain chemistry: Brain chemistry is another potential brain-related cause. Recent research indicates that changes in the function and effect of brain chemicals called neurotransmitters may play a significant role in depression and consequently, in its treatment.
Known risk factors
PDD is a chronic condition, often beginning early in life—in childhood, adolescence, or young adulthood. According to mental health researchers, specific factors appear to increase the risk of developing high-functioning depression.
These factors include:
- A first-degree relative (e.g., a parent, sibling, or child) with MDD or another type of depressive disorder
- Traumatic or stressful life events, such as family bereavement, abuse or violence
- Specific personality traits, such as persistently low self-esteem, pessimism, or high levels of self-criticism
- A history of other mental health disorders, such as personality disorders
Potential complications of PDD include…
- Major depression, anxiety disorders, and other mood disorders
- Reduced quality of life
- School- or work-related issues and decreased productivity
- Chronic pain and other medical illnesses
- Other mental health disorders
- Relationship difficulties and family conflicts
- Suicidal ideation (thoughts of suicide) or behaviors
Living with high-functioning depression
Anyone living with PDD is at significant risk of experiencing major depressive episodes. In fact, most people with high-functioning depression will suffer at least one such episode. For some with this type of depression, it may feel as though their persistent, low-level depression could take a turn into severe depression at any time.
However, despite occasional episodes of severe depression, those with high-functioning depression can typically function at higher levels than those suffering from MDD, which in severe cases is completely debilitating.
What happens during a major depressive episode?
A major depressive episode is a period of two weeks or longer in which a person experiences symptoms of major depression, which include
- Feelings of sadness and hopelessness
- Fatigue
- Weight gain or weight loss
- Changes in sleeping habits
- Loss of interest in activities
- Suicidal ideation
These symptoms must be nearly constant throughout the two weeks and cannot be easily mitigated by the individual, even if they seemingly contradict their current circumstances. Major depressive episodes recur periodically in people diagnosed with MDD and less frequently among those with high-functioning depression.
Although there are many individual differences in the symptoms of major depressive episodes, there are distinct differences in the episodes of men and women. Men are more likely to express anger and irritability and will often make risky choices and decisions, whereas women are more likely to feel sad, guilty, and ashamed. In rare cases, a major depressive episode can cause psychotic symptoms, such as delusions and paranoia.
For those with high-functioning depression, functioning drops significantly only during their relatively rare episodes of major depression. At such times, people with PDD may experience the following:
- Poor performance at work or school
- Inability to complete normal responsibilities
- Avoidance of activities they usually participate in and enjoy
- A drop in self-care and personal hygiene
- Social withdrawal
To cope with a major depressive episode, consider the following strategies, even if you feel like nothing will work. These treatment approaches can reduce the severity of symptoms and can even shorten the duration of the episode:
- Therapy sessions: Like a car, people sometimes need tune-ups. When experiencing signs of worsening depression, it is important to talk to a professional.
- Medications: Consider antidepressants to get through the worse of an episode. Follow your medication regimen consistently, even if you start to feel better, and never discontinue an antidepressant without a doctor’s guidance, as quick cessation can cause withdrawal effects.
- Social support: During an episode of major depression, reaching out may be the last thing a person wants to do, but it can help significantly. Connect with family and friends or seek a peer support group.
- Self-care: Extra attention to self-care is important whenever a depressive episode begins. Self-care includes attending therapy or support groups, practicing meditation or yoga, actively challenging negative thoughts, and simply doing activities that are relaxing or enjoyable.
- Healthy habits: Eat a healthy diet, try to get enough sleep, get plenty of exercise, and avoid drugs and alcohol.
- Outside activities: Sunlight and being in nature are proven mood boosters. While they can’t cure depression, they can certainly help.
Author: Modern Recovery Editorial Team
NOVEMBER 24, 2022