High-Functioning Depression


NOVEMBER 24, 2022

High-Functioning Depression

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High-functioning depression is a lay term often used in clinical psychiatry, but it is not a recognized disorder in itself, unlike “major depressive disorder” – the most common form of clinical depression.

However, people with high-functioning depression – who are clinically assessed as being “depressed” and who are still able to function relatively normally – are typically diagnosed with the medical condition “persistent depressive disorder” – often abbreviated to PDD, and previously known as “dysthymia.”

Although not as severe as major depressive disorder (MDD), without a correct diagnosis and professional treatment, high-functioning depression can have serious consequences. For example, individuals with high-functioning depression still suffer many of the symptoms of MDD.

These symptoms are normally milder and less intense as MDD symptoms, but in themselves, they can still heavily impact an individual’s daily life.

It is possible for an individual to experience symptoms of both disorders at the same time – persistent depressive disorder / PDD, and major depressive disorder / MDD.

Furthermore, it is even possible to be diagnosed with both disorders at the same time.

To the outside world, someone with high-functioning depression may appear to be fine – hence the expression “high-functioning” – but, in reality, they are struggling with a mental health condition that significantly lowers their quality of life.


    What is High-Functioning Depression?

    High-Functioning Depression

    High-functioning depression is typically diagnosed as persistent depressive disorder / PDD – a recognized mental health disorder that should be diagnosed by a qualified psychiatrist or other mental health professional.

    Specific criteria, as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), exist to describe the symptoms of the disorder, and these need to be met for a formal diagnosis to be made.

    As we mentioned previously, many of the symptoms are similar to those used to diagnose major depression, but are generally less severe. One notable feature of persistent depressive disorder, for example, is that the condition lasts for a minimum of 2 years.

    How is High-Functioning Depression Diagnosed?

    The first criterion for persistent depressive disorder (PDD) is the individual experiences a depressed mood on most days, and feels that way for most of the day, and these symptoms must continue for a minimum period of two years.

    In addition, the depressed mood must include 2 or more of the following symptoms:

    • Decreased appetite or overeating
    • Irregular sleeping patterns, such as insomnia or oversleeping
    • Lack of energy and fatigue
    • Lowered self-esteem
    • Difficulty concentrating and making decisions, and
    • Feeling sad and hopeless

    Furthermore, there are a few other criteria that also have to be met to make a formal diagnosis of PDD:

    • The depressed mood characterized by the above symptoms must occur on most days for at least 2 years, without any relief from the depression for longer than two months during that period
    • The individual has never experienced a period of mania or hypomania – 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 some impairment in one or more areas of normal daily functioning, and must also be the cause of significant distress in the individual
    • A person diagnosed with PDD can also meet the criteria for major depression disorder (MDD)

    What is the Difference Between Persistent & Major Depressive Disorder?

    According to the National Institute on Mental Health (NIMH), persistent depressive disorder (PDD) affects around 1.5% of adults in the U.S., with women more likely to experience the disorder than men.

    Major depressive disorder (MDD), on the other hand, is far more common. In fact, it is one of the most common mental health disorders in the U.S., affecting around 7.1% of adults across the nation.

    A primary difference between the PDD and MDD is their duration. For a psychiatrist or another qualified mental health professional to diagnose PDD in an adult, symptoms must have lasted for at least 2 years, whereas adults with MDD experience major depressive episodes (often abbreviated to MDEs) with a gap of at least 2 months between them.

    With regard to their actual symptoms, both disorders have many similarities, and an individual can have several symptoms of both disorders at the same time.

    The Signs & Symptoms of High-Functioning Depression

    High-Functioning Depression

    As we have described previously, the signs and symptoms of high-functioning depression (PDD) are similar to those caused by major depressive disorder (MDD), but are less severe.

    The signs and symptoms generally include changes in both eating and sleeping habits, fatigue, hopelessness, low self-esteem, and difficulty concentrating, although this can vary between individuals.

    Symptoms will persist on most days, causing a near-constant depressed mood that lasts for 2 years or more. Many people with PDD can function almost normally, but their internal struggle is near-constant, too.

    Known Signs & Symptoms of High-Functioning Depression

    • Loss of interest in daily activities
    • Tiredness and a lack of energy
    • Sadness, emptiness or feeling down
    • Low self-esteem and self-criticism
    • Hopelessness
    • Avoidance of social activities
    • Difficulty concentrating and making decisions
    • Decreased activity, effectiveness and productivity
    • Irritability or excessive anger
    • Feelings of guilt, worries over the past
    • Sleep problems
    • Poor appetite or overeating

    Causes, Risk Factors & Complications of High-Functioning Depression

    As with many mental health disorders, the exact cause of high-functioning depression is not yet known. As with major depressive disorder, it may well involve more than just one solitary cause.

    Possible Causes:

    Obviously, it is often difficult to ascertain the exact cause of any mental health disorder. Is it genetic? Is it trauma? Is it something else? However, it is believed it is the conjunction of more than one underlying cause that results in such conditions.

    These are the most common of the known potential causes of high-functioning depression:

    • Inherited / Genetic: High-functioning depression appears to be more common in people whose blood relatives also have the condition. However, researchers are still trying to find and 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 issues, financial problems or anything else that exacts overwhelming stress on the individual, can cause types of depression in some people.
    • Biological / Changes in Brain Structure: People with high-functioning depression may have experienced physical changes in their brains, such as a structural alteration. The significance of these changes is still uncertain, but they may eventually help pinpoint causes.
    • Brain Chemistry: Another potential brain-related cause is the chemistry of the brain. Neurotransmitters are naturally occurring brain chemicals that likely play a significant role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters may play a significant role in depression, and therefore, its treatment.

    Known Risk Factors:

    Persistent depressive disorder is a chronic condition, often beginning early in an individual’s life – childhood, adolescence or young adult life. According to mental health researchers, specific factors appear to increase the risk of developing high-functioning depression.

    These factors include:

    • A first-degree relative, ie. a parent, sibling or child, with major depressive disorder (MDD) or another type of depressive disorder
    • Traumatic or stressful life events, such as family bereavement, abuse or violence
    • Personality traits such as constantly low self-esteem, or being too self-critical or pessimistic
    • A history of other mental health disorders, such as a personality disorder

    High-Functioning Depression: Potential Complications

    • Major depression, anxiety disorders and other mood disorders
    • Personality disorders or other mental health disorders
    • Reduced quality of life
    • Substance abuse or addiction
    • School or work-related issues and decreased productivity
    • Relationship difficulties and family conflicts
    • Chronic pain and general medical illnesses
    • Suicidal ideation (thoughts of suicide) or behaviors

    Living with High-Functioning Depression

    High-Functioning Depression

    Anyone living with high-functioning depression / persistent depressive disorder (PDD) is also at significant risk of experiencing episodes of major depression, known in short as MDEs.

    In fact, most people with high-functioning depression will have one such episode at least once in their lives. For some people with this type of depression, it may feel as though the persistent, low-level depression could take a turn into severe depression at any time.

    While the two conditions are similar, and can even occur in the same person, there are some significant differences, as we discussed earlier – most notably in duration and severity.

    These differences normally result in someone with high-functioning depression being able to function at a higher, less restricted level than someone with major depression, which in severe cases can be completely debilitating.

    What Happens During a Major Depression Episode (MDE)?

    A major depressive episode (MDE) is a period of 2 weeks or longer in which a person experiences certain 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, and
    • Suicidal ideation ( thoughts of suicide)

    These symptoms are constant for the 2 weeks or so, and cannot be easily changed, even if they are seemingly contradictory to a person’s circumstances. MDEs recur periodically in people diagnosed with major depression, and less frequently for those with high-functioning depression.

    Although there are normally slight differences between those suffering a MDE, there are more obvious differences between 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 MDE can even cause psychotic symptoms, such as delusions and paranoia.

    For an individual with high-functioning depression, the only periods in their lives when their level of functionality drops significantly are during major depressive episodes (MDEs). In practical terms, this can mean:

    • Poor performance at work / in school
    • Unable to complete normal responsibilities
    • Drop out of activities they usually participate in and enjoy
    • Drop in their level of self-care and personal hygiene, and
    • Become socially withdrawn

    It is important for someone to take the following steps to cope with a MDE, even if they feel like nothing will work. These steps can limit the severity of the symptoms, and can even reduce the MDE’s duration:

    • Therapy Sessions: Just like a car, sometimes people need tune-ups. When there are signs of worsening depression, it is important to talk to a professional.
    • Medications: Antidepressants should never be discontinued without a doctor’s guidance, as quick cessation can cause a harmful withdrawal process. Patients should always be consistent with medications, even as they begin to feel better.
    • Social Support: During an episode of major depression, reaching out may be the last thing a person wants to do, but it does help significantly.
    • Self-care: Extra attention to self-care is so important as soon as a MDE begins. This may include attending therapy or support groups, avoiding alcohol, practicing meditation or yoga, actively challenging negative thoughts, or 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.
    • Go Outside: Sunlight and being outside in nature are proven mood boosters. While this won’t cure depression, it can certainly help a little.

    10 Aspects of Living with High-Functioning Depression

    High-Functioning Depression

    The diagnostic criteria for high-functioning depression outline exactly what it means to struggle with high-functioning depression in clinical terms.

    However, this is not necessarily what it actually feels like to go through it on a daily basis. Living with high-functioning depression normally includes these following elements:

    10 Aspects of Living with High-Functioning Depression


    Your low mood is almost always present, and it feels like you will never get relief. When you actually do feel happy, it doesn’t last for long


    Other people may notice your low mood, and may refer to you as gloomy, cynical, or sad


    You may feel tired all the time, even if you get enough or too much sleep


    You often just can’t summon the energy to do more than is necessary to function at a basic level


    You feel bad about yourself, unworthy, and as if you don’t deserve to be happy or to be liked by other people


    You gain or lose weight without meaning to, because you either have no appetite or overeat without thinking about it


    You may feel hopeless often, or cry a lot without any reason


    Focusing on your tasks is difficult to do, let alone maintain


    You have to force yourself to engage in social activities, when you would rather withdraw and be alone


    High-functioning depression can also cause complications that may seem unrelated, like substance abuse, chronic pain, relationship difficulties, and problems at work or school

    Treating High-Functioning Depression

    High-Functioning Depression

    While a person who has persistent depressive disorder can be described as “high-functioning,” they still require immediate treatment. Treatment for high-functioning depression usually involves therapy, medication, and involvement with a support group.

    Furthermore, a psychiatrist or another mental health professional may well recommend dietary changes and other improvements to a patient’s lifestyle, such as classes in mindfulness or yoga.

    1. Therapies for High-Functioning Depression

    Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are designed to help treat your depression, as well as help you cope with any shame or fear related to actually having the condition.

    Qualified therapists can work with you within the boundaries of your work life, family, cultural background, or other factors that may be influencing you to hide your depression.

    2. Medications for High-Functioning Depression

    Antidepressant medications will likely be prescribed for moderate to severe depression. These medications work by improving the balance of neurotransmitters in the brain. There are many different types of antidepressants, so it may take some time for you and your psychiatrist to find the one that works best for you.

    3. Support Groups for High-Functioning Depression

    Support groups can be helpful in providing a safe space for you to discuss your depression with people who have similar experiences, particularly useful if you are not comfortable talking to others in your life about it.

    4. Lifestyle Changes for High-Functioning Depression

    Changes in your lifestyle that may be recommended include healthy eating habits, ensuring you get enough quality sleep, improving your exercise routines, such as learning yoga, learning relaxation techniques, and taking classes in meditation or mindfulness techniques.

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