Highlights
- People with high-functioning depression can keep up the appearance of productivity while struggling with symptoms.
- It can come as a shock to discover that someone close has high-functioning depression because its symptoms are concealed below the surface.
- While people with this type of depression “show up” to work, school, and social events, they often have intense psychological and sometimes even physical pain.
- High-functioning or “smiling depression” isn’t any less dangerous than other forms of depression just because symptoms aren’t as obvious.
High-functioning depression hides in plain sight. This condition is often called “smiling depression” because the people it affects remain fully functioning. Many patients appear to be productive and highly motivated, living “perfect” lives, and this is what makes this condition so dangerous. Keep reading to learn the signs of high-functioning depression and how to cope with it.
Understanding High-Functioning Depression
High-functioning depression is mystifying to people looking in from the outside. Most people picture any type of depression as a state of fully withdrawing from life or not being able to get out of bed in the morning. However, those having its high-functioning type can keep up with the demands of daily life without, or almost without, missing a beat.
Unlike major depressive disorder (MDD) which has debilitating effects on one’s personal and professional lives, high-functioning depression involves pain and “misery clouds” that stay concealed from others.
The fact that high-functioning depression is not that noticeable does not mean that the affected person experiences it any less intensely. In many cases, they are in constant anguish. In some ways, the struggles of people with a high-functioning form of the condition can be more intense compared with people having conditions that present visible symptoms. It happens because hiding the signs requires additional effort.
What It Feels Like to Live With High-Functioning Depression
People with high-functioning depression often feel like they are living double lives. It can truly feel like “all the world’s a stage” as they navigate daily life without letting on that they are struggling. They often live with persistent feelings of sadness and emptiness. While they exist in the world, they often feel that there is a thick veil between them and the people they interact with. Life also tends to feel hopeless and pointless. While they push forward, they are plagued by a deep sense that there’s simply no point in any of the tasks or goals they are working on.
They may feel as though they are hanging by their last thread even though they are showing up to social gatherings and meeting work deadlines. It’s like a pond that looks clean and glistening from a distance until you get up close to see that it’s overrun by brambles and rusting pipes just inches from the surface.
Some people with high-functioning depression may be struggling to keep up with work and life tasks even though they don’t appear to be falling behind. As they attempt to stay on track, they struggle with foggy memories, trouble focusing, and indecisiveness that leave them feeling exhausted. Many also deal with fatigue and tiredness. They may begin to experience burnout resulting from their attempts to suppress their feelings.
If you or someone you love deals with this, it's a great time to schedule an appointment and get the ball rolling in the right direction."
Hiding the Fact That You Have Depression
Why do some people decide to hide the fact that they are depressed? There are myriad reasons for concealing mental health struggles. For some, emotions were simply never discussed in their families of origin. There may even be shame or stigma surrounding mental health.
For some people with high-functioning depressive disorder, there is a fear of judgment. Someone who pushes forward through productive depression at all costs may be motivated by fear of what will happen if people find out. They worry that the “wheels will come off” and their career will be harmed if they actually do take time off and seek treatment.
However, sometimes, the root cause is the lack of awareness. A person might not know that what they are experiencing is depression. They may internalize what they feel as something that’s “bad” or “wrong” about them. Or, they may simply not know any other way besides pushing forward through the pain. Maintaining routines or continuing to strive in their careers gives them a sense of comfort or control. Maybe, working hard and succeeding has been the only way they have felt in control of their lives during times of struggle or uncertainty.
Signs and Symptoms
In many cases, the symptoms of high-functioning depression are similar to those of MDD or treatment-resistant depression and include:
- Feelings of sadness, helplessness, or hopelessness.
- Anhedonia—a loss of interest in previously pleasant activities.
- Persistent feelings of guilt about the past.
- Persistent negative thoughts and worry about the future.
- Difficulty concentrating or making decisions.
- Avoidance of social activities.
- Excessive anger or irritability.
- Low self-esteem.
- Self-criticism.
Some people with high-functioning depression may also experience somatic symptoms that take on characteristics of physical illness. This is especially prevalent among people with what researchers refer to as “
- Changes in eating patterns and appetite: eating too little or overeating.
- Changes in body weight.
- Excessive sleeping or insomnia.
- Fatigue and low energy.
- Digestive issues.
- Muscle tension.
- Headaches or other unexplained pain.
One of the nuances is that a person with high-functioning depression might not perform at their best even though they still show up. One may be more quiet or withdrawn as they attempt to muddle through social interactions.
Causes and Risk Factors
There’s no single cause for being susceptible to high-functioning depression (which is true of any form of depression), and it can happen to any person at any age. Experts believe that a number of
Some risk factors include:
- Personal or family history of depression.
- Major negative life changes.
- Trauma.
- Stress.
It’s also possible that some medications can contribute to the onset of depression. A number of
How Is It Diagnosed?
Although high-functioning depression is the term used to describe people who maintain stability while experiencing the symptoms, this isn’t a formal clinical diagnosis. The actual diagnosis beneath high-performing depression is typically clinical depression or major depressive disorder.
Any type of depression can only be formally diagnosed by a licensed healthcare provider. They use DSM-5 (
If you think you have depression, regardless of maintaining high productivity levels, consider keeping a journal. This practice will help you monitor the dynamics of your symptoms and the overall emotional health. You may also complete the Beck Depression Inventory, a standardized test for assessing the severity of symptoms. When you are ready to see a healthcare professional, all this information will help them make an accurate diagnosis and provide you with the most appropriate recommendations and treatment.
Treatment
With high-functioning depression, it can seem like everything’s fine until it isn’t. While a person is fully functioning, they often struggle with thoughts of self-harm and suicide. This can come as a shock to the people around them. It’s important to immediately seek help when depressive symptoms turn to thoughts of self-harm.
If you’re experiencing suicidal or self-harming thoughts and require immediate assistance, contact a crisis hotline, such as 911,
Once a person has been diagnosed with high-functioning depression, different forms of therapy can be helpful. Cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), behavioral activation, and commitment and acceptance therapy have been proven effective.
When treating high-functioning depression, many people also benefit greatly from group psychotherapy because this space provides a way to “unmask” with others who have similar struggles. Group therapy was also found to significantly
In moderate to severe cases, a person with depression may be prescribed antidepressant medication. They affect neurotransmitters in the brain, helping one to deal with the symptoms better and regain energy for attending psychotherapy and making beneficial behavioral or lifestyle changes. These medications can take several weeks to show effects but it’s important to take them as prescribed and keep in touch with a healthcare professional regarding the effectiveness of treatment or any side effects.
Final Thoughts
The important thing to remember is that depression is not likely to go away on its own. For people who have been white-knuckling their way through untreated high-functioning depression, finally getting support can feel like getting oxygen for the first time in weeks, months, or years.
Proper treatment makes it possible to safely manage depression symptoms and improve well-being. At MEDvidi, you can see a healthcare professional in 24 hours to go through a mental health assessment and get the care and support you need to thrive.
