“High-functioning” depression – could you have it?

Are you someone who has trouble getting out of bed every day? Are you someone who calls into work sick because they can’t leave the house? Are you someone who constantly isolates themselves from friends? Are you someone who sleeps 12 hours a day and constantly feels hopeless?

Would you ever envision a popular, good-looking, successful, university graduate living it up in the big city with a great job, a good group of friends and a long list of accolades to their name, as someone who wakes up each morning with a gripping sense of anxiety and an internalized pressure to continue to be “perfect” and “keep it all together”? And would you picture that smiling, competent, friendly co-worker of yours, who always seems to be getting everything done, as someone who secretly and inwardly feels like they’re a complete failure, fearing the time flying past them while they waste every day?

Let’s face it: you’re probably not going to picture this type of people as facing such problems and anxieties. And yet, people like them could be a perfect example of someone dealing with what’s known as high-functioning depression. While it doesn’t look like the stereotype of depression most of us hold in our heads, this diagnosis nevertheless carries significant risks if left untreated.

But the tricky thing about high-functioning depression is that it is very hard to spot because the people dealing with it look, from the outside, like they’re doing fine and holding it all together. This can lead to a lack of ability to self-identify as depressed and a possible resistance to seek treatment because of the stigma surrounding more “typical” depression. And this in itself is a big problem.

I want to explain what high-functioning depression really is, discuss six common signs of it, the risks associated with having this disorder and how you or your loved ones can get the help you need if you recognise it in yourself or someone close to you.


What is high-functioning depression?

High-functioning depression is a psychological term for what’s clinically known as dysthymia. Someone struggling with dysthymia may still be able to get up and go to work, be in a romantic relationship, post convincing smiley photos on social media, regularly get together with their friends and family, and generally handle all the adult stuff in their life. While the person doesn’t “look depressed”, inwardly they may be gripped with a challenging set of symptoms invisible to those of us who love and know them. Symptoms that may greatly diminish their overall quality of life, their career, their relationships, and bloom into more challenging mental health concerns if left untreated.

Six real-life symptoms

1. Difficulty experiencing joy

With high-functioning depression, the things that used to bring you pleasure – be it exercising or getting together with your friends – don’t spark joy anymore. They may seem like burdens or events to avoid because it feels like more effort is required than you can face.

2. Constant self-doubt

You may constantly doubt what you do with your life, whether you’re on the right career path or in the right relationship, or if you can even handle being an adult. This pattern of constant self-doubt may be situational or pervasive but it feels like you just can’t get over it.

3. Diminished energy

If getting through each day feels like you have just walked up Mount Everest, if you feel like you barely have the mental, emotional and physical energy to handle your life anymore, if your overall energy levels are greatly diminished, this could be another sign of high-functioning depression.

4. Small things feel like huge obstacles

You find yourself feeling overwhelmed or greatly distressed by an event that perhaps wouldn’t have felt like such a huge deal in the past, for example a friend cancelling plans you had, your shopping bags breaking when you’re carrying them, you spilling a small amount of water on yourself. What would normally be an everyday annoyance, feels like the end of the world and you find your stress response disproportionate to the event itself. This may well be a sign of dysthymia.

5. Constant guilt and worry about past and future

You worry that you chose the wrong course at university, you question whether you’re in the right job, you worry about paying off your student loan, you worry that you married the wrong person, you worry about who’s going to care for you when you get older. We all have these worries from time to time, but if feelings of guilt and worry over your past and future feel pervasive and dominant, this may be more than “normal” worry and could also be a sign of high-functioning depression.

6. General sadness

You find yourself with a general sense of sadness and you can’t seem to pinpoint the cause of it. You drop your mask of smiling competency when you close the door behind once you get home, while having a subtle sense of hopelessness that never seems to go away. This could be part of dysthymia.

The risks of high-functioning depression

Mental health struggles come in all shapes and sizes but, as we remove the stigma around the entire issue, most of us are likely to still hold an unconscious image in our heads of what a depressed person looks like. And, while this image of someone who can’t get out of bed, who can’t hold down a job, and who has constant suicidal tendencies is the typical stereotype we hold in our heads, it doesn’t mean that someone who appears perfectly fine won’t recognize in themselves the signs listed above. They might also be dealing with depression.

At the same time, these people may not be willing to see themselves as depressed, which can be a big problem. There is a unique set of risks to being someone with high-functioning depression and not acknowledging the problem.

First, because you’re still “holding it all together” it can make it harder for both you and others to spot the real mental and emotional strain you may be under. You and those around you doubt the seriousness of what you may internally wrestle with because, after all, your life still looks pretty great from the outside, right?

Second, as someone who is high-functioning, you may grow up believing that, with enough effort and willpower, you can achieve, gain or fix anything that life throws at you. Not so with dysthymia.

High-functioning depression isn’t just a bad attitude and you can’t simply “walk away” from it. Dysthymia is a biological and psychological disorder that requires adequate and clinical treatment. Arguably, the more you push and “will yourself out of it” instead of seeking proper support, the worse your symptoms may get.

For example, if left untreated, dysthymia can potentially bloom into major depression or major depressive episodes, during which your biological and psychological functioning is severely impaired.

Bottom line: high-functioning depression requires clinical treatment as much as the most stereotyped version of major depression does. The good news is that with treatment dysthymia can be managed.

Treatment and support for high-functioning depression

While there is no single reason for someone to develop dysthymia and no real way to prevent it, there are many effective treatments to help you manage it and support yourself through psychotherapy and/or medication.

The reality of dealing with high-functioning depression and moving through your days is that it can often feel like you’re attempting to build a castle on a foundation of quicksand. Get the help you need to build a solid, stable foundation for yourself, so you can build and craft a life in a more sustainable way. You’re worth it!

-Andrew F