High-functioning depression is a term used to describe individuals who are dealing with symptoms of depression while still being able to perform their daily home and work responsibilities. But although they appear to be functioning well on the surface, they may struggle to get by internally. They may not appear like someone who has depression as most people consider it.
Frequently, people with depression can’t keep up with the day-to-day demands of life such as:
- Keeping a steady job
- Caring for children
- Having meaningful friendships and relationships
- Maintaining a home
- Paying bills on time
Depression makes every chore a Herculean task and, eventually, things start to slide. But not always. According to psychologist Dawn Potter, PsyD, “For some people, depression lives under the surface. It can be extremely challenging to go about your day-to-day, but you seem to be doing reasonably well to the rest of the world.”
People with high-functioning depression can look especially “together” to the rest of the world, and may only see their depression as something temporary that will pass on its own. But high-functioning depression is still a mental illness that deserves care.
How is High-Functioning Depression Different from Regular Depression?
The difference between high-functioning depression and major depression is that people with major depression typically have problems taking care of the things in their lives that require their attention. On the other hand, people with high-functioning depression share the same feelings as people with major depression but still manage to keep up with their responsibilities. They may not show any of the visible signs of “decay” in terms of lifestyle or appearance as someone with a lower functioning form of depression.
Types of Depressive Disorders
Depression can happen to anyone, from any background or stage of life. It can also take many forms depending on the person, including:
- Major Depressive Disorder (MDD)
MDD is also known as clinical depression. It’s a significant depression that persists for more than two weeks. - Persistent Depressive Disorder (PDD)
Also called dysthymia, PDD persists for over two years and fluctuates in severity. - Seasonal Affective Disorder (SAD)
This form of MDD tends to diminish in the summer and reappear during the winter. - Perinatal Depression
A form of MDD which includes depression during and after pregnancy, - Premenstrual Dysphoric Disorder (PMDD)
PMDD is a more severe type of PMS, influenced partly through the hormonal fluctuation during a woman’s menstrual cycle. - Bipolar Depression
People with bipolar disorder may have periods of serious depression. - Psychotic Depression
People with this form of MDD have symptoms of psychosis, such as hallucinations and delusions.
It’s important to remember that “high-functioning” is not an official diagnosis. It can describe a person’s state while dealing with a form of depression.
Symptoms of High-Functioning Depression
An individual with high-functioning depression can have the same underlying symptoms as someone with MDD. These may include symptoms like:
- Feeling helpless, hopeless, or sad
- Losing interest in things that used to bring them happiness
- Changes in their eating habits
- Difficulty sleeping, or sleeping too much
- Problems concentrating
- Negative thoughts about themself or other people
High-functioning depression may occur at any level of severity, from mild to so severe that the person is self-harming or a suicide risk. The person may continue to hide their symptoms regardless of severity, sometimes out of a desire to avoid a diagnosis of depression.
What Are Some Causes of High-Functioning Depression?
Depression is caused by a combination of several elements. These include:
Genetics
Depression can run in families. It is estimated that depression is about 40% determined by genetics.
Brain chemistry
Neurotransmitters (brain chemicals) that regulate mood and other things can lead to depression if there is an imbalance.
Life events
Stressful or upsetting life occurrences can bring on depression. When symptoms of grief get worse, it can turn into depression.
Trauma
Traumatic events or stressful conditions can promote the development of mental health conditions such as depression, anxiety, and PTSD (post-traumatic stress disorder).
Medical conditions
Medical conditions such as heart disease, cancer, diabetes, Parkinson’s, or chronic pain can make you more likely to develop depression at the same time.
Medications
Some medications can cause depression as a side effect. Drugs that have been found to contribute to depression include anticonvulsants, stimulants, and benzodiazepines.
Substances
Personality
The Danger of Self-Medication
A person with depression may not realize that they’re self-medicating for depression. Drinking alcohol is socially acceptable in many cultures, recreational drugs like marijuana are legal in many places, and prescription medications can often be found in bathroom cabinets. For someone looking to relieve themselves of the weight of depression, it’s easy to keep symptoms at bay with these easy-to-obtain substances.
Here are six signs that you may be self-medicating:
- You use substances when you feel stressed, anxious, or depressed. If you’re regularly using substances just to cope, you may be self-medicating.
- Alcohol and drugs tend to make you feel worse. After the numbing effects of substances wear off, you’re likely to feel worse (maybe due to poor circumstances caused by the addiction).
- You need more and more of the substance to experience relief. It can be increased drinks or bowls — the previous amount of substances is no longer enough.
- Your problems are increasing. You may have started using a substance to help cope with depression, but it has only provided a release and not a solution.
- You’re irritated when you don’t have drugs or alcohol available. The more distressed you get at being disconnected from your substance of choice, the more likely that self-medication is taking place.
- Your family and friends are concerned about your substance use. Have the people close to you expressed worry? They may see the effects of your substance abuse more than you.
Self-medication is frequently a self-destructive impulse that comes from a need to feel immediate relief. Long-term work on underlying causes, and dual diagnosis treatment for any resulting addiction, is the only way to deal with high-functioning depression long term.
Treatment of High-Functioning Depression
Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms of depression. However, many people with depression also benefit from seeing a psychiatrist, psychologist, or other mental health professional to address underlying causes of depression.
If you have severe depression, you may need a hospital stay or to participate in a treatment program until your symptoms improve. Here are some treatment options:
Psychotherapy
Also known as “talk therapy,” psychotherapy is used to treat depression by talking about your condition and other issues with a mental health professional. Different types of therapy are effective for treating depression such as:
Cognitive Behavioral Therapy (CBT)
CBT will help you recognize and change faulty or negative thought patterns and the resulting behaviors.
Dialectical Behavioral Therapy (DBT)
DBT helps you deal with suicidal ideations, depression, and unhealthy substance use by working to accept yourself now while building emotional resilience.
Lifestyle Changes
Some lifestyle changes have been shown to ease depression, including ensuring proper nutrition, exercise and ensuring that you’re getting adequate sleep. But beyond this, it’s important to work to maintain social contacts and obligations so that you’re not fully devoid of a support system. This doesn’t mean to not seek professional help for depression. This falls into the trap of high-functioning depression. What’s more important than presenting yourself like everything is fine is working to keep your life running while you seek a deeper understanding behind the roots of your depression.
Dual Diagnosis Treatment
If your depression and subsequent self-medicating have led you down the road to an addiction (substance use disorder), you need to have both disorders treated simultaneously. Treating one without the other will only exacerbate both conditions.
Heal From Addiction and Co-Occurring Depression at First Steps
At First Steps Recovery, we are experienced in treating mental health issues and substance use disorders. Unfortunately, these conditions often go hand-in-hand. We can offer you or your loved one a comprehensive program created with your needs and requirements in mind.
We can provide gender-specific detox and multiple forms of treatment programs, all to suit your needs and recovery. You likely have many questions, and we are happy to provide answers. Contact us today to learn more.
Dr. Curl is the Medical Director and primary on-site provider for First Steps Recovery. He is a Board Certified Internist and Addiction Medicine Specialist having attended the David Geffen School of Medicine at UCLA and completing his residency at Mount Auburn Hospital with Harvard Medical School. Following several years work as an internist and physiatrist (physical medicine and rehabilitation). Dr. Curl completed the Addiction Medicine Fellowship at Howard University in Washington DC and participated as a RAM Scholar (Research in Addiction Medicine). While part of the fellowship, Dr. Curl pursued research investigating the barriers to expanding and improving medication for opioid use disorder. Following his fellowship, Dr. Curl spearheaded the Opiate Use Disorder outpatient clinic and worked in the Department of Psychiatry and Behavioral Sciences within the Howard University Hospital. In 2023, Dr. Curl completed his Board Certification in Addiction Medicine.
