High-Functioning Depression: Recognizing the Signs and Symptoms

The signs and symptoms of high-functioning depression are similar to but less severe than major depression. They often include changes in sleeping and eating habits, low self-esteem, hopelessness, and trouble focusing. People experience high-functioning depression symptoms nearly every day for two years or longer. 

People with high-functioning depression typically appear normal, but they are struggling on the inside. Treatments such as psychotherapy and medication can help manage signs of high-functioning depression.

What is High-Functioning Depression?

The official diagnosis of high-functioning depression is called a persistent depressive disorder, or PPD. Common high-functioning depression symptoms include a lack of energy and constant fatigue. To receive a diagnosis of high-functioning depression, a person must experience symptoms for two years or more. 

It can be difficult to recognize when someone shows signs of high-functioning depression. To the outside world, they go to work or school, attend social events, and even smile. But, inside, they are struggling. 

People with high-functioning depression often push through their feelings and are perfectionists. They are typically concerned with their image and struggle to admit they need help. This can cause emotions to build up, and one thing can cause emotions to overflow. 

Symptoms and Diagnosis of High-Functioning Depression

High-functioning depression is a mental health disorder diagnosed by a psychiatrist or other mental health professional. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the criteria and symptoms for a diagnosis. Many high-functioning depression symptoms are similar to major depression but typically less severe. 

One major criterion is that a person experiences a depressed mood almost all day, every day for at least two years. This must also include two or more of the following symptoms:

• Overeating or not eating enough
• Insomnia or sleeping too much
• Fatigue or lack of energy
• Low self-esteem
• Trouble concentrating and making decisions
• Feeling hopeless and sad
• Talking or moving slowly
• Thinking about self-harm, death, or suicide
• Physical symptoms such as headaches, cramps, digestive issues, unexplained aches and pains

In addition to these symptoms, a person must also meet the following criteria:

• While symptoms must be present for at least two years, periods of relief from symptoms can’t exceed two months. 
• The person has not experienced mania or hypomania, periods of energetic moods, or unusual euphoria.
• High-functioning depression symptoms are not better explained by another medical condition, mental health disorder, or substance use disorder. 
• Symptoms and low mood must somewhat interfere with daily function and cause significant distress. 
• A person with high-functioning depression may also struggle with major depression.

Causes of High-Functioning Depression

A combination of factors is typically the cause of depression disorders. These factors include:

• Brain chemistry – Imbalance in brain chemicals or neurotransmitters that regulate mood
• Genetics – Depression often runs in the family
• Life events – Stressful and traumatic events such as a death, loss of a job, or a relationship ending can trigger high-functioning depression.
• Medical conditions – Chronic health issues such as heart disease, cancer, and chronic pain can cause people to develop depressive disorders. 
• Medication – Certain medications have depression as a side effect.
• Substances – Drug and alcohol use can lead to or worsen high-functioning depression symptoms.
• Personality – Some personality traits are more prone to developing depression.

What it Feels Like to Live With Depression

The criteria for diagnosis explain exactly what it means to live with high-functioning depression. But what does it feel like to live with high-functioning depression?

• You feel down or depressed most of the time. People may notice and describe you as a downer, gloomy, or cynical.
• You feel like there isn’t any relief. If you do feel happy, it is short-lived.
• You may always feel tired even when you have gotten plenty of sleep.
• You may feel lazy, but you just don’t have the energy to function normally.
• You feel like you don’t deserve happiness.
• While you handle responsibilities like work, school, and house cleaning, it takes everything you have. 
• Your weight is constantly going up or down. 
• You may cry for no reason and feel hopeless.
• While you do a good job at work or school, focusing is challenging.
• You force yourself to go to social activities when you would rather stay home. 
• High-functioning depression symptoms can cause other issues, such as chronic pain, relationship difficulties, and substance abuse. 

Signs You May Be Dealing with High-Functioning Depression

During an evaluation, mental health professionals look for clinical signs of high-functioning depression. However, you may have different signs than others. Some signs you may be dealing with high-functioning depression include:

• You may have trouble seeing the bright side of things. People might describe you as a downer or gloomy.
• You may struggle to find the energy to do things, and you may be called lazy.
• You may constantly criticize yourself, even other people. Additionally, if someone compliments you, you have a hard time believing it. 
• Your weight may go up and down depending on your mood.
• You may cry or feel hopeless for no apparent reason.
• Although you get your work done, you may struggle to appear normal.
• You may self-medicate with drugs or alcohol. 

What Happens When High-Functioning Depression Co-Occurs with Substance Abuse?

When a person struggles with a mental health condition and an addiction, it is known as a “dual diagnosis.” High-functioning depression can co-occur with other mental illnesses, but it more often co-occurs with addiction. People with high-functioning depression sometimes use drugs or alcohol to find relief from their symptoms. But that only makes things worse over time. 

People may self-medicate with the following to cope with high-functioning depression symptoms. 

• Alcohol
• Prescription medications
• Heroin
• Cocaine
• Opioids

Treating a dual diagnosis requires addressing both addiction and mental health disorders simultaneously. This is because addiction and mental health disorders feed off each other. If you only treat high-functioning depression, the addiction typically continues. Likewise, treating the addiction without addressing the high-functioning depression can cause a relapse. 

A comprehensive treatment program addresses addiction and co-occurring high-functioning depression simultaneously. Dual diagnosis treatment can help you understand and manage your high-functioning depression without drugs and alcohol. While treatment also enables you to build healthy coping skills and relapse prevention tools to encourage lasting recovery, 

How to Manage High-Functioning Depression

Many people with signs of high-functioning depression feel like there is no way out. They fall into a vicious thought pattern and believe nothing can help or that relief will be temporary. However, there are things you can do to manage high-functioning depression symptoms. 

• Get active – While it may be challenging to get started, you should be physically active for thirty minutes a day. You can go for a walk, take a jog, or do yoga, for example. If thirty minutes is too long, start with five or ten minutes and work your way up.
• Eat healthily – Eating healthy, well-balanced meals improves mood and overall well-being. 
• Get enough sleep – Sticking to a bedtime routine, such as going to sleep and waking up at the same time every day, improves mental health. 
• Get outside – Spend time in the sun. Sunlight increases vitamin D and significantly improves high-functioning depression.

If you have tried these things and still struggle with depression, it may be time to consider a mental health treatment program.

Treatment for Depression

It is important to emphasize that when signs of high-functioning depression are described as less severe than major depression, it does not mean they are less serious. The label “high-functioning” may cause someone to dismiss their high-functioning depression symptoms or fail to seek treatment. 

The first step in diagnosing high-functioning depression is getting a mental health evaluation. If a mental health professional determines you have high-functioning depression,