Signs of High-Functioning Depression: Symptoms & Treatment

The study of depression and its effects on the brain is ongoing. In recent years, clinical research has revealed a subtle form of depression that frequently goes undiagnosed and untreated. Functional depression can cause long-term harm to those suffering from it, compounded by the difficulty in recognizing or accepting its presence. While depression is often associated with sadness, crying, and prolonged isolation, functional depression can exist behind a facade of great success. Individuals with high-achieving careers, important family roles, or active social lives may inwardly struggle with functional depression.

Today’s article will cover what depression is and how it differs from high-functioning depression. We’ll take a look at the most common high-functioning depression symptoms and help you further understand what does high-functioning depression look like?

What Is Depression?

Depression is a common but serious mental health disorder characterized by persistent feelings of sadness, hopelessness, lack of interest, and other emotional and physical symptoms that interfere with daily life. Someone who is diagnosed with major depressive disorder (MDD) must meet specific criteria outlined by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition).

The DSM-5 defines MDD as having at least five symptoms for two weeks, including depressed mood, loss of interest, weight change, sleep issues, fatigue, guilt, poor concentration, and suicidal thoughts [1]. Symptoms must also impair daily functioning like sleeping, eating, or working in order to qualify for an MDD diagnosis.  

What Is High-Functioning Depression?

High-functioning depression, also known as functional depression, refers to a less severe but chronic form of depression where individuals maintain their daily responsibilities and outwardly appear normal while experiencing depressive symptoms internally. 

Many people wonder, “Is high-functioning depression a thing?” Indeed, it often goes unnoticed because individuals can continue functioning outwardly. However, it can still deeply affect a person’s overall life satisfaction, and if left untreated, it can worsen over time, potentially leading to a major depressive episode. This crisis may occur when someone can no longer suppress their emotions or if there is a persistent lack of joy in daily life. Due to the subtle nature of functional depression, even close family and friends may be shocked to discover that their loved one is suffering profoundly.

The hidden nature of high-functioning depression makes it particularly dangerous, as it’s frequently dismissed or untreated until it becomes severe. This contributes to the tragic prevalence of unexpected suicides, leaving those around the individual stunned. The ability of this disorder to remain concealed allows it to persist and cause significant harm.

What Are the Signs of High-Functioning Depression?

Recognizing signs of high-functioning depression can be challenging as individuals often seem successful and capable. Common high-functioning depression symptoms include:

• Persistent feelings of sadness or emptiness
• Fatigue and low energy
• Difficulty concentrating or making decisions
• Feelings of hopelessness or pessimism
• Changes in appetite or sleep patterns
• Low self-esteem

Dr. Scott Eilers, a clinical psychologist who has extensive experience treating mood disorders, outlines additional signs of high-functioning depression [2], such as:

• High achieving but emotionally disconnected: Individuals with functional depression often appear skilled, successful, and highly educated, but they experience little joy or pride in their accomplishments. They continue to achieve without celebration or appreciation, which indicates a disrupted reward system where the link between actions and positive internal feelings is broken.
• Dismissing positivity and extreme pessimism: High-functioning depression leads individuals to completely disregard positive events, adopting an extremely pessimistic outlook where “nothing matters.” Positivity is dismissed, making it challenging to find lasting meaning or fulfillment.
• Socially acceptable “addictions”: Individuals may master “healthy coping mechanisms” by excessively engaging in activities like fitness or work to avoid confronting deeper emotional issues. These behaviors can serve as escapes from loneliness, relationship problems, or other emotional pain. Because these pursuits appear healthy and are socially approved, many fail to recognize them as problematic or potentially harmful coping mechanisms.
• Relationships without connection: Despite having relationships and socializing, individuals with high-functioning depression often feel chronically alone. They frequently feel disconnected and may feel they are playing a role during social engagements rather than experiencing genuine connection.
• Driven by insecurity and inferiority: The drive to accomplish things is not rooted in positive, genuine achievement but rather a deep-seated feeling of worthlessness. They are often highly critical and harsh towards themselves.
• Persistent fatigue: No matter how much or how well they sleep, individuals never feel fully refreshed. They describe feeling constantly foggy, distracted, and forgetful, which often leads to misdiagnoses such as ADD (Attention Deficit Disorder). 
• Loss of interest in hobbies: Activities once enjoyed now feel like a waste of time. An individual with functional depression may struggle to derive any joy from their hobbies. Their reward system delivers little to no emotional benefit for fun activities, so their perceived value is lost. They may opt to focus solely on activities with tangible benefits, usually financial, at the expense of their emotional well-being. 
• Engagement in risky behaviors: High-functioning individuals with depression may engage in significant risks, such as entrepreneurial ventures, because they may undervalue their lives and often think, “What do I have to lose?” Risk-taking might also provide a rare chance to feel something, potentially sparking a cycle of increasingly risky behavior.

While many individuals often ask themselves, “Do I have high-functioning depression?”, recognizing these common signs and behavior patterns can provide valuable insight into the condition. If you identify with several of these symptoms, speaking with your doctor and exploring available support options is recommended. 

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

When high-functioning depression co-occurs with substance abuse, it can exacerbate symptoms and complicate treatment. Substance abuse may temporarily mask depressive symptoms but ultimately worsens emotional and physical health. According to the 2023 National Survey on Drug Use and Health, 35%, about one-third, of adults aged 18 and over in the U.S. who have a mental health disorder also have a substance use disorder [3,6].

In cases of high-functioning depression, individuals often develop specific behaviors to cope with their mental health struggles. Initially, these coping mechanisms may involve socially acceptable habits, such as excessive exercise or immersing oneself in work. However, when these strategies fail to distract from or alleviate emotional distress sufficiently, individuals may resort to more harmful measures, such as substance misuse. A person with high-functioning depression might secretly abuse substances in a concealed and controlled manner, but the longer their depression goes untreated, the greater their risk of escalating substance misuse. 

Over time, substances like alcohol, prescription medications, and illicit drugs can lead to physical dependence and addiction, making it increasingly difficult to stop due to severe physical and psychological withdrawal symptoms. This co-occurrence of depression and substance abuse complicates treatment and poses serious risks to the individual’s overall well-being.

Dual diagnosis is essential to effectively treat substance use disorders that co-occur with mental health conditions, including high-functioning depression. A comprehensive treatment plan must address both the physical aspects of addiction—such as withdrawal management and physical health stabilization—as well as the psychological components, including underlying depressive symptoms, coping mechanisms, and emotional triggers.

What Is Dysthymia?

Dysthymia, often synonymous with high-functioning depression, is a chronic, low-grade form of depression with symptoms lasting for at least two years. Symptoms are usually less severe than major depression but persistently impact quality of life. Dysthymia, similar to depression, can cause persistent sadness or emptiness, difficulty concentrating, fatigue, hopelessness, changes in appetite or sleep patterns, and low self-esteem [5]. 

Recent research provides further evidence that dysthymia may be caused by hormonal and chemical imbalances in the brain, particularly involving corticotropin-releasing hormones, arginine vasopressin, and monoamines [4]. Chronic stress and adverse childhood experiences (ACEs) can significantly disrupt these chemical and hormonal balances, making some individuals more prone to dysthymia or severe depression. The research also notes that while antidepressants may temporarily relieve depressive symptoms, they do not address the underlying chemical changes associated with dysthymia. As a result, individuals discontinuing medication are at higher risk for relapse and potentially worsening symptoms.

What Is Smiling Depression?

Smiling depression is another term for high-functioning depression, where individuals mask their depressive symptoms behind a façade of happiness and normalcy. This term is a hallmark trait of high-functioning depression, as many people with this condition effectively conceal their inner struggles from those around them. This ability to disguise one’s feelings is often not meant to be deceptive but instead rooted in a desire to appear “okay” to the world. The vulnerability it takes to identify with depression as a mental health condition is difficult for many, yet this acknowledgment is the crucial first step toward healing.

If you have noticed signs of functional depression in your life, it may be time to seek help. A mental health professional can provide clarity on how depression may be affecting your daily life and help you start treatment toward lasting recovery and mental wellness. 

How to Manage High-Functioning Depression

Managing high-functioning depression may involve a combination of psychotherapy, medication, lifestyle changes, and support systems. Effective treatments often include:

• Cognitive Behavioral Therapy (CBT)
• Antidepressant medication
• Regular physical activity
• Improved sleep hygiene
• Social support and community engagement

Since high-functioning depression often remains hidden, it’s important to regularly check in with a mental health professional, even when things seem manageable. Prioritizing open communication with trusted friends or family members is also invaluable in preventing symptoms from escalating.

If you are experiencing chronic depression, reach out for help today. Call Connections Mental Health at  844-759-0999 for immediate assistance.

Functional Depression | FAQs

What is functioning depression like?

Functioning depression refers to experiencing depressive symptoms while still managing daily responsibilities (like work and family life, etc.) effectively. Individuals often appear successful and put-together externally but struggle internally with chronic sadness, low motivation, and feelings of emptiness.

What is the functional cause of depression?

While researchers continue to study—and even disagree about—the root causes of depression, many believe that imbalances in brain chemistry are pivotal to its onset. In particular, imbalances in neurotransmitters like serotonin and dopamine significantly affect mood regulation. External factors, such as chronic stress, trauma, and genetic predisposition, can also alter brain function and contribute to depressive symptoms.

What is a functioning breakdown?

A functioning breakdown occurs when someone with high-functioning depression, who has maintained normal daily activities despite underlying distress, reaches a breaking point. Their coping mechanisms fail, leading to significant depressive symptoms such as hopelessness, despair, anger, and intense emotional distress. This typically results from prolonged, untreated stress or depression, leaving the individual unable to manage everyday tasks or responsibilities.

What medication is used for high-functioning depression?

For the most part, high-functioning depression is medicated similarly to other depressive disorders like MDD. Medications commonly prescribed for high-functioning depression include SSRIs (e.g., sertraline, fluoxetine) and SNRIs (e.g., venlafaxine, duloxetine). These medications alter neurotransmitter signals to alleviate depressive symptoms while allowing individuals to maintain daily functioning. However, medication is just one method of treatment that is best paired with holistic and lifestyle changes for lasting symptom improvement. 

Begin Your Road to Recovery at Connections Mental Health

High-functioning depression is not something you can ignore forever, as untreated mental illnesses tend to get worse with time. However, tackling depression is possible with the right support. Take care of future you today and consider Connections for effective mental health treatment. 

At Connections, our inpatient program allows you to focus on your mental health journey without distractions and stressors. Our staff provides knowledgeable care with empathy and patience, allowing you the space to mentally relax and begin your path to healing. 

Our homes offer a variety of evidence-based therapies, including:

• 24/7 clinically supervised care
• Peaceful oceanside location
• Medication-assisted treatment (MAT)
• Dual-diagnosis mental health treatment
• Aftercare planning
• Counseling
• Group therapy
• Family therapy
• Aftercare
• & More

If depression is holding you back, find your freedom today by calling our admissions team at 844-759-0999

Sources

[1] https://www.uptodate.com/contents/image?imageKey=PSYCH/89994

[2] https://podcasts.apple.com/us/podcast/8-signs-you-have-high-functioning-depression/id1665803718?i=1000680945254

[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC2851027/

[4] https://www.nature.com/articles/4000697

[5] https://www.hopkinsmedicine.org/health/conditions-and-diseases/dysthymia#:~:text=What%20is%20dysthymia%3F,body%2C%20mood%2C%20and%20thoughts.

[6] https://nida.nih.gov/research-topics/co-occurring-disorders-health-conditions#mental