Rarely is there a one-size-fits-all diagnosis in the world of mental illness, especially when it comes to depression. Depression—like anxiety—manifests differently from person to person. So, what if you sometimes feel depressed but aren't sure, because your symptoms aren't as severe as those portrayed in the media (or exhibited by folks around you who have depression)? You might have heard the term high-functioning depression tossed around. But as it turns out, high-functioning depression isn't an actual diagnosis, and you might be dealing with something a bit different. Here's what you need to know.
So You Think You Have High-Functioning Depression
It's important to note that high-functioning depression (sometimes referred to as functional depression), is neither a diagnosis nor its own clinical disorder. In fact, some therapists disagree with the term altogether, arguing that the term can be misleading. High-functioning depression is often seen as a form of depression that's less debilitating and allows a person to live a relatively “normal” life (whatever normal means).
Though it may not be an accurate term, that's not to say less persistent or severe depressed feelings aren't valid. Here's how Margaret Robinson Rutherford, Ph.D., the author of Perfectly Hidden Depression, described what she calls Perfectly Hidden Depression to Psychology Today: "Maybe you get up in the morning. You're more than aware of a sadness lurking behind your eyes; maybe you suffered abuse that still gives you nightmares; maybe you're grieving the death of your best friend. Maybe most mornings you don't want to get out of bed. But you put a smile on your face, take your kids to school, and do the best you can do. You simply don't talk much about the pain you know is there. You stay busy trying to put your best foot forward. Maybe you go to therapy. Maybe you don't."
If it's Not High-Functioning Depression, Why Do I Feel This Way?
When your bad mood becomes your status quo and feelings of worthlessness, sadness, guilt or disinterest greet you every morning in the mirror, it might not be just a bad mood anymore. It might not be high-functioning depression, but it could be dysthymia or persistent depressive disorder (PDD).
Many people with PDD have successful social lives, careers and families. We see them doing it all and admire them for it. As Bridges to Recovery, a mental health treatment center, states, to the outside world a person suffering from PDD seems fine. However, internally it takes enormous effort for these people to get up and maintain all of their relationships and roles. They do it, but it hurts. And it’s hard. And this feeling lasts a long time. (We’re talking years.)
A psychiatrist or licensed mental health professional needs to diagnose PDD. To do so, they look for less intense versions of symptoms similar to those of major depressive disorder (MDD) over a period of at least two years. The American Psychiatric Association lists changes in sleeping and eating habits, lack of motivation, general feelings of emptiness, low self-esteem and indecisiveness as symptoms of MDD. If these occur almost every day, all day, for no discernable reason over a period of two years or more, it can indicate PDD.
It’s worth noting many people living with PDD suffer in silence, either because they haven’t recognized their symptoms yet or they don’t want to acknowledge them. People with high-functioning depression fulfill obligations, possibly even excelling above peers, and may consider constant irritability just a part of life. Often, even if someone recognizes symptoms of PDD, they convince themselves they aren’t feeling them severely enough to warrant asking for help. “I get to work on time every day and see my friends on the weekends! I can’t possibly be depressed!”
If you feel as though you’ve been in a bad mood since 2017, or even experienced extended bouts of sadness on and off for a few years, it’s worth checking in with a therapist or other mental health professional to see if PDD is the culprit. There are treatments available and therapists who can help you through it and out the other side.
You’re also not alone. Check out this informative and vulnerable piece from writer Christine Yu on discovering her own high-functioning depression.