Do I Have High Functioning Depression? Published: February 02 2017
What is high functioning depression?
High functioning depression belongs to a group of disorders referred to as “depression” or “depressive disorders”. The term is used to describe people who experience consistent symptoms of depression for a long period of time (over 2 years), but continue to complete the activities necessary to lead functional lives. They work and often have thriving careers. They take care of their families, their homes and their appearance while they are struggling with feelings of negativity, sadness, and despair. The symptoms are examined in more detail below.
Why is high functioning depression unique?
Depressive disorders are associated with feeling “blue” and a lack of motivation. This can impact lives in many different ways. Sometimes, it can mean that it takes extra effort to complete the tasks of daily living, including preparing and eating healthy meals, maintaining a cleanly household, maintaining personal hygiene or completing logistical tasks, like paying the bills. For certain individuals, these tasks are consistently passed over. When these tasks are not being completed on a regular basis, it may become apparent to others, who can, in turn, express concern and offer support.
On the other hand, it is possible that individuals experiencing high functioning depression may not shirk their responsibilities, despite the fact that their chores may seem like a heavy burden. They push themselves to complete the daily tasks of living while facing other, often devastating, symptoms of depression. This is referred to as “high functioning depression”. Individuals grappling with the disorder experience symptoms of depression, but continue to lead productive lives.
Can I be diagnosed with high functioning depression?
High functioning depression is not diagnosed as a distinct type of depression. It is a lay-term for a specific experience of “persistent depressive disorder”, which is a new diagnosis. What is now called persistent depressive disorder was formerly two categories; chronic depressive disorder and dysthymia. Although high functioning depression is not a diagnosis, it is a term that can help us better understand the experience of certain individuals.
Extra challenges associated with high functioning depression
To be diagnosed with persistent depression, must report that they feel “down” most of the time. This report comes either from the person experiencing the symptoms or from their loved ones. In the case of high functioning depression, the person experiencing the symptoms may be able to hide their feelings, making it difficult for others to notice that they are feeling “blue”. This adds some extra difficulty in identifying individuals who may be in need of help. It is important that people disclosing these types of feelings are offered an empathetic ear and treatment, if necessary, regardless of how “together” they may seem.
How common is high functioning depression?
Estimates of the incidence high functioning depression are not currently available. However, according to the American Psychiatric Association, approximately 1 in 200 people may experience persistent depressive disorder within any given 12-month period.
A common false assumption about high functioning depression
It is a common mistake to assume that individuals who are leading productive lives are also happy. This is not always the case. Individuals experiencing high functioning depression may accomplish many things over the years, but feel little joy of accomplishment, regardless of the magnitude or impact of their deeds. It is not necessary that an individual experience extreme mood swings or thoughts of death and suicide in order to receive treatment for a depressive disorder.
Common symptoms of high functioning depression
According to the reference guide psychologists use to assign diagnoses, persistent depressive disorder is present when an individual experiences a depressed mood for most of the day on more days than not for 2 years. The individual must also experience 2 or more of the following:
1) Low self-esteem
People who are experiencing high functioning depression often appear, from the outside, to have happy and productive lives. They may be able to “put on a happy face” while interacting with others. However, their inner dialogue may be rife with negativity.
When they are thinking about the problems they face, things may seem like they couldn’t get any worse. Problems seem like they will be long-lasting, rather than temporary. (E.g. “I was fired. I’ll never find another job again!”) Stressful events are also perceived as broad-reaching, rather than impacting just one aspect of life. (E.g. “I didn’t get the promotion. My partner will be angry and stop loving me. I’ll be jobless, penniless and alone.”)
Problems are perceived as insurmountable when individuals don’t believe they have the resources to cope with them. This is a result of low self-esteem and self-criticism, common to depressive disorders.
Often, people experiencing high functioning depression feel like they’re wasting time, continuing to keep themselves busy, but feel hopeless when it comes the idea of building a happy life. While major depressive disorder can be associated with thoughts of death or suicidal ideation, persistent depressive disorder is associated with a general sense of hopelessness. This doesn’t make it any easier. The long-lasting nature of the disorder is relentless. Major depressive disorder can go into remission in between depressive episodes, leaving the individual to experience a symptom-free life for a time, while persistent depressive disorder tends to continue for longer periods with remission times less than 2 months in duration.
3) Difficulty sleeping
The typical healthy adult requires 7-9 hours of sleep nightly (Hirshkowitz et al, 2015), but individuals experiencing depressive symptoms may find it difficult to regulate their sleep. Some may sleep more than this, while others may sleep less.
4) Low energy or fatigue
Regardless of sleeping difficulties, people who are depressed often find that they experience fatigue (Demyttenaere, De Fruyt & Stahl, 2005) and have very little motivation to complete any task at all. This is often the reason that so many depressed individuals neglect simple daily tasks. People with high functioning depression are not exempt from this feeling. However, these individuals may continue to complete their tasks in the face of these symptoms. That doesn’t mean it’s easier for them or that they are less deserving of treatment than those who do not complete these types of tasks.
5) Poor Appetite or Overeating
Eating well can be a great pleasure. It can also be a lot of work. With depression, sometimes individuals will indulge too often and they gain weight (Simmons et al, 2016). Alternatively, individuals may lose motivation to eat and lose weight (Simmons et al, 2016). When supporting an individual experiencing depressive symptoms, it is prudent to encourage healthy eating habits.
6) Impaired concentration or difficulty making decisions
On occasion, it can be the cognitive symptoms associated with depressive disorders that lead individuals to seek help. With pervasive depressive disorder, memory is impaired (Yoon, LeMoult, & Joormann, 2014) such that people may walk into a room to fetch an item, but forget which item they were seeking. They may forget where they are headed while driving or fail to remember all of the items on their grocery list. These troubles may seem common and innocuous, but when they happen frequently, they have a significant impact on daily functioning.
What can be done about high functioning depression?
If you or someone you know is experiencing the symptoms described above, there are many things that can ease the symptoms. Before undergoing any of these proven depression-relief methods, please consult with a professional.
Also known as talk therapy, psychotherapy helps patients reach awareness of their own thoughts, feelings, behavior, and mood. You will work with a licensed therapist to map out personal history and identify the foundational issues triggering your depression. There are many kinds of psychotherapy, including one-on-one, group, and family.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy aims to alter a patient’s negative thinking patterns. The therapist will work with you to disarm recurrent depressive thoughts and feelings before they can take hold. It is a strategy often used to treat drug and alcohol abuse, anxiety, insomnia, and depression. Once your therapist helps you identify your session goals, he or she will work with you for several months to refocus your thought processes, derail bad habits, and approach your emotional problems from new angles.
Simply, CBT helps the patient gain clarity about what they’re feeling emotionally. Ideally the therapy helps to uproot negative automatic thoughts so that the patient can solve problems removed from drowning emotions.
Cranial Electrotherapy Stimulation (CES)
Serotonin is a chemical that helps facilitate neurological messages between cells. A stable level of serotonin helps regulate sleep, appetite, memory, learning, and mood/level of perceived happiness. Individuals with lower serotonin levels, may experience a higher level of depression since the neural connections don’t have enough messengers, so-to-speak. So, how can we improve that serotonin level?
Handheld pulse generators like the FDA-approved Fisher Wallace Stimulator® enhance the production of serotonin and lower the stress-producing hormone cortisol over time. It helps treat not only high-functioning depressive symptoms, but also insomnia, post-traumatic-stress, panic, and anxiety. The Fisher Wallace Stimulator is also FDA-cleared to treat bodily pain.
Cranial Electrotherapy Stimulators are very easy to use and comfortable. Comprehensive research supports their true effectiveness. Consult your doctor if you are interested in trying out this unique, new method for enhanced depression relief.
In some cases, depressive symptoms are far too rooted and overwhelming to be alleviated by exercise, diet, or good sleep. Different symptoms call for the use of different approved-medications: anti-depressants, anti-anxiety medication, mood stabilizers, and antipsychotic medication. Though a certain ailment may be incurable, drugs can assist someone experiencing debilitating symptoms. Be aware that since these are not natural methods for relief, so a spectrum of side-effects are likely to occur.
Often, medication is prescribed to patients with hereditary depression and anxiety. Unfortunately, some people naturally don’t produce enough serotonin. Consult your doctor, psychologist, or psychiatrist if you would like to try prescription medication. It’s important to note that, while drug therapy benefits many, you may not be compatible with certain drugs. Each prescription is slightly different and prompts a different physiological response from the user. Simply ‘trial and error’ administration is often the best course of action for you and your doctor.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Demyttenaere, K., De Fruyt, J., & Stahl, S. M. (2005). The many faces of fatigue in major depressive disorder. The International Journal of Neuropsychopharmacology, 8(01), 93-105.
Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., ... & Neubauer, D. N. (2015). National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health, 1(1), 40-43.
Klein, D.N., & Black, S.R. (2013). Persistent depressive disorder. Psychopathology: History, Diagnosis, and Empirical Foundations, 334.
Nemeth, V. L., Csete, G., Drotos, G., Greminger, N., Janka, Z., Vecsei, L., & Must, A. (2016). The effect of emotion and reward contingencies on relational memory in major depression: an eye-movement study with follow-up. Frontiers in Psychology, 7.
Simmons, W. K., Burrows, K., Avery, J. A., Kerr, K. L., Bodurka, J., Savage, C. R., & Drevets, W. C. (2016). Depression-Related Increases and Decreases in Appetite: Dissociable Patterns of Aberrant Activity in Reward and Interoceptive Neurocircuitry. American Journal of Psychiatry, 173(4), 418-428.
Yoon, K. L., LeMoult, J., & Joormann, J. (2014). Updating emotional content in working memory: A depression-specific deficit?. Journal of behavior therapy and experimental psychiatry, 45(3), 368-374.