Depressed? No! You look okay!
Does that sound familiar? If yes, you might be experiencing high functioning depression. Now, in case you are wondering what is high functioning depression and what does it look like, continue reading.
Depression is a form of serious mental illness, often regarded as a mood disorder. Experiencing depression is more complex than dealing with a mere mood swing.
A person is diagnosed with depression if the symptoms are persistent for more than two weeks.
General symptoms include:
- feeling worthless
- being self-critical
- losing appetite
- crying over self-made future scenarios
- and much more…
Depression occurs in many forms; it can be a major depressive disorder, postpartum depression, psychotic depression, bipolar depression, premenstrual dysphoric depression, seasonal depression, and the one we will be discussing here is Persistent Depressive Disorder (High functioning depression or Dysthymia)
The term high functioning depression (HFD) is not recognized as a clinical diagnosis. In clinical terminology, it is referred to as persistent depressive disorder or Dysthymia as per the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). This Greek word Dysthymia is translated as “mental illness” in English.
In relation to the other forms of depression, high function depression is often misdiagnosed or not diagnosed at all. This is because individuals with high functioning depression show minimal or no signs of mood disturbance.
Dysthymic people persistently struggle with revealing their true feelings and usually keep a fake mask of contentment on.
It is high time that we discuss the untold battle high functioning depression puts its victims into.
Depression, just like any other disease, needs to be diagnosed and treated timely. Since the diagnosis of persistent depressive disorder is usually always delayed because of the very nature of this disorder, a thorough understanding of its nature is essential.
How is High Functioning Depression different from other forms of depression?
What comes into your mind when you think of a depressed individual?
Yes, your answer is true in most cases. A depressed individual does seem uninterested, away from the world, isolated, someone whose life is falling apart, whose gloom and misery have eaten his academic and professional career.
All this might be true for all forms of depression EXCEPT for high functioning depression, where a person’s social and professional life does not seem to have been affected much.
As its name suggests, a dysthymic person prefers to combat his inner demons by functioning normally or even higher than he usually would. This is why people have a hard time believing in them, even if they consider asking for help.
High functioning depression is a chronic form of depression that typically affects the individual for two or more years.
People experiencing HFD are better at hiding their emotions, and despite feeling miserable, they tend to be high achievers in their respective fields.
To the world, they may be living a perfect life, with an ideal job and a great family, but to them, their everyday struggle only keeps worsening with each passing day without treatment.
It feels like you are aimlessly repeating everyday customs, waking up, getting dressed, setting out to work, functioning at your utmost, getting back home, eating, and off to bed. You are performing, but you are no longer connected to the world.
You are in the crowd, but on the inside, you are standing ALL ALONE!
High Functioning Depression and stigma towards seeking professional help
Seeking mental help has frequently been put through social stigma regardless of the type of mental illness. However, the complexity doubles while seeking assistance with high functioning depression. Let us dissect how.
A person with high functioning depression may assume that he can defeat his distressing emotions by occupying himself with work and other commitments.
This thought mainly occurs because of the seemingly lower intensity of HFD symptoms than other significant forms of depression.
A person might think that the regulatory mechanism works this way. He keeps on indulging himself in his work, study, games, or even self-destructive habits, including alcoholism, substance abuse, and its likes.
Simply put, a dysthymic individual does not deem it essential to seek professional help for his mental condition because it is the way of life for him.
On the other hand, people around the HFD person, who, in other cases, are much observant in identifying any mental distress, do not believe the victim. It happens because the artificial coping mechanism of the HFD person is integrated so perfectly that people around him are convinced.
It further makes it harder for a high functioning depressed person to receive psychotherapy in time, even if he successfully recognizes the problem.
What do people with High Functioning Depression have to say about it?
The real-life struggle to live with high functioning depression is understood by the people experiencing it.
It is equally significant for healthy individuals to understand HFD, in case they experience any such symptom in the future or get to live with someone dealing with HFD.
Let us have a look at what HFD sufferers want to share and see how living with high functioning depression looks like
“I didn’t think I was “depressed enough” to get help.” – Claire Gillespie (writer/blogger)
“When I told my husband, I felt depressed, and he didn’t believe me. As I sat on the edge of the bed, knees pulled into my chest, and he launched a valiant effort to convince me everything was A-OK.” – Christine Yu (NY based writer)
Living with High Functioning Depression, how Redditors describe it:
“The worst is having loved ones around, and you can tell they’re frustrated. Especially after the 8th day of them asking to go for a walk and you say no.”
Overthinking about past events
“Constantly focusing on the past is a big issue I have to deal with. Not having the motivation to do anything is my biggest issue right now. I hate going through multiple days without doing anything productive.”
Having troubling proving themselves and that their depression is REAL
“I don’t know if this is worse than the exhaustion, self-doubt, or suicidal thoughts, but *one* of the worst things was that no one, therapists included, seemed to believe I was really having that bad of a time.”
“My will to live is not for me but for the people around me. Like I’m just playing my part as a daughter, sister, friend, and officemate while me being in an autopilot mode.”
“Every day feels the same: I get up, live my day and go to bed. It feels like I take care of everyone but myself and like I’m living the same day over and over again. I’m able to do what I have to do, but it’s the absolute bare minimum, and even that’s exhausting.”
Typical symptoms of High Functioning Depression
Many symptoms of high functioning depression are similar to that of major depression; however, it becomes pretty hard to recognize these symptoms in HFD due to its concealed nature.
As mentioned before, identifying HFD is challenging for both the person going through it and the people around him.
A few symptoms that might help to get a hint of high functioning depression in a particular individual are listed below:
- No motivation to perform everyday tasks
- Trying to get everything perfect.
- Feeling of emptiness, grief, and gloom.
- An intense wave of hopelessness that may hit many times in a day
- Extreme tiredness and lethargy
- Considering one’s self incompetent and unworthy.
- Being self-critical most times.
- Decision-making comes as a challenge.
- Trouble focusing on essential tasks
- Easily triggered with minor discomforts.
- Unnecessary display of anger
- Reduced productivity
- Inner discomfort causing inefficiency
- Isolation and reduced social activities
- Always on a guilt trip, blaming one’s self for events of the past.
- Eating disorders may accompany overeating or under eating.
- Sleeping disorders are common, insomnia or hypersomnia.
- People with other depressive disorders find it quite grueling to understand their symptoms and cope with them, whereas on the other hand, people with high functioning depression superfluously do it. They go so overboard in devising their own coping strategies against their symptoms that they end up standing on the edge of the cliff.
Causes of High Functioning Depression
Depression most commonly stems from childhood trauma, isolation, social or work-related stress, and neurochemical imbalance. However, high functioning depression, like any other form of depression, can also run in the family.
Depression is generally referred to as a mood disorder, which starts from a random mood fluctuation and brings about much darker and persisting emotion of despair over time.
The inability of internal regulatory mechanisms to equilibrate the sudden rush of emotions makes it even worse.
Neurochemicals or neurotransmitters in the brain are responsible for regulating psychological behaviors. Any imbalance can result in altered psychological outputs.
Stressful conditions due to a tragic event or series of events play a significant role in altering the natural mood regulatory mechanism.
Medicines given in depression reset the natural regulatory mechanism back to normal by balancing neurotransmitters. 
Having an immediate family member diagnosed with any form of depression increases the chances of depression twofold. Such people are at greater risk of developing high functioning depression.
Traumatic past experiences
High functioning depression is more likely to be triggered by unpleasant past experiences, including grief, unstable work and family relationships, sexual abuse, betrayal, and other tragic events.
How to treat High Functioning Depression
High functioning depression is a mental illness and should be treated like one. Just because you cannot see it does not mean it is not there.
Diagnosis of high functioning depression is undoubtedly the most complicated part, which keeps getting easier as we approach the treatment.
Like other mental health disorders, treatment of high functioning depression is two-way. Making appropriate changes in lifestyle and seeking professional help both go hand in hand.
1) Low paced exercise
Low-paced exercise has shown to be the most effective activity for depression, as per reports. This kind of exercise can be sustained over time and releases a protein named neurotrophic, often called the growth factors.
Hippocampus is a part of the brain that regulates mood. Neuroscientists believe that in depressed people, the hippocampus’s size is relatively smaller than that in ordinary people.
Thus, the growth factors released during a low-paced exercise help grow the hippocampus, form new neuronal connections and ultimately improve mood. 
2) Have a good night’s sleep
The reason why sleeping disorders trigger depression is that lack of sleep activates stress systems, contributing to stress . However, the relation between depression and sleep is bidirectional, which means both the factors trigger each other. 
3) Healthy eating never disappoints
The association of diet with depression is undeniable. Various studies have shown the impact of diet on the levels of mood hormones.
Research supporting this phenomenon shows how a diet comprised of antioxidants, fruits, vegetables, olive oil, fish, and low-fat dairy products helps to alleviate the symptoms of depression.
The same study then shows how an unhealthy diet can elevate the risk of depression in healthy subjects. 
4) Cut ties with alcohol
People fighting depression may assume taking alcohol would relieve their stress. It does make them feel free of those piercing emotions but for a brief period.
According to The National Institute on Alcohol Abuse and Alcoholism, in the long run, alcohol consumption further disrupts the brain’s neurochemical synthesis, thus worsens depression. 
Seek professional help
It is crucial for the treatment of high functioning depression to seek professional help. Professional therapy is not the same for all individuals dealing with persistent depressive disorder (HFD).
The severity of symptoms is taken into consideration by psychotherapists before initiating the treatment.
Psychotherapy and medications are two vital components of high functioning depression therapy. Both of these components are to be administered simultaneously for effective therapeutic outcomes.
Psychotherapy includes talking to the patient in the most efficient way to rule out the root cause of high functioning depression.
Since high functioning depression is a complex form of depression that often holds the patient from sharing his real emotions, one must choose a qualified psychotherapist for this job.
A competent psychotherapist will:
- Let the patient speak, empathize with him and make him feel comfortable.
- Keenly observe the thought patterns of patients and help them replace their negative self-belief into a positive one.
- Help patients identify their triggers and devise an effective strategy to help them deal with them.
- Strengthen patients’ self-coping mechanisms by advising them to keep a journal, implement healthy lifestyle changes, and meditate.
- Encourage the depressive patient to socialize more and nourish their relationships with friends and family.
- Performs cognitive behavioral therapy to help identify problems and explains how the negative thoughts give rise to depression. Sessions are often conducted with friends and family to ensure optimal therapeutic effects.
Treatment of high functioning depression is insufficient without proper medications that would complement the effectiveness of the therapy.
Many anti-depressants can be used to treat high functioning depression; however, the right choice of medicine should only be left to the therapist.
Depending upon the symptoms, a psychotherapist prescribes the best-suited medications. Self-medication in any condition is prohibited as it may impart adverse drug reactions and other potentially harmful side effects.
Some anti-depressants that are used to treat high functioning depression are:
- Selective serotonin reuptake inhibitors (SSRIs)
- Tricyclic anti-depressants (TCAs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
How to care for someone with High Functioning Depression
Reading the description stated above, some of you might be thinking of a close acquaintance who is probably facing these issues and wondering what they should do about it.
Here is what you can do if a loved one from friends and family suffers from high functioning depression.
The more you know about high functioning depression, the more accurately you will be able to identify its signs. Since identifying the signs of HFD is crucial to eradicating them, education makes the process quick and effective for the victim.
Listen to empathize, not to advise
Exercise restraint over your urge to offer solutions while listening to a person with high functioning depression. People with HFD are already quite inexpressive due to their disorder; thus, even slight negligence would take them back into their inexpressive phase.
Be a good listener.
Repercussions of not seeking professional help
Now that you are fully aware of what high functioning depression is and how it refrains the individual from seeking professional help, it is equally necessary to know what repercussions it may present if left untreated.
The assumption, a high functioning depressed person, may display is that their mood will be cured, naturally.
As per studies, only 10% of high functioning depression cases are cured naturally, whereas 20% develop the major depressive disorder and 15% develop bipolar II disorder.
This clearly explains why the treatment of high functioning depression is so necessary. If left untreated, HFD may lead to even complex mental disorders compromising one’s quality of life. 
As complex as its symptoms may sound, the good news is, High functioning depression is treatable. You can still find peace and be able to enjoy the life you deserve after all the struggles HFD put you through.
You need to understand that not everything gets cured naturally, especially mental disorders where your self-regulatory mechanism is already disrupted.
Seeking help will only do you good, do not hesitate to get therapy.