What does it mean to have ‘high functioning’ depression?

Written by Lauren Geall

Struggling with low mood and a lack of energy, but able to keep up appearances in your day-to-day life? You could be dealing with high functioning depression.

Although we’re talking about our mental health more than ever nowadays, there’s still plenty of people whose conditions and day-to-day experiences remain a mystery to many of us. As a society, we’ve definitely come a long way when it comes to destigmatising some of the symptoms of conditions such as anxiety and depression, but outside of these small parameters, there’s still lots of work to be done.

One condition which many people still struggle to understand is high functioning depression. Loosely defined as a form of depression in which someone experiences the common symptoms of depression without it affecting their ability to complete day-to-day activities, people who are dealing with high functioning depression often struggle to access support precisely because they “seem fine” on the outside.

Someone with high functioning depression may also believe they’re “doing too well” to have depression and therefore avoid seeking help, or put their low mood and lack of energy down to other reasons such as poor sleep or not eating well (both of which can also be symptoms of depression). 

Although this form of depression may not seem as ‘severe’ as the kind which makes it difficult to get out of bed, for example, the fact that high functioning depression often goes unrecognised by both the person with the depression and the people around them makes it particularly difficult to deal with and treat.

To find out more about high functioning depression, including what it is, and what treatments are available, we asked chartered psychologist Dr Meg Arroll to explain. Here’s what she had to say.

What does it mean to be ‘high functioning’?

“High functioning in this sense means being able to continue with ‘activities of daily living’ – not necessarily being the CEO of a blue chip company or an Olympic athlete, but rather being able to hold down a job, take care of family and from the outside look as if everything is fine,” Arroll explains.

“However, doing all those things you need to do in daily life, such as going to work, running a home, maintaining relationships and friendships feels like a colossal effort when you have high functioning depression.

“The reason why this definition is important with regards to depression is that one key sign of this mental health disorder is disruption in activities of daily living, hence someone who is high functioning may be un- or misdiagnosed.”

What are the symptoms of high functioning depression?

For the most part, the symptoms of high functioning depression are the same as the typical depression symptoms – the main difference between the two is that people with high functioning depression typically don’t experience much disruption to their everyday life.

Apart from this, Arroll explains, “the symptoms of high functioning depression are the same as depressive disorder – for example, feeling hopeless, helpless and/ or empty inside, experiencing tearfulness and irritability, feeling tired or easily fatigued either with or without sleep dysfunction, experiencing changes in eating behaviour and cognitive problems such as concentration on tasks that used to be completed without difficulty.” 

Arroll adds: “Sometimes referred to as persistent depressive disorder, high functioning depression is not feeling low for an obvious reason such as a bereavement, but rather experiencing many or all of the symptoms of depression but outwardly functioning normally.”

Does being high functioning mean your depression is any less serious?

“No, being high functioning certainly does not mean an individual’s condition is less severe,” Arroll says.

“Because those on the higher end of the functional ability spectrum may be un- or misdiagnosed, they may find it harder to access treatment and support. Left untreated, depression can worsen so high functioning individuals often don’t receive help until a crisis point. Therefore, in some cases, being high functioning may lead to more severe symptomatology.”

What treatment options are available for people with high functioning depression?

“The treatment options for people with high functioning depression are generally the same as those with major depression (e.g. talking therapy such as cognitive behavioural therapy, mediations, exercise and social support) but, as above, the point at which they access services may differ as health professionals, friends and family may not be aware that you’re struggling,” Arroll explains.

“This is why it’s important for us all to do a regular mental health check, just as we would go for a physical health check-up.

“The NHS also has a handy Mood Assessment tool which only takes a few minutes to complete.”

Coping with depression

If you’re struggling with depression right now, it’s important to remember that you’re not alone, and that there are places and people who are able to help.

If you’re looking to read more articles about depression, here’s three to get you started:

  • The main symptom of depression outsiders often struggle to understand
  • 4 women share their experiences of dealing with depression in lockdown
  • Michelle Obama has talked about low-grade depression, but what exactly is it?

And for more information on depression, including what it is, how to cope and when and where to seek help, you can check out NHS Every Mind Matters or visit the Mind website.

For confidential support you can also call the Samaritans in the UK on 116 123 or email jo@samaritans.org.

Images: Getty

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