Before we discuss High Functioning Depression we first need to discuss depression in and of itself. Depression is technically a group of conditions associated with the elevation or lowering of a person’s mood. It affects the thought process, perception of life, and self-esteem. These conditions are categorized by the causes of their onset and/or their severity and characteristics. One such condition, clinical depression, is a mental health disorder characterized by persistently depressed moods and a consequent loss of interest in daily or social activities.
Causes of Depression
Depression can be caused by a host of reasons:
- Loss of a loved one: The death of a loved one can send someone into a deep depression, depending on the nature of their relationship
- Stress: stressful situations like major life changes or economic downturns often have hugely negative impacts on mental wellness. Depression can easily come about if the stress persists
- Medication: certain medication has the capability of causing depression as a side effect
- Abuse: abuse, physical or emotional can have severe effects on mental health, often leading to depression
- Illness: medical conditions may trigger episodes of depression
- Substance abuse: people with substance abuse problems are very likely to fall into depression in a condition known as co-occurring disorder.
Depression As You Know It
Your mind is conditioned to associate depression with the characteristics of clinical depression:
- Suicidal tendencies
- Anti-social tendencies
- Lack of appetite
- Low self-esteem
- Lack or over-abundance of sleep
- Weight imbalances
- Low energy levels
At face value, these symptoms are easy enough to pick up on. On the flip side, lack of these signs is interpreted as an absence of depression. Therein lies the danger.
The information readily available from various sources paints depression in a certain light. To you, there is no way that a person who is depressed will attend work, school, a date, and even church. You imagine someone who is bed-ridden, constantly crying, and not eating. While these are indicators of depression, people with high functioning depression do not exhibit these traits and continue with their normal lives as if nothing is amiss.
What is High Functioning Depression?
Also known as Persistent Depressive Disorder (PDD) and (formerly) Dysthymia, functional depression is a mental health condition that is not immediately recognizable. People living with high functioning depression are pictures of seemingly perfect physical and mental health. Nothing will immediately strike you as off even if you observe them. It is a scary thought, especially when people living it are not self-aware.
People with functional depression will smile, laugh, and cry when others are crying. They will organize birthdays and surprise parties, are extremely well-organized and might have perfectly-balanced lifestyles. It is really difficult to tell. However, within them, things are not experienced in the same way. There is a numbness to their emotions.
High functioning depression is not severe but lasts for years (5 on average) thus earning the ‘persistent’ in its name. While not obvious, some signs of functional depression are:
- Emotional numbness
- Lack of actual joy and happiness
- Feeling unsettled
There are shared symptoms between Major Depression (MD) and PDD. For example, one may have irregular sleeping habits and fatigue which are not severe but persist for days, causing a low mood that extends for years.
The Depressing Statistics
Statistics from the World Health Organization (WHO) state that upwards of 264 million globally have experienced some form of depression, irrespective of their age. In the United States, over 6.7% of adults experience a major depression episode yearly. For context, 6.7% of the American population is over 16 million people. High functioning depression affects 1.5% of American adults annually.
While the acknowledgement of mental health problems and treatment has come leaps and bounds, the association of depression with certain signs and symptoms is still a stumbling block for those wishing to seek treatment for functional depression. To most, if there are no clear and obvious indicators that someone is in a depressed state, they are ‘attention seekers’ and whatever they are going through is ‘tolerable’ at the very least.
What are the Signs of High Functioning Depression? Symptoms & Diagnosis
An often definitive sign of functional depression is the consistent recurrence of symptoms with a slight reprieve coming for no more than 2 months intermittently. As such, diagnosing functional depression requires that symptoms be present for at least a year or 2 years for children and adults respectively.
When compared to major depressive disorder (MDD) the duration required for diagnosis is much longer. Even with shared symptoms like fatigue, a lack of concentration, irregular sleeping patterns, and trouble eating, MDD can be diagnosed after 2 weeks as compared to 2 years for functional depression. Symptoms are less severe for functional depression but last much longer.
Because of the complexity in diagnosis, high functioning depression should be diagnosed by a mental health professional. There are criteria to be met to qualify the diagnosis. This high functioning depression test is found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In addition to a prevailing low mood for at least 2 years, there must also be at least two of:
- Eating disorder
- Low self-esteem
- Sleeping disorder
- Impaired concentration and decision-making
There should also be:
- No period of euphoria or energetic mood experienced
- No better link between the symptoms and another condition
- Impairment in one or more areas of normal function
From a personality perspective, some signs to look out for may include:
- Increased indulgence in alcohol
- Increased self-criticism
- Changes in attitude
- Increased concern for productivity and perfection as a distraction tactic from their numbness
Functional depression can occur concurrently with MDD, a state referred to as double depression.
Functional Depression and Perfectionists
Studies have established a correlation between functional depression and perfectionist notions. Very successful people can have nearly undetectable high functioning depression. They are overwhelmingly worried about making mistakes, internal and external criticism, and frequently doubt themselves.
Children conditioned for perfectionism have a higher chance of developing depressive disorders.
First Person Perspective of Functional Depression – What It Feels Like
Whether for yourself or a loved one, it is important to walk a few steps in the shoes of someone with functional depression.
From that perspective, your perfectionism is a gift and a burden, leaving you constantly exhausted. An overachiever from the outside, you have a constant need to keep pleasing everyone else. Nothing brings you joy and you are very hard on yourself. You are struggling, and:
- Living with it is exhausting
You constantly have to act like you’re happy and enjoying yourself. You feel the need to be the best in anything and everything just to fill a void.
- You feel you are not doing your best
In spite of your best efforts, you still feel like there is an upper level to get to. Nothing you do is enough.
- Some days feel normal
Good days are the normal days. Nothing special happens but you get through them without the feeling of hopelessness and despair. Your concentration is solid and you actually feel productive.
- Some days are devastating
Getting yourself together on these days is a task but you have to do it. You have to appear fine in spite of the turmoil you are feeling inside. You’re functioning, barely, but your focus is just not there.
- The bad days are draining
It takes a lot of effort to pull the facade together. To force a smile. Your tasks take longer to complete. Your frustrations are just about boiling over.
- You feel like a fake
You feel like you’re constantly playing a version of yourself that appeals to people.
- You can’t seem to justify your need for help
How can you be depressed when you seem to be doing just fine, right? Your life is not falling apart, and thus, to everyone else you do not need any help.
- Asking for help is a daunting task
Where to start?
Living with functional depression might actually form part of how people describe your personality. You are said to be a downer. Your brief stints of joy are too brief and the lows do not end. You’re always tired, but do everything you’re supposed to no matter how draining it is. Your self-esteem is non-existent and you feel undeserving of affection from others. Hopelessness is a well-known feeling to you. Your concentration goes on vacation for most days. You struggle with all kinds of relationships, social activities, and might even be a victim of substance abuse as a coping method.
Dangers of High Functioning Depression
Functional depression may be hard to recognize within, let alone in others. The danger of this lack of awareness is that mitigating steps might not be taken early enough.
It is characteristic of people living with high functioning depression to hide what is going on inside. Seeking treatment is therefore difficult. They have no outlet to express themselves and feel increasingly isolated as time goes by. The people around them, unknowingly, will expect certain levels of interaction which will only make them more depressed as they struggle to live up to those expectations and carry on the notion that everything is fine. The risk of suicide becomes very high.
If you are aware of such a person, it is important to take the following suicide prevention steps:
- Call the local emergency number or 911
- Do not leave the person alone
- Remove any weapons or would-be weapons from sight
- Allow the person to talk to you
- Call the National Suicide Prevention hotline
If untreated, high functioning depression can lead to self-medication or turning to other substances as an escape. At this point, addiction is never far off. Substance abuse worsens the symptoms of mental disorders, and the patients use more drugs to attempt to numb the pain. The vicious cycle greatly worsens the situation and can even lead to death by overdose.
Treatment For High Functioning Depression
Functional depression is curable. Seeking help is the first and best step when battling functional depression. Feeling the need for a diagnosis is difficult, and more often than not it has to be pointed out by a loved one. Either way, getting a diagnosis is a major turning point.
Treatment consists of both appropriate therapy and medication like antidepressants. Personalized care goes a long way in determining the best and most effective combination to use on a patient. Therapy offers a guide to improved self-awareness. It is important to be able to recognize and counter signs and symptoms as they crop up. Therapy encourages sharing, which a lot of people living with functional depression struggle to do. Positive reinforcement from loved ones helps boost feelings of self-worth and acceptance, which consequently boosts self-esteem.
In the case of co-occurring disorders, dual diagnosis treatment programs will most likely be residential, because a change in environment and lack of access to the substances is important. There is also professionally-administered medication used to dial down the withdrawal symptoms on the road to recovery.
To supplement the professional treatment programs, there are DIY steps that reinforce the necessary lifestyle changes:
- Eat and stay healthy: studies have shown a correlation between a healthy lifestyle and a healthy mental state
- Express yourself: speak up or write it down. Getting out whatever emotions you may be experiencing eases the mental burden and struggle of keeping things hidden inside
- Avoid alcohol and other substances: they only worsen the depression symptoms
- Read extensively: information is power, always read up on your condition. Feeling in control is a huge plus for treatment.
With treatment comes the promise of brighter days. The promise of lifting the heavy burden carried inside. A person living with functional depression feels the need to carry on as is, to not burden others with their problems, fears and insecurities. Slowly but surely, that feeling is replaced by genuine happiness, a feeling that may feel foreign, as more awareness is created for the condition. Functional depression is a real thing. Whether for yourself or a loved one, seek help today.