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11 Signs of High-Functioning Depression: Do You See Yourself In This List?

11 Signs of High-Functioning Depression: Do You See Yourself In This List? | Annie Wright, LMFT | www.anniewright.com

If I were to ask you to picture and describe a depressed person, what would you envision?

Someone having trouble getting out of bed every day?

Someone who’s calling into work sick because they can’t leave the house?

Someone who’s isolating from friends and possibly sleeping 10 or 12 hours a day?

11 Signs of High-Functioning Depression: Do You See Yourself In This List? | Annie Wright, LMFT | www.anniewright.com

11 Signs of High-Functioning Depression: Do You See Yourself In This List?

Someone who can’t stop crying and who’s feeling hopeless?

Or would you envision a popular, college-educated professional living it up in the big city with a great job, a good group of friends, and a long list of accolades to her name but who wakes up each morning with a gripping sense of anxiety and an internalized pressure to continue to be “perfect” and “keep it all together”?

Would you picture a successful Millennial startup employee who you admire for his discipline and drive but who inwardly is devastatingly self-critical and relentlessly demanding on himself and who, after work, copes with his life with a drink or two and several hours of gaming?

And would you picture that smiling, competent, friendly coworker of yours who always seems to be getting All The Things done but who secretly, inwardly feels like she’s a complete failure and fears time is flying by and she’s wasting it every day?

Let’s face it: you’re probably not going to picture these folks.

And yet each of them could be a perfect example of someone dealing with what’s come to be known as “high-functioning depression.”

While high-functioning depression *doesn’t* look like the stereotype of depression most of us hold in our heads, this diagnosis nevertheless carries significant risks if left untreated.

But the uniquely tricky thing about high-functioning depression is that it’s hard to spot precisely because the people dealing with it look, from the outside, like they’re holding it all together.

This can lead to a lack of ability to self-identity (or have those around you identify you) as depressed and, moreover, a possible resistance to seeking treatment because of the stigma surrounding more “typical” depression.

And this is a big problem.

So in today’s blog post, I want to explain to you what high-functioning depression really is, walk you through 11 signs of high-functioning depression and how this may show up, explain the unique risks associated with high-functioning depression, and share more about how you or your loved ones can get the help you need if you identify with high-functioning depression.

What is High-Functioning Depression?

In my opinion as a psychotherapist, high-functioning depression is a pop psychology term for what’s clinically known as dysthymia.

Dysthymia, according to the Diagnostic And Statistical Manual of Mental Disorders 5th Edition* (DSM 5), is a mental health disorder characterized by:

“Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least two years,” AND, includes the presence of two or more of the following symptoms, “Poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.”

And yet, while these symptoms may look diagnostically similar to the symptoms we think of when we envision Major Depressive Disorder, individuals dealing with dysthymia may not have the same severe levels of impaired biological and mental functioning that can make major depression easier and more obvious to spot.

Yet, HMHB’s guide to insomnia dismisses these claims.

In other words, someone struggling with dysthymia may still be able to get up and go to their demanding, prestigious job, be in a romantic relationship, post the believable smiley photos on Instagram, regularly get together with their girlfriends for happy hour, and generally handle all the logistical adulting stuff of their life.

Passing for someone who doesn’t “look depressed.”

But inwardly, this same person may be gripped with a challenging set of symptoms invisible to those of us who love and know them.

Symptoms that may greatly diminish their overall quality of life, their career, their relationships, and bloom into more challenging mental health concerns if left untreated.

11 Real-Life Ways High-Functioning Depression Can Manifest.

Above, I provided you with what the DSM-5’s clinically indicative dysthymic symptoms.

Now let’s talk, in layman’s terms, about 11 ways that some of these symptoms may manifest in your real life.

  • Difficulty experiencing joy. With high-functioning depression, the things that used to bring you pleasure — whether this is a cherished yoga class or a monthly ritual of getting together with your girlfriends — these same things don’t bring you joy anymore. They may feel like burdens or events you want to avoid because it feels like more of an effort than support.
  • Relentless criticality – of self and others. You may have a relentless and invasive internal narrative that’s critical of yourself, of others, and of the world in general. You think you’re a failure, you think your boss is an idiot, your partner’s the most irritating person to have ever lived, and life’s just one big slog. This chronically negative thought pattern may feel like something you just can’t turn off.
  • Constant self-doubt. You may constantly doubt whether or not you’re on the right career path, whether you’re in the right relationship, doubt what you’re doing with your life and if you can even handle being an adult. This pattern of constant self-doubt may be situational or pervasive but it’s something that feels like you just can’t get over.
  • Diminished energy. If it feels like getting through each day is like walking up a mountain with a backpack of rocks, if you feel like you barely have the mental, emotional, and physical energy to handle your life anymore, if your overall energy levels are greatly diminished, this could be a sign of high-functioning depression.
  • Irritability or excessive anger. If you find yourself blowing up over small things — your partner says something wrong, your coworker messed up a project, your kid just broke your favorite coffee mug, if you find yourself exploding in a way that feels disproportionate to the event, if irritability and excessive anger are something you’re wrestling with, this may be a sign.
  • Small things feel like huge things. Similarly, if you find yourself feeling overwhelmed or greatly stressed by an event that happens that maybe wouldn’t have felt like such a huge deal in the past (a friend cancels weekend plans, the grocery bags break when you’re carrying them in, your darn trackpad stops working because you spilled some coffee on it) and it feels like The End Of The World instead of the annoyance that it is, if you find your stress responses disproportionate to the event itself, this may well be a sign of high-functioning depression.
  • Feelings of guilt and worry over the past and the future. You worry that you chose the wrong career in college, you question whether you’re in the right grad school program, you worry about paying off all those student loans, you worry that your biological clock is running out, you worry that you married the wrong partner, you worry about who’s going to care for your folks when they get older, etc., etc., etc.. We all have these worries from time to time, but if feelings of guilt and worry over your past and future feel pervasive and dominant, this may be more than “normal” worry.
  • Relying on your coping strategies more and more. If you find yourself needing extensive zone-out time after work and on the weekends, turning towards your coping mechanisms more often than not — such as substances or behaviors like using alcohol, weed, excessive gaming, constant Netflix, etc., — all in an effort to escape your life, this could speak to underlying depression.
  • Generalized sadness. If you find yourself feeling a generalized sense of sadness that you can’t seem to pinpoint the cause of, if you drop your mask and armors of smiling competency when you close your door behind you, if you feel a subtle sense of hopelessness, this could speak to high-functioning depression.
  • Seeking perfection. This one’s a tough one. In a way our society condones perfectionism — getting good grades, getting into the Ivies, landing that amazing tech job, striving, striving, striving. But perfectionism has a shadow side where striving turns into unrealistic demands of yourself and psychologically beating yourself up when you fall short of the bar you set for yourself. If you find yourself doing this and it’s causing you distress, be curious about whether this a sign of high-functioning depression.
  • Inability to rest and slow down. If you need to clean up, tidy, and organize the house after you arrive home from an exhausting day of work before you even consider letting yourself rest, if you find yourself uncomfortable with slowness, stillness, and fallow periods of time because of the uncomfortable thoughts and feelings you come into contact with when you do actually slow down, this could be a sign of high-functioning depression.

Now, a caveat to this list: Chances are we can all see ourselves in this list some of the time. Occasional diminished energy, a desire to really indulge in your coping mechanism of choice, irritability after a long day, all of these are normal and natural human experiences and I don’t mean to pathologize them.

Where we want to be curious is if you’re feeling most of these signs, most of the time, for durations that span months if not years. That’s when there’s a greater likelihood that you’re dealing with high-functioning depression, or, in other words, dysthymia.

The Unique Risks To Being Someone With High-Functioning Depression.

Mental health struggles come in all shapes and sizes but, as we undo the stigmatization and globalization of mental health scripted over these past few decades, most of us likely still have an unconscious image in our heads of what a depressed person looks like.

And while this internalized image of someone who can’t get out of bed, who can’t hold down a job, and who has constant suicidal ideations may be one form of depression, it doesn’t mean that someone who sees themselves in the list above or in the clinical descriptor of dysthymia isn’t also dealing with depression.

But these folks may not be willing to see themselves as depressed. And this can be a big problem.

Because, in my clinical opinion, there’s a unique set of risks to being someone with high-functioning depression.

First, because you’re still “holding it all together” it may make it harder for both you and others to spot the very real mental and emotional strain you may be under because you pass.

You fly under the radar.

You and those around you doubt the seriousness of what you may internally wrestle with because, after all, your life still looks pretty great from the outside, right?

Second, as someone who is high-functioning, you may grow up believing that with enough effort and willpower, you can achieve, gain, or fix anything that life throws at you.

Not so with high-functioning depression.

High-functioning depression isn’t just a bad attitude, and you can’t just “will your way” out of it.

High-functioning depression is a biological and psychological disorder that requires adequate and clinically appropriate treatment. Arguably, the more you push and “will yourself out of it” instead of seeking proper support, the worse your symptoms may get.

For example, if left untreated, high-functioning depression, or dysthymia, can potentially bloom into major depression or major depressive episodes where your biological and psychological functioning is more severely impaired.

Or, perhaps in your attempts to deal with your high-functioning depression on your own, comorbid disorders — such as eating disorders or substance use disorders — can develop from your attempts to manage your intolerable feeling states.

Bottom line: Dysthymia, or high-functioning depression, requires adequate clinical treatment as much as the most stereotyped version of major depression does.

And the good news is that with proper clinical treatment, dysthymia can be managed.

Treatment and Supports for High-Functioning Depression.

While there is no single reason why someone develops dysthymia or high-functioning depression and while there is not necessarily a way to prevent it, there are several evidence-based effective treatment modalities to help you manage and support yourself if you deal with it:

Psychotherapy and/or medication. In fact, according to a paper from The Canadian Psychological Association,

“Psychotherapy is as effective as medication in treating depression and is more effective than medication in preventing relapse. For some patients, the combination of psychotherapy and medication will be more beneficial than either treatment on its own.”

So if you see yourself in this article today, I strongly encourage you to seek out a therapist and/or speak to your doctor or psychiatrist about what treatment options may be available to you.

The reality is with high-functioning depression and moving through your days is that it can often feel like you’re attempting to build a castle on a foundation of quicksand.

Get the help you need to build a solid, stable foundation for yourself – whatever that takes! – so you can build and craft a life in a more sustainable way.

If you would like additional support right now and you live in California or Florida, please feel free to reach out to me directly to explore therapy together.

Or if you live outside of these states, please consider enrolling in the waitlist for the Relational Trauma Recovery School – or my signature online course, Hard Families, Good Boundaries, designed to support you in healing your adverse early beginnings and create a beautiful adulthood for yourself, no matter where you started out in life.

And until next time, please take very good care of yourself. You’re so worth it.

Warmly, Annie

Note: If you or someone you love is feeling suicidal and you need support right now, please call the National Suicide Prevention Lifeline at 1-800-273-8255.

Additional Resources:


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  1. Maggie Sobiech says

    Very good article that prompted me to seek therapy along with my medication. Having had numerous counselling sessions, I realise that therapy is what I need. I would encourage anyone who feels remotely like this to seek support. As is the nature of this sometimes debilitating condition you may tell yourself that there are people worse off…undoubtedly true but that is not the point. You are worthy and deserve to feel better.

    • Annie says

      Hi Maggie,

      Thank you so much for reading the article and for taking the time to write. I’m really touched to hear that the article prompted you to seek out therapy and medication and to get all the supports you need in order to feel better. Sometimes just recognizing that we’re worthy of help from professionals and people in our personal lives is the biggest hurdle of all.

      Thank you for sharing your experience. It may inspire others!

      Warmly, Annie

  2. Shawna says

    This is the best article I have seen regarding HFD. I realize I am not alone and now have a better understanding of my inner turmoil and extreme self-doubt. I intend to seek treatment and get to a better state. Thank you.

    • Annie says

      Hi Shawna,

      Thank you so much for your kind words about this article. I’m so glad you’re recognizing yourself in HFD and, more importantly, are willing to get support around this. You so deserve it.

      Warmly, Annie

  3. JJ says

    Thank you for this article, that is me all over. However, I avoid medications at all costs. My life is a bit crazy right now so I wrote it off as that, is it possible I will improve as my situation improves? I think I don’t understand the purpose of medication, will it gloss over my temperment and reduce my natural drive to survive. I guess my fear is that meds will put me in a state of happy and I will lose the sense of urgency that is required in my daily life. I am a single mother of 2 and I am also responsible for my mothers care, she lives in my home. They require me to get things done. Thank you for your time.

    • Annie says

      Hi JJ, your doctor or a psychiatrist will be able to talk to you about medication side affects and answer all your questions about possible pharmaceutical assistance. I’d definitely encourage reaching out to your family doctor and talking your concerns through with him/her. Warmly, Annie

  4. Rebecca says

    Wow. This is absolutely me. No one would ever know my struggles except my spouse and close family. I have begun to think it can’t get better. People see me as happy go lucky with a great sense of humor, but people close to me know the monster I have to slay. Unfortunately I live in an area with such poor/no therapy opportunities. Medicine has never cut it for me. I feel like therapy would be so helpful.

    • Annie says

      It sounds like you really saw yourself in this article, Rebecca. I’m so sorry there aren’t high quality counselling and therapy services around you but I wonder if it might be worth it to explore online counselling services like TalkSpace? They might be a terrific resource for you. Warmly, Annie

  5. Carole Crews says

    You have articulated what I’ve witnessed for years with someone close to me. I’ve been chronically depressed most of my life and am high functioning to a degree. But my symptoms fit the “normal” depressive state. I began therapy in my late twenties and attribute much of my health today to the work I did (and continue to do). I would tell someone who is resistant to therapy to consider this self care for their heart, their emotional health. We allow ourselves to spend money on physical health and beauty without guilt. We spend time vacationing, watching sports, going to movies or concerts and this is self care of the mind. I would encourage them to commit to a specific time frame to try it out before making any final decision to stop or continue. And lastly, your pain will not swallow you whole. You may be afraid to open that part of yourself out of fear it will just take over. It won’t. It might hurt but it won’t take over.

  6. Kelsey says

    This is exactly me! I stumbled across a different article regarding high functioning depression that led me here. Your article has helped me understand that I am not the only one who feels this way. I recognize myself in most, if not all of these points. I put way too much pressure on myself at the office, and while I am always smiling with friends, family, and coworkers, the smile disappears the minute I’m alone. No one would ever suspect how I truly feel each day. Will I seek out therapy? Although I know I should, I will likely put that off a while longer. For the moment, I simply do not believe talking with someone about this could actually help me. Thanks for this article! It was quite informative.

    • Annie says

      Hi Kelsey,

      Thank you for your kinds words and I’m so glad you found this article helpful. I know personally and professionally how hard it can be to imagine that therapy could help with what you’re struggling with, but studies have shown that psychotherapy can be very effective for treating anxiety and depression. And, of course, I trust you know what might feel best for you in terms of when to seek out mental health care support. In the meantime, please do take very good care of yourself and know you’re not alone in living your days with high-functioning depression.

      Warmly, Annie

  7. Katarina says

    I really see myself for all the descriptions that I had read here.

    Is it really that bad? Do I need to seek professional help for this?

    • Annie says

      Hi Katarina,

      I don’t think we need to call it “bad” at all for seeing yourself in the descriptions on the list. I think many of us will! It just means that you may want to consider seeking out some additional support if you find that any of these symptoms are impairing your life in any way. Professional support can be a terrific resource when treating high-functioning depression.

      Warmly, Annie

  8. Catherine says

    I’m just now starting to deal with the fact that I probably have this, per diagnosis of a close mentor.. and this article was a gentle way of acknowledging the things I’m feeling and WHY without making me feel guilty for it. Thank you. I’m seeing a psychiatrist Tuesday.

  9. Rae says

    I cried a little reading this, knowing that these feelings I’ve had for years are not just isolated to me. This is eye-opening and at the same time a wake up call that I need to seek help so I can get better. I’m so happy I stumbled on this.

  10. Hani says

    I don’t apply to all symptoms, in fact quite a little. But I really cant seem to enjoy moments and feel involved in the present, I really wanna try seeing a therapist to make sure I’m okay but I’m only a high schooler, so maybe not now. If I feel needed, I’ll go to one asap. Thanks for the article!

    • Annie says

      Hi Hani,

      Thanks so much for taking the time to comment! I’m glad you enjoyed the article and I’m proud of you for being aware of how important your mental health is. High school can be such a stressful time, I’d encourage you to talk to a parent or other trused adult about how you’re feeling.

      If you decide you’d like to explore therapy, your school counselor may be able to put you in touch with your school’s psychologist and that can be a great place to start. In the meantime, please take such good care of yourself, you’re so worth it.

      Warmly, Annie

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