Masked depression?

High-Functioning Depression Isn’t Always Easy to Identify, So Here Are the Top Signs to Watch Out For (and What to Do)

Depression looks a little bit different on everyone, affecting all of us in different ways. Some people feel tired all the time, spending most of the day in bed. Others engage in self-sabotaging and self-destructive behavior. In many cases, it’s clear the individual is struggling internally.

But sometimes, it’s not as obvious. For some people, depression doesn’t impact their ability to function, making it hard for loved ones to pick up on what’s going on. This is called high-functioning depression, and it’s more common than you might think.

What is high-functioning depression?

High-functioning depression is a form of depression that refers to people who can function normally in day-to-day life while simultaneously experiencing depressive symptoms.

“High-functioning depression is not a term doctors use,” says Dr. Gail Saltz, MD, a clinical associate professor of psychiatry at the NY Presbyterian Hospital Weill-Cornell School of Medicine. “It is a lay term used to describe someone experiencing some symptoms of a clinical depression or dysthymia but who is still able to function at a reasonably competent level, at work, at home, socially, such that other people and even they, may not recognize they are none the less diagnosable and depressed.”

It’s not always obvious to the individual or those around them that there’s an underlying issue.

“It is often overlooked because problems in external functioning are a clear indicator that something is amiss, whereas problems that are largely internal are not as obvious to ourselves or others,” Dr. Suraji Wagage, PhD, JD, a licensed Clinical Psychologist, Co-Founder and Director of the Center for Cognitive Behavioral Therapy and Mindfulness, explains. “We may think ‘I’m fine, I just need to snap out of it.’”

Related: Feeling Down? Try Incorporating These Depression Fighting Foods in Your Diet

Common signs and symptoms of high-functioning depression

Dr. Wagage says these are the signs to watch for:

  • Loss of motivation or apathy
  • Numbness, and a general muting of experience: colors aren’t as bright, food doesn’t taste as good, music sounds duller, as if someone turned down the volume on life, so to speak.
  • Feeling more irritable than usual and more mentally “cloudy” or overwhelmed.

“Signs also include the symptoms of depression—low mood, loss of interest in things we used to enjoy, weight or appetite changes, sleep changes, restlessness or physical slowing, fatigue, worthlessness or guilt, reduced concentration, thoughts of death,” Dr. Wagage adds.

How high-functioning depression affects your life

High-functioning depression negatively affects your work, relationships and most aspects of your life.

“We may procrastinate more at work because everything feels pointless and we lack motivation, and then fall behind,” says Dr. Wagage. “We may get into more arguments in relationships or distance ourselves through our apathy and detachment. There is a loss of potential: even if we are functioning ‘well enough,’ we are just getting by, not functioning at our best.”

Overall, there is a lack of satisfaction and fulfillment in everyday life. Dr. Saltz explains, “PDD or dysthymia can rob you of enjoying or feeling satisfied in work, in relationships. They can cause you to socially withdraw or tax relationships to the point of ending them, they can prevent you from concentrating and working to your abilities. HFD is not a diagnosis.”

Related: Little-Known Facts About Mental Health Awareness Month

10 ways to address high-functioning depression

If you (or someone you love) is dealing with high-functioning depression, here are some ways to cope.

Think of activities that used to give you a feeling of enjoyment or pleasure, and do one of them every day

Changes in behavior are effective when it comes to alleviating depression.

“One of the first things to suffer when we are depressed is rewarding activities,” Dr. Wagage states. “We think we have to be in the right mood to make a behavior change, but mood often catches up to behavior. Don’t give up. Every little step helps. Even if it doesn’t make you feel better in the moment, it’s still better than nothing.”

Practice self-care

Being compassionate and nonjudgmental toward yourself is a vital part of the healing process. “Take excellent care of yourself as you would somebody you love very much and make sure you are getting proper nutrition, sleep, exercise, and work-life balance. Recognize there is a powerful connection between food and mood and read books like Dr. Drew Ramsey’s Eat to Beat Depression and Anxiety,” says Joyce Marter, LCPC, licensed psychotherapist and author of The Financial Mindset Fix: A Mental Fitness Program for an Abundant Life.

Learning to become more mindful is the foundation of all self-care habits.

“Mindfulness practices such as deep breathing, meditation and yoga are great for promoting mental wellness,” Marter explains. “Apps like Daylio are a great way to chart your mood and identify connections between other variables such as sleep, stress or menstrual cycle.”

Think of activities that once made you feel productive or accomplished

Making progress and acknowledging it is an instant mood lifter. “A feeling of mastery or accomplishment is also important for mood, and these activities are also quick to suffer when we are depressed. Chores count if they make you feel accomplished,” says Dr. Wagage. “Have you ever wanted to pick up a new hobby? Is there one small step you can take toward that hobby today?”

Access support

Asking for help isn’t a sign of weakness, it’s a sign of strength. “Breakthrough the barriers between you and the support you need and deserve,” Marter explains. “Start talking with trusted friends and family about your depression. You are not alone and depression is not your fault and not a weakness. Ask your support network for the type of support you need.”

Think about the people who are good listeners and there for you on a regular basis. “If you need more emotional support, ask the people in your network who are capable of providing that type of support to listen to you, check in with you regularly, or make sure you are staying socially connected and not isolating with your feelings,” says Marter.

 Notice confirmation bias

People with high-functioning depression often have a distorted view of reality.

“Depression is like wearing sunglasses: it tints everything we see,” Dr. Wagage states. “All of our experiences are filtered through depression, and we naturally notice evidence that seems to confirm what we already believe. If you have the belief, ‘I shouldn’t try, I always just fail,’ you’ll look for evidence that seems to prove this. Try to look for disconfirming evidence: times that this did not happen.”

Exercise regularly

One of the best ways to quiet your mind and feel a little better is to turn your attention to your body.

“Exercising regularly, especially cardiovascular exercise like walking, jogging, or biking can release endorphins that will improve your mood,” Marter explains. “Just 30 minutes three times a week can significantly raise your baseline mood.”

 Thoughts are thoughts, not facts

In the moment, our negative thoughts may seem real, but they are far from it.

“Our thoughts can actually be far from reality, says Dr. Wagage. “Practice noticing your thoughts throughout the day and labeling them as thoughts. You can go further and label them as thoughts about the past, future, judgments, and so on.”

Test your beliefs

A depressed person often has deep-rooted beliefs that are holding them back from healing and moving forward.

“If you have a thought like, ‘I shouldn’t text my friends, they don’t want to hang out with me anyway’—test it. Text them,” Dr. Wagage explains. “Practice acting the way you would if you didn’t have that belief. Thoughts can’t control our actions, even if it feels like it at times. Continue to notice and test your assumptions.”

See a counsellor or therapist

Prioritizing your mental health is just as important as staying on top of your routine physical checkups.

“Many people ask me when they should go see a therapist and I tell them not to wait. You do not have to have serious mental health issues to see a therapist. You can have wellness checks and tune-ups as needed, Marter states. “Therapy is covered by most insurance (thanks to Mental Health Parity Law) and many people have an EAP benefit through their employer that offers anywhere from 3-8 free sessions per issue per year and includes family members. Check your insurance card or talk to HR to find out if you have EAP benefits. Most insurance companies are covering teletherapy and some like Aetna have waived copays for telemedicine.”

Related: Everything You Need to Know About Telehealth if You Suffer from Depression 

Talk to your doctor

There may be an underlying physical issue that’s responsible. “Let them know you believe you are dealing with depression and ask them to check your thyroid functioning (untreated thyroid issues can cause depression) and to check your vitamin D levels (if you don’t get a lot of natural sunlight and don’t take supplements like fish oil, your vitamin D levels can be low which exacerbates depression),” says Marter.

For women, the OB-GYN is a great place to start. “Women should definitely talk with their OB-GYN as there is a big connection between depression and hormones. You might notice your depression worsens just before or at the start of your period,” Marter explains.

Birth control can play a major role in mood, so it’s worth looking into alternative options.

“Certain birth control pills can help with hormonal depression and others seem to make it worse, so be sure you are being assertive with your doctor to help you find the right fit for you,” Marter states. “Ask them for a referral to a therapist within your network. Ask them if they think medication, such as an antidepressant, might be right for you. They may be able to prescribe it themselves, or refer you to a psychiatrist who specializes in mental health medications.”

Treatment options for high-functioning depression

Cognitive-behavioral therapy

CBT is one of the most popular techniques to relieve depression. “This is a highly empirically supported form of therapy where you address negative thought patterns or irrational beliefs that fuel your depression and reprogram them to more neutral, positive, and adaptive ways of thinking. There are many great CBT workbooks for depression,” says Marter.

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Medication

In some cases, people may need additional support. “A low dose of an antidepressant can lift your baseline mood and help you feel so much better,” Marter explains. “You wouldn’t try to power through high blood pressure and argue with your doctor about taking blood pressure meds. The same should be true for your treatment of depression. Medication can be extremely helpful and can sometimes create lasting change in your brain functioning.”

Next, read the 40 best books about depression that will inform, inspire and help you feel less alone.

Sources

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