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What is High Functioning Depression (Smiling Depression)?

High Functioning Depression, sometimes called “Smiling Depression,” can be easy to miss.

Most of the time, the symptoms of depression are easy to spot in our self or other people.

But in situations when there’s only a slight nagging sadness, a drag in our energy, or a lack of normal focus, depression can be more difficult to recognize. Especially when on the outside, everything seems like it’s going great.

This is often the case with high functioning depression. Even though it may seem mild in comparison to a major depressive disorder, it still needs to be addressed.

High Functioning Depression

According to clinical psychologist Dr. Heidi McKenzie, “People with smiling depression often mask the symptoms they’re experiencing. They can get up each day, get dressed, show up for work and continue to interact with others in a way that belies how badly they are feeling inside,” she said in an interview with Women’s Health.

Despite the stigma associated with mental health issues, like depression, they’re much more common than the general public realizes.

The Centers for Disease Control and Prevention (CDC) estimates that around 7.6 percent of the population struggles with depression in any given two week period.

That doesn’t mean, however, that everyone battling depression is struck with a major depressive episode that leaves them bed ridden.

The official diagnosis of high functioning depression is Persistent Depressive Disorder (PDD). People living with PDD deal with many of the same symptoms of major depression, though less severely.

The condition is often difficult to detect in oneself, much less another person, which means it can go untreated for years and lead to an unnecessarily poor quality of life.

Signs of High Functioning Depression Symptoms

High Functioning Depression symptoms were previously referred to as Dysthymia, until the American Psychiatric Association officially renamed it Persistent Depressive Disorder in the fifth edition of the Diagnostic and Statistical Manual (DSM-5), released in May 2013.

Most people still call it high functioning depression or even “functional depression,” since people are able to carry out a normal routine every day.

But because it flies under the radar, so to speak, a person living with the condition often experiences little relief from the symptoms for long periods of time.

The signs and symptoms of high functioning depression can include some of the following:

  • Feelings of hopelessness and worthlessness
  • Poor self-image and self-esteem
  • Fatigue and lack of energy
  • Inability to make decisions
  • Difficulty focusing on tasks
  • Overeating or a decrease in appetite
  • Trouble falling asleep or insomnia
  • Sleeping more than normal
  • Feeling disconnected from friends, family or colleagues

These are normal struggles that almost everyone deals with from time to time, or once in a while.

On the other hand, a person living with high functioning depression experiences these symptoms on a regular basis, with few periods of relief, sometimes for at least two years.

People living with PDD are usually able to smile through the day while at work or school, and take care of business without anybody knowing there’s a problem. For some individuals, it’s starting and ending the day where things can be difficult.

It can take a lot of effort to get up and begin the day, and once the day is finished, they are emotionally drained.

Left untreated, people with functional depression can develop more serious depression or suffer other consequences, such as substance abuse and addiction as a result of self-medicating with drugs or alcohol to cope with the symptoms.

Signs of High Functioning Depression Symptoms

Recognizing and Treating High Functioning Depression

Detecting Persistent Depressive Disorder, as noted earlier, is not always easy. But for anyone who is consistently struggling to get out of bed in the morning, feeling caught in a rotating cycle of negative emotions, avoiding friends, or making unhealthy lifestyle choices, it might mean it’s time to seek help.

Persistently living with any of the symptoms listed above without any relief should be a clear sign that something isn’t normal and it’s time to get a diagnosis.

It’s important to add that any feelings of shame or guilt about coping with depression should be ignored. These feelings are not useful and all too often keep people from getting the help they need and deserve.

The good news is that high functioning depression is very treatable. Antidepressant medications can help improve mood and function if necessary.

Cognitive Behavioral Therapy (CBT) is a skill-oriented therapy that teaches people how to manage negative thoughts and understand how thoughts, emotions, and behaviors all relate to each other.

Dialectical Behavior Therapy (DBT) is a form of cognitive therapy that can also be useful for learning emotional regulation and mindfulness techniques.

Persistent Depressive Disorder is most successfully treated with a combination of medications and behavioral therapy together.

Self-Care for Functional Depression

One of the first things people do when they are depressed, whether it’s mild or severe, is cut back on a regular self-care routine. This is true even for people with high functioning depression.

They are able to get through the most important parts of the day to fulfill work duties, but they often feel physically and emotionally drained when trying to accomplish anything else.

People with PDD might find it a struggle to exercise and eat healthy meals, so instead they find comfort in unhealthy junk food like ice cream on the couch or in bed.

Traditional treatment methods like medications and cognitive therapies can be effective, but a self care routine like regular exercise and a healthy diet will also be needed for a full recovery.

In fact, getting daily exercise outdoors in sunlight when possible, and eating fruits, vegetables, healthy protein, and cutting back on unhealthy carbs and snacks might keep some of the symptoms at bay without the need for treatment.

These types of self-care techniques have shown to be successful for treating many types of depression on their own. When combined with therapy, many people find they feel better than they have for a long time.

Recognizing the subtle but lasting damage high functioning depression can have in our lives is a sure key to recovery. When we develop the ability to have compassion for ourselves, it becomes easier to detect and address these internal struggles.


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What is High Functioning Depression (Smiling Depression)?
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What is High Functioning Depression (Smiling Depression)?
High Functioning Depression is also called smiling depression or persistent depressive disorder. What are the signs of high functioning depression symptoms?
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Inspire Malibu
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