What is High Functioning Depression?

Sometimes the symptoms of depression are easy to spot in ourselves or others, but what about in situations when there’s simply a nagging sadness, a drag in our energy, or a lack of normal focus even when, on the outside, everything seems like it’s going great?

This might be a case of High Functioning Depression, sometimes called “Smiling Depression.”

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 bedridden.

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 severe.

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

Signs of High Functioning Depression Symptoms

Previously referred to as Dysthymia, the American Psychiatric Association renamed it persistent depressive disorder in the fifth edition of the Diagnostic and Statistical Manual (DSM-5), released in May 2013.

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

The 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
  • Insomnia or sleeping more than normal
  • Feeling disconnected from friends, family, or colleagues

These are struggles that most people deal with from time to time, but a person with diagnosed high functioning depression experiences these symptoms, with few periods of relief, for at least two years.

Left untreated, people with PPD can develop major depression or suffer other consequences, such as substance abuse and addiction as a result of self-medicating with drugs or alcohol.

Signs of High Functioning Depression Symptoms

Recognizing and Treating High Functioning Depression

Detecting PDD, as noted, is not always easy, but 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, along with any of the above-listed symptoms, might mean it’s time to seek help.

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.

Cognitive Behavioral Therapy (CBT) is a skill-oriented therapy that teaches people how to manage negative thoughts and develop healthier habits.

PDD is most successfully treated with a combination of medications and behavioral therapy together.

In addition to traditional treatment methods, adding a regular exercise plan in conjunction with a healthy diet heavy in fruits and vegetables that avoids junk foods, has shown great success, and many people find that they’re functioning better than they ever have before.

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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