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High-Functioning Depression: What It Looks Like

Katelyn Hagerty

Medically reviewed by Katelyn Hagerty, FNP

Written by Our Editorial Team

Last updated 8/11/2021

If you’ve got depression, you might put on your best brave face, though on the inside you could experience continuous sad moods — sometimes filled with anxiety, or an overwhelming feeling of hopelessness and despair. 

Performing tasks or simple day-to-day activities might seem to take all your energy, and it might be tough to sleep. It can also be hard to wake up from a night’s rest.

While depression is widely accepted to be many of these things, this mental illness can also be hard for outsiders to detect — which can sometimes make it easier to ignore by those living with it. 

This is what high-functioning depression looks like — when the widely accepted signs and symptoms of depression get buried beneath a brave smile or calm appearance. 

In spite of how high-functioning depression might look, however, it can be severe — and should be taken seriously. 

Read on to learn how to identify high-functioning depression, as well as treatment options that can help.

What Is High Functioning Depression?

Depression is a condition that affects around 40 million American adults, including those suffering from mild depression (which is when only a few symptoms are present, yet enough to cause minor interference in daily activities).  

On the flip side, this population also includes those with chronic, persistent depression, also known as dysthymic disorder. 

In this case, severe depressive episodes can persist or wax and wane for two years or more. These episodes are usually enough to disrupt daily life. 

Those suffering from high-functioning depression typically fall within the latter group.

If you’re unfamiliar with the term ‘high-functioning depression,’ this may be because it isn’t a recognized clinical diagnosis for the mood disorder. 

More accurately, high-functioning depression is a commonly observed pattern of behavior seen in people who live with the mental health disorder. It can in fact be a form of major depression. 

The National Alliance on Mental Illness describes it as ‘smiling depression,’ during which inner conflict and chronic unhappiness are masked by someone pushing through the hardship of depression.

A high-functioning depressed person may have an active social life, for example, where he meets up with friends and organizes hangouts with colleagues. 

This same person may also find it incredibly difficult to get up in the morning and may discover that his clothes are looser or even tighter due to weight changes brought on by his condition.

A high-functioning depressed person might also complete work deadlines and make time for physical activities, but struggle with a lack of attention and often suffer through suicidal ideations. 

This condition can be so serious, it may push a person to suicide.

People with this condition work very hard to hide their emotional pain, making it difficult for friends, family and even spouses to properly identify a high-functioning loved one.

Signs of High-Functioning Depression

Because high-functioning depression is often masked under a veneer of normalcy, this can make its symptoms invisible to the regular observer. 

However, with this form of depression being a persistent disorder, there are dysthymic symptoms to look out for:

  • Insomnia

  • Lack of energy

  • Loss of confidence

  • Poor concentration

  • Suicidal ideation

  • Loss of interest or pleasure in activities, including social activities

  • Generalized sadness that may come with feelings of guilt, worthlessness and helplessness (depressed mood)

Additional symptoms include changes in appetite, difficulty in making decisions and sleeping excessively at different points of the day. 

A person with high-functioning depression may have been hiding any of these symptoms for two years or more — and forging through them, unbeknownst to anyone else.

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Treatment Options for High-Functioning Depression

It doesn’t matter how long or how well depression is hidden from loved ones and colleagues, the fact remains that this condition is serious and capable of greatly affecting the quality of life of anyone attempting to power through it.

The good news, however, is that any form of depression — obvious or hidden —  can be successfully treated. 

These treatment methods usually involve a combination of psychotherapy and medication, or each individual method on its own.

Here’s how these methods help with improving depression:

Medication

Antidepressants are usually the first point of call when looking to manage depression. Common types include tricyclic antidepressants, which like other forms of the medication help improve the way the brain employs chemicals like serotonin and norepinephrine which control mood and stress.

For best results, it's important to consult with a healthcare professional who will give recommendations after an examination. 

You should know that not all antidepressants work the same, and medications can work differently for different individuals.

It’s also important to note that even if a medication works, it may not provide immediate results.  

Antidepressants typically take around two to four weeks to kick in, and may take anywhere from six to 12 months before it is recommended to stop using them.

While antidepressants may be useful for treating depression, they can still cause side effects. 

Anxiety, restlessness, insomnia, diarrhea, headaches and a diminished libido are just some of the adverse effects associated with antidepressant usage. 

In cases where negative effects are hard to tolerate, speaking with your healthcare provider can provide the right guidance.

Psychotherapy

Speaking to a mental health professional about the challenges of depression can offer a useful substitute to medication. 

Psychotherapy or online counseling can be useful as standalone treatments for managing depression. 

In particular, targeted treatments such as cognitive behavior therapy (during which a therapist may offer techniques to challenge and change negative ways of thinking) and interpersonal therapy (when a therapist helps focus on understanding relationships with others and how they affect the symptoms of depression) can help. 

Likewise, problem-solving therapy may offer the skills to view life’s difficulties as challenges that may be solved with the right temperament and tools. 

Psychotherapy has also been advised as a depression remedy for its long-term benefits for those living with the condition.

If you’d like to speak with a professional about managing your high-functioning depression or point someone else to care, it’s easy to find a mental health professional online who can help guide your treatment from the comfort of your home.

Brain Stimulation Therapies

In severe cases of high-functioning depression when medication or psychotherapy doesn’t seem to help, electroconvulsive therapy carried out over a series of sessions may be useful for providing relief. 

This treatment involves small electric currents sent to the brain to manage symptoms of depression. It may, however, cause side effects like confusion and memory loss. 

High-Functioning Depression: Beyond the Mask 

A lot can be hidden behind a smile, stellar work, or even a big laugh with friends. Lurking behind all of this activity is the very real possibility that a family member, loved one, or significant other is battling through difficulties that have the potential to take away happiness and zest for life. Or maybe you’re the one behind the mask.

High-functioning depression can lurk behind many a brave face, and reaching out to a mental health professional is the best place to start, to help get it under control. 

Your healthcare provider can provide the correct first and subsequent steps to manage and triumph over depression.

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7 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. Nimh.nih.gov (n.d) Depression. Retrieved from: https://www.nimh.nih.gov/health/topics/depression/
  2. Adaa.org (n.d) Understand anxiety and depression. Retrieved from: https://adaa.org/understanding-anxiety/facts-statistics
  3. National Collaborating Centre for Mental Health (UK). Depression in Adults with a Chronic Physical Health Problem: Treatment and Management. Leicester (UK): British Psychological Society; 2010. (NICE Clinical Guidelines, No. 91.) Appendix 12, The classification of depression and depression rating scales/questionnaires. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK82926/
  4. Coward, L. (2016, September 20) What You Need to Know About “Smiling Depression”. Nami.org. Retrieved from: https://www.nami.org/Blogs/NAMI-Blog/September-2016/What-You-Need-to-Know-About-Smiling-Depression%E2%80%9D
  5. National Collaborating Centre for Mental Health (UK). Depression in Adults with a Chronic Physical Health Problem: Treatment and Management. Leicester (UK): British Psychological Society; 2010. (NICE Clinical Guidelines, No. 91.) Appendix 12, The classification of depression and depression rating scales/questionnaires. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK82926/
  6. Ramic, E., Prasko, S., Gavran, L., & Spahic, E. (2020). Assessment of the Antidepressant Side Effects Occurrence in Patients Treated in Primary Care. Materia socio-medica, 32(2), 131–134. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428926/
  7. Cuijpers, P., Quero, S., Noma, H., Ciharova, M., Miguel, C., Karyotaki, E., Cipriani, A., Cristea, I. A., & Furukawa, T. A. (2021). Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types. World psychiatry : official journal of the World Psychiatric Association (WPA), 20(2), 283–293. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129869/

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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