Depression can be sneaky. It doesn’t always appear as feeling sad or spending the evenings in bed crying. For those with high functioning or “functional depression”, things may appear perfectly normal on the outside. High functioning is not an official medical diagnosis but describes individuals with depression who can function normally.
You might excel at work, maintain relationships, and function well. But if you struggle with brain fog, fatigue, chronic or unexplainable physical health problems, and difficulty feeling pleasure or joy in things you used to enjoy, you could be struggling with a depressive disorder.
What is High-Functioning Depression?
High-functioning depression isn’t a formal medical diagnosis. But it can be a helpful way to describe how some individuals struggle with symptoms of depression while keeping up a stable life. People with high-functioning depression may struggle with Major Depressive Disorder (MDD) or Persistent Depressive Disorder (PDD), but are simply able to “mask” or “hide” their symptoms more effectively.
High-functioning depression describes people who have similar feelings to those with non-functional depression. The only difference? They can keep up with their responsibilities even if they feel like they are drowning under the surface.
Up to 75% of people with high-functioning depression also experience major depressive episodes, but only around 62% seek treatment due to the subtle nature of symptoms [1].
“Depression isn’t always something you can see in others or pinpoint easily in yourself,” says psychologist Dawn Potter. “For some people, living with depression can be extremely challenging to go about your day-to-day, but to the rest of the world, you seem to be doing reasonably well.”
“The difference lies in the ‘functioning,’” Dr. Potter clarifies. “A person living with high-functioning depression may appear as if nothing is amiss, but in reality, they may feel as if they’re hanging on by a thread. If it takes a person without depression 5% of their energy to do their laundry, it may cause a person with depression 10 times that. A person with high-functioning depression will probably get the laundry done. But the expense is huge” [2].
Signs of High-Functioning Depression
Depression can manifest emotionally, behaviorally, and physically. For those with high-functioning depression, the signs are often there, even if they aren’t intense enough to impact daily functioning.
Emotional Signs
- Ongoing sadness, low mood, or emptiness
- Difficulty feeling pleasure or joy in activities you once enjoyed
- Trouble focusing or decision-making
- Easily irritated or frustrated
- Low self-esteem or feeling inadequate
- Feelings of shame, guilt, or worthlessness
Behavioral Signs
- Perfectionism or overachieving
- Overeating or undereating
- Isolation and social withdrawal
- Decline in self-care
- Rumination and overthinking
Physical Signs
- Low energy or chronic fatigue
- Trouble falling asleep or feeling refreshed in the morning
- Sudden weight gain or loss
- Brain fog
- Stomachaches, nausea, gastrointestinal problems
- Headaches, migraines, muscle aches
What Causes Depression?
There is no single cause of depression, and a combination of factors plays a role. Some individuals may be genetically vulnerable to the development of depression, while others struggle with depression due to trauma or ongoing chronic stress. Common factors that increase the risk of depression include [3][4]:
- Genetics: Depression has a 40% genetic risk, meaning a family history of depression nearly doubles the risk of developing the disorder.
- Brain Structure Differences: Studies show that reduced grey matter and altered activity in the prefrontal cortex are more common in depressed patients.
- Trauma: Abuse or neglect, especially during childhood, is a leading risk factor for depression.
- Grief or Loss: Losing a loved one significantly raises the risk of short-term depression.
- Drugs and Alcohol: Substance use disorders can affect brain structure and chemical processes, increasing the risk of depression by 3 to 4 times.
- Seasonal Changes: Seasonal affective disorder affects 5% of the population and is caused by disrupted circadian rhythms and serotonin levels from changes in daylight.
- Discrimination/Systemic Injustice: Individuals who are part of minority groups (black, Latino, LGBTQ+) are at a higher risk of experiencing depression and suicidal ideation.
- Work Stress: Job burnout and chronic stress from work affect nearly 15 to 20% of workers and increase the risk of depression.
What Causes High-Functioning Depression?
Several reasons can cause someone’s depression to be “high-functioning”. These include [2]:
- Severity of Symptoms: Depression has several subtypes that range in severity. People living with persistent depressive disorder (PDD) often have milder symptoms than people diagnosed with major depressive disorder. People with high-functioning depression may have more chronic and persistent symptoms of depression, but they are less intense or severe, and therefore easier to function or “get by”.
- Masking: People with high-functioning depression may feel intense or severe symptoms but are able to “mask” (hide their emotions from the people around them). This might create an illusion that everything is fine, but in the long run, it often only worsens symptoms.
- Hidden Dysfunction: Some individuals with depression may not be as high-functioning as they appear. They may excel at work or in a specific area of life, but often that depression is keeping them from functioning in other areas of their lives.
How is High-Functioning Depression Treated?
If you’re struggling with high-functioning depression, it’s important not to give up hope and know that treatment has evolved, with several therapies and medication options available.
Outpatient treatment programs can help those with high-functioning depression address underlying thought patterns that contribute to depression and practice skills to release the burden of “masking” their depression. Treatment goals often focus on building the necessary skills to cope with triggers, increase self-esteem, and prevent depression from worsening.
Some of the most effective treatment options for high-functioning depression include:
- Cognitive Behavioral Therapy (CBT): Encourages patients to identify and reframe negative thoughts that increase feelings of isolation, loneliness, shame, and guilt.
- Medication: Antidepressant SSRIs can balance chemicals in the brain to stabilize acute symptoms that impact mood, sleep, and appetite.
- Family Therapy: Addresses attachment wounds, strained relationships, and communication difficulties that can increase the risk of depression.
- Group Therapy: Peer support groups offer a safe space for clients to work through feelings of loneliness, isolation, and shame. These can foster connections, community, and improve self-esteem.
Cutting-Edge Treatments for Severe Depression at Maple Mountain
Maple Mountain Mental Health and Wellness offers advanced options like ketamine therapy, TMS, and neurofeedback for patients with treatment-resistant severe depression, providing rapid relief when traditional antidepressants fall short.
These non-invasive or minimally invasive therapies target brain dysfunctions linked to mood regulation, often showing effects within hours to weeks.
Ketamine Therapy for Depression
Ketamine therapy delivers rapid antidepressant effects, often within hours, by blocking NMDA receptors to trigger glutamate surges. Low-dose infusions significantly reduce symptoms of depression, with response rates around 35-44% in treatment-resistant cases, including reduced suicidal ideation [5].
TMS Therapy for Depression
Transcranial magnetic stimulation (TMS) uses magnetic pulses to stimulate the dorsolateral prefrontal cortex, resetting dysfunctional neural connections and improving mood regulation in treatment-resistant depression.
Sessions last around 30 minutes and have a nearly 60% response rate with over half maintaining remission at six months when combined with ongoing care [6].
EMDR for Depression
EMDR, or Eye Movement Desensitization and Reprocessing, is an evidence-based therapy originally developed for PTSD that effectively treats depression by helping patients reprocess traumatic memories and negative beliefs through guided eye movements or other bilateral stimulation.
Research shows EMDR significantly reduces depressive symptoms, particularly in severe cases or when depression is linked to past trauma. Therapists tailor EMDR to target root causes like childhood events, enhancing emotional regulation without relying solely on medication.
Healing Chronic Depression in Utah
At Maple Mountain, these advanced therapies are integrated into personalized, multidisciplinary care plans, ensuring each client receives compassionate support to help them overcome chronic, high-functioning depression.
Our compassionate team can help you verify insurance benefits and set up a personalized treatment plan that meets your unique mental, physical, financial, emotional, and spiritual needs. Contact our admissions team today.
Sources
[1] Depression. 2024. National Institute of Mental Health.
[2] Cleveland Clinic. 2024. What Is High-Functioning Depression? Signs and Symptoms.
[3] Smoller, J. et al. (2015). Genetic determinants of depression: recent findings and future directions. Harvard review of psychiatry, 23(1), 1–18.
[4] Gong, Y. (2018). Brain structure alterations in depression: Psychoradiological evidence. CNS neuroscience & therapeutics, 24(11), 994–1003.
[5] Vázquez, G. (2024). IV low-dose ketamine infusions for treatment-resistant depression: Results from a five-year study at a free public clinic in an academic hospital. Psychiatry research, 335, 115865.
[6] Boes, D. (2017). Initial Response to Transcranial Magnetic Stimulation Treatment for Depression Predicts Subsequent Response. The Journal of neuropsychiatry and clinical neurosciences, 29(2), 179–182.