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Signs of High-Functioning Depression?

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In your house, everything has to be perfect, down to the spotless floor and folded laundry. At work, your desk is organized, your calendar is up to date and the entire department knows whom to come to if they need something done yesterday. Your world is ordered and predictable and that makes you feel safe — and exhausted at the same time.

If only you could step out of perfectionism long enough to relax, you might feel better about yourself. But the weight of pleasing everyone that drives you is the same weight that feels like you’re wearing waders full of water. And at the risk of falling completely apart, you just keep going and going. Some may see you as an overachiever. But if they understood how nothing brings you joy and how hard you are on yourself, they might just see the real you: a person struggling with functional depression.

Functional Depression Basics

High-functioning or functional depression is a term that has been popularized in the last few years and used to describe a condition known as dysthymia. Dysthymia is a type of depression characterized by a depressed mood for most of the day and on more days than not. The condition is often marked by symptoms like overeating or poor appetite, insomnia or sleeping too much, low energy or fatigue, low self-image, the inability to concentrate, difficulty making decisions and general feelings of hopelessness.1

According to Anne Marie Dine, Director of Outpatient Services at Michael’s House’s sister program Foundations Atlanta at Midtown, people with high-functioning depression also are often pessimistic high achievers. “The person with high-functioning depression is often negative or pessimistic in their outlook on their experiences as well as themselves, struggles with self-doubt, appears irritable, deals with worry or guilt that seems excessive and may generally be the person who is most likely to make a mountain out of a molehill,” she said in an interview. “In my experience, perfectionists are the most likely group to have something that seems like high-functioning depression.”

Symptoms of High-Functioning Depression

Because people with functional depression are just that – functional – the symptoms of the condition can fly under the radar of friends and loved ones for years. That’s what makes this type of depression hard to recognize both for the person struggling and those closest to her. Some of the symptoms of high-functioning depression include the following:

  • Loss of interest in daily activities
  • Seeking perfection
  • Sadness, emptiness or feeling down
  • Hopelessness
  • Tiredness and lack of energy
  • Low self-esteem, self-criticism or feeling incapable
  • Trouble concentrating and trouble making decisions
  • Irritability or excessive anger
  • Decreased activity, effectiveness and productivity
  • Avoidance of social activities
  • Feelings of guilt and worries over the past
  • Poor appetite or overeating
  • Sleep problems2

Unlike other types of depression where a person is completely incapacitated by their symptoms, those with high-functioning depression are able to “go along to get along” most days. And each day they push through makes it easier to rely on their own coping strategies rather than reach out for the help they so desperately need.

“It is an issue that likely causes challenges in most parts of life, ranging from work, to relationships and even to relaxing,” Dine explains. “The person with dysthymia is likely to identify feelings of loneliness and use coping skills that may become harmful, such as substance abuse or other self-harming behavior, and may go on to develop major depression.” And the movement toward self-harm and substance use means early treatment can prevent complications from secondary conditions.

Treatment for Functional Depression

When a person thinks functional depression may be causing symptoms, it’s important to reach out for help. As with other forms of depression, treatment for the condition typically includes a combination of medication and psychotherapy. In many cases, psychotherapy is the primary treatment option, and patients often see improvement in their symptoms without the need for medication. Medication without psychotherapy is not recommended for any form of depression, and in the case of functional depression, psychotherapy has been proven to be the best way to prevent a recurrence of symptoms.1

If you have a friend or loved one who is suffering from functional depression, here are some things you can do to help:

  • Educate yourself: Knowing as much as you can about the condition can help you better respond to your loved one when symptoms are causing a bad day.
  • Develop your listening skills and validate her feelings: People with functional depression often just need someone who will listen to them without judging or trying to fix anything.
  • Be specific with ways you can support: Rather than offering general support, which can make situations feel even more overwhelming, be specific. Phrases like “I can drive you to the doctor tomorrow” or “I am bringing dinner for your family on Wednesday” can make tasks seem bearable and doable.3

Finding Help for Functional Depression

If you or a loved one struggles with functional depression, we are here for you. Call us 24 hours a day at 760.548.4032 to speak with an admissions coordinator about the best treatment options for your situation.

By Patti Richards, Contributing Writer


1 Wright, Annie. “What Are the Signs of 'High-Functioning' Depression and Could You Have It?” The Mighty, May 17, 2017.

2 “Persistent Depressive Disorder (Dysthymia).” Mayo Clinic, August 8, 2017.

3 Pager, Nicole. “11 Little Ways To Support Someone With High-Functioning Depression.” The Huffington Post, April 17, 2018.