Could You Have High-Functioning Depression?

Does this sound familiar? You appear "put together" and "fine" to the outside world because you meet your daily obligations. The problem is that your ever-present low mood interferes with your enjoyment of life. You may have a version of high-functioning depression.

“Although high-functioning depression is not an official clinical diagnosis, it is now commonly used to describe someone who appears to be doing well in daily life—maintaining relationships, holding a job, and meeting responsibilities—while struggling with significant symptoms of depression internally,” says Adrian Jacques H. Ambrose, MD, MPH, MBA, FAPA, associate professor of psychiatry at Columbia Vagelos College of Physicians and Surgeons. “The longer it goes untreated, the more entrenched the emotional distress can become.”

Dr. Ambrose answers common questions about high-functioning depression, explains who it most commonly impacts, and shares steps for finding relief.

What are some symptoms of high-functioning depression? Doesn’t everyone feel depressed sometimes?

High-functioning depression symptoms are generally the same as symptoms for a major depressive disorder episode, but they may vary in frequency, intensity, and how much they impact your daily activities. I typically describe the experience for patients as a floating duck: On the surface, everything seems calm, but they may be furiously paddling underneath.

When should I be concerned about high-functioning depression?

I recommend monitoring the level of impairment and severity of symptoms. If someone is experiencing significant distress about their symptoms (such as hopelessness) or if they are no longer able to maintain their work or daily activities, those are important signs that they may be progressing to a major depressive episode. In addition, whenever safety concerns emerge, like thoughts of self-harm or suicidality, it is crucial to seek clinical care. High functioning doesn't mean it's harmless.

Are there different versions of high-functioning depression?

I usually tell patients that while everyone may experience depression differently, their personal experiences and suffering are valid. Some may experience persistent symptoms of low moods or low energy that last for months to years. If it lasts for at least two years, they may be experiencing a persistent depressive disorder, which is a formal clinical diagnosis.

If I'm chronically depressed, what treatments are available?

Typically, depending on the severity of symptoms, depression can be addressed with a wide range of treatments that may be used in combination. If medications, talk therapy, or lifestyle changes (like diet and exercise) don’t provide enough relief, other therapies that stimulate the nervous system (such as transcranial magnetic stimulation, electro-convulsive therapy, and esketamine or ketamine) may help.

It is important to navigate these options with a health professional to individualize the treatment choices. There is no one-size-fits-all approach because everyone can have a different experience of the same depressive symptom and may respond differently to the same medication.

Who is most likely to have high-functioning depression?

One of the most common groups I see having high-functioning depression is adolescents and young adults. It is very common for me to hear from well-meaning parents that their kids can’t have depression because they’re still getting good grades. Furthermore, in children and adolescents, depressive symptoms may look more like irritability and anger than sadness. If you have concerns about your kids’ mood changes, a health care professional, like a child psychiatrist, can help navigate the nuances and treatment options alongside you.