Is High Functioning Depression a Real Diagnosis

Is High Functioning Depression a Real Diagnosis

There are many misconceptions about what depression looks like. You can imagine someone who is too desperate to get out of bed. Otherwise, you can imagine someone who is unable to work or engage in activities due to a bad mood.

Depression takes many forms and can vary greatly in severity. Sometimes people suffer from what is known as “functional depression”.

Someone who has symptoms of depression but is functioning at a normal or high level in most aspects of their life is considered high functioning. High-functioning depression causes persistent low mood with similar but less severe symptoms than major depression. Depression occurs most days and lasts for two years or more with little relief. Treatment with therapy and medication can help someone with functional depression feel better.

Although high-functioning depression is not an official clinical diagnosis, it is a term commonly used to describe people whose depression is so well hidden that it does not interfere with their daily functioning. For example, they often meet with friends, meet expectations at work and do not express hopelessness, but internally they fight.

What Is Depression?

Depression is an emotion and a state of mind that everyone experiences from time to time, but it is also a diagnosable mood disorder and a category of related mental illnesses. As a diagnosable mental illness, depression is a serious condition that causes moderate to severe symptoms that are persistent and do not improve without treatment. The hallmark symptoms of depression are: 

  • Feelings of depression and sadness 
  • Loss of interest in typical and once pleasurable activities 
  • Loss of appetite or overeating 
  • Insomnia or falling asleep 
  • Fatigue and lethargy 
  • Trouble thinking, concentrating, remembering, or making decisions 
  • Feelings of guilt or shame 
  • Unusual affect that may be diminished and shallow or excited and angry 
  • Suicidal thoughts and behaviour

There are also different types of depression. Bipolar depression is accompanied by manic periods. Postpartum depression occurs in women after childbirth. Premenstrual dysphonic disorder is a serious premenstrual syndrome that also includes depression. Seasonal affective disorder causes depression in the fall and winter. There is also a type of depression called persistent depressive disorder that causes milder symptoms of depression that allow most sufferers to function better.

Why Is It So Difficult to Identify High-Functioning Depression?

Persistent stereotypes about depression equate “real” depression with dysfunction. You can’t get out of bed, you’re always sad, and you don’t have what it takes to be good at work.

These stereotypes do not apply to someone with “high-functioning depression”. They don’t seem “sick,” making it difficult for loved ones, and even those with the condition, to recognize feelings of inadequacy, self-doubt, and anxiety as signs of depression. Furthermore, “high functioning” implies (misleadingly) that there is no clear need for an intervention since a person can function.

What Are Common Symptoms of “High-Functioning” Depression?

In professional circles, high-functioning depression is known as persistent depressive disorder (PDD) or dysthymia. Although dysthymia is not usually as severe as major depression, sufferers can experience many of the same symptoms, ranging from mild to severe, at different times. 

These symptoms may include: 

  • Avoidance of social activities 
  • Changes in appetite (increased or decreased) 
  • Difficulty concentrating or making decisions 
  • Excessive anger or irritability 
  • Tiredness and lack of energy 
  • Hopelessness 
  • Emptiness, sadness, or depression 
  • Feeling guilty or preoccupied with the past 
  • Low self-esteem 
  • Decreased productivity, activity, or efficiency 
  • Self-criticism or inability to do certain things difficulty sleeping 

The difference between major depressive disorder (MDD) and dysthymia is that the symptoms of dysthymia tend to come and go depending on the individual’s situation. For example, someone with dysthymia may show up for work or school but behave more reservedly than usual. Or they may seem fine when socializing but are not performing as well as usual at work. 

Additionally, to be diagnosed with MDD, someone must have had five of the above symptoms for at least two weeks. For someone to be diagnosed with PDD, at least two of the above symptoms must have been present for more than two years.

If You Are “High Functioning,” Are You Sick Enough to Need Help?

People with dysthymia may assume they are not ill enough to need help and therefore do not seek it. Nothing could be further from the truth as depression, even when it’s “high functioning,” still affects your quality of life.

It is important to remember that ‘highly functional’ does not mean fully functional. People with dysthymia still experience some level of impairment even if they can perform most tasks most days. Associating your depression with extreme cases or stereotypical symptoms that don’t match your experience doesn’t mean you wouldn’t qualify for or benefit from professional help. Just like with physical illnesses, early intervention is important. If symptoms of depression are not treated, it can cause dysfunction and lead to MDD or complications such as substance use, chronic pain, and suicidal thoughts or behaviour.

Signs and Symptoms

Since high-functioning depression is not recognized by experts as a disorder, there are no objective clinical symptoms. However, many people confuse high-functioning depression with PDD.PDD implies low-grade depression with symptoms lasting at least 2 years. In PDD, a person’s depressed mood lasts most of the day, and depression occurs more frequently. 

In addition to being moody, people with PDD may also have at least two of the following symptoms: 

  • Changes in appetite 
  • Too much sleep or insomnia 
  • Extreme fatigue 
  • Low self-esteem 
  • Difficulty concentrating and making decisions 
  • Feelings of hopelessness, worthlessness, or guilt 

People with PDD may experience seizures more normally Experience moods that last less than 2 months. They are also more likely to develop major depressive disorder than other people.


A doctor cannot diagnose a person with high-functioning depression. However, if a person has depressive symptoms, they should speak to a doctor right away.

Conditions people often confuse with high-functioning depression, such as B. PDD, can be difficult to diagnose. People are likely to have low-grade symptoms and may not know they have depression.

A physician is likely to use a standard clinical interview for diagnosis. For a person to have PDD, they must have had chronic depression for at least 2 years and have some additional symptoms.

How Does It Feel to Live With High-Functioning Depression?

The diagnostic criteria for PDD accurately describe what it means clinically to struggle with high-functioning depression, but it doesn’t necessarily feel like going through it. It may be more helpful to think about how it feels to have this mental illness: 

  • You feel a little depressed most of the time. Other people may notice this and label you as gloomy, cynical, or depressed. Your bad mood is almost always present, and you never seem to get any relief. If you feel happy, it doesn’t take long. 
  • You can feel tired all the time, even when you get enough or too much sleep. 
  • You may seem lazy, but you just can’t find the energy to do more than is necessary to function at a normal level. 
  • You feel bad, unworthy, and as if you don’t deserve to be happy or loved by others. You do everything you’re supposed to do, like go to school or keep the house clean, but it always seems like a monumental effort. 
  • You gain or lose weight without wanting to, either because you don’t have an appetite, or you overeat without thinking about it. 
  • You may often feel hopeless or cry a lot for no real, concrete reason. 
  • You do reasonably well at work or school, but it is challenging and difficult to concentrate on tasks. 
  • You must force yourself to participate in social activities when you’d rather withdraw. PDD can cause unrelated complications, such as substance abuse, chronic pain, relationship problems, and problems at work or school.

Signs of a Major Depressive Episode

Everyone with PDD is also at risk of experiencing major depressive episodes. In fact, most people with PDD will experience one of these episodes at least once in their lives. Some people with PDD may feel that persistent low-level depression can turn into major depression at any time. Although the two conditions are similar and can occur in the same person, there are some significant differences.

Two important differences are duration and severity. PDD lasts for a long time, two years or more, while major depression occurs in episodes lasting less than two weeks, but at least. Symptoms are similar but more severe during a major depressive episode.

The distinction between functioning is also important. Someone with PDD functions at a typical level, but during a major depressive episode this function declines. They may perform poorly in school or at work, fail to complete certain tasks, skip activities they normally participate in, become socially withdrawn, or even neglect self-care and personal hygiene. Finally, there are some additional symptoms that can occur during a major depressive episode. Many of the symptoms can be the same, only more severe, but major depression can also cause a disinterest in activities that are normally enjoyable, extreme feelings of guilt, changes in emotional affects, and suicidal thoughts and behaviours. In rare cases, a depressive episode can even produce psychotic symptoms such as delusions and paranoia.

High-Functioning Depression Can Be Treated

While PDD may not be as severe or debilitating as major depression, it still causes impaired functioning and a reduced ability to enjoy life. There’s no reason anyone should live with perpetually low mood when there are effective treatment options. The first step to getting help for high-functioning depression is a diagnosis. This can be difficult when a person doesn’t realize that their bad mood is a treatable mental illness. It helps when loved ones can point out that there might be a problem.

Once diagnosed, PDD can be treated with a combination of medication and therapy. Antidepressants can help improve mood, although they take several weeks to work. It may also take a few tries with different types to find a drug that works best. Therapy helps treat PDD by showing patients ways to identify negative thought patterns and actively change them. While outpatient therapy can help, many people with PDD can benefit from the intensive, focused, and comprehensive therapy offered in inpatient treatment programs. It’s not always easy to spot the signs of high-functioning depression. It’s an insidious mental illness because it hides behind functioning. Even for the person struggling with these feelings, it is not easy to recognize that there is in fact an underlying mental illness. Getting help is important because treatment can make life easier, improve mood, improve functioning, and result in a better outlook and overall quality of life.


  • People who are still functioning despite depression can convince themselves that their depression isn’t that bad.
  • Some people downplay their problems
  • Some people with functional depression may downplay the severity of their illness and are less likely to seek treatment.
  • They are also less likely to receive emotional support from others if their depression goes undetected. Friends, family, and co-workers may have no idea the person is depressed.
  • In addition, someone with high-functioning depression may feel guilty about seeking help (guilt often goes together with depression). You may think that people with worse depression deserve more help.
  • Some people think they shouldn’t be depressed
  • They can also convince themselves that they have no reason to be depressed. They may think they should be happier since they can still function. They believe that someone who has a job, and a family shouldn’t be depressed. These thoughts can also keep them from asking for help. All types of depression can lead to an increased risk of suicide, including functional depression. Someone suffering from functional depression may have increased thoughts about death and consider ending their life.
  • Other people may misunderstand high-functioning depression. You may think that a person who is socially withdrawn is not interested in being friends. Or they label an individual’s struggle for motivation as laziness. These misconceptions tend to create even greater problems for someone already struggling with depression. They could increase their social isolation or cause them to try to overcompensate by pretending to be fine when in fact they are sinking deeper into depression.


Saravavan Nadarajan (Vanan)

Vanan, fitness expert and leader at EzFit Singapore, specializes in holistic training—home-based, boot camps, and corporate fitness—with over a decade of industry experience.