By HAYDEN FINCH, PhD
When you think of someone who’s depressed, what comes to mind? Someone in bed crying? Someone who can’t get off the couch? Someone who’s stopped going to work? The old Zoloft commercial (remember the groaning blob that was constantly under the raincloud)? Maybe the image of depression in your mind looks something like one of these:
What if depression looked totally different?
What if it looked like a super high-achieving student who is top in her class but is crippled by perfectionism? What if it looked like someone who’s always got their work done AND finds time for the gym and friends and hobbies while being a homeowner? What if it looked like a corporate manager who recently got a promotion but needs to unwind with a few drinks at night? What if it looked like hustling to work 60 to 80 hours a week and never slowing down? What if it looked like a stay-at-home mom whose kids are always dressed to perfection, who prepares healthy meals each day for her family, who always looks perfect in the school drop-off lane, and who runs a successful business on the side while volunteering each week for children with disabilities? Do those people, who clearly aren’t lying in bed all day and wallowing in sadness, even have depression? Maybe. It might be what’s being called “high functioning” depression. So, what is that?
One thing to know is there are different kinds of “depression.” One kind is Major Depressive Disorder, and that’s what’s typically called “clinical depression.” Another kind is a less severe but typically more chronic form of depression called “dysthymia” or Persistent Depressive Disorder. Many of the symptoms of Major Depressive Disorder and Persistent Depressive Disorder are the same, such as depressed mood, changes in sleep or appetite, fatigue, problems with concentration or indecisiveness, and feelings of hopelessness. But Major Depressive Disorder is also characterized by markedly diminished interest or pleasure in all or almost all activities, feeling agitated or slowed down, feelings of worthlessness or excessive guilt, and recurrent thoughts of death or suicide. So, a person with “high functioning” depression might still be doing most or all their activities, they might not feel worthless, and they might not be on the brink of suicide. But they can still have depression, often a kind that is invisible to their friends and family.
You might not have all these indicators of high-functioning depression because depression looks different in different people. But if you have more than one or two, it’s worth a chat with a healthcare provider.
- Sadness or numbness
- If you’re not overwhelmingly sad but start to notice mild sadness when you’re alone, you might have high functioning depression. When you’re out in the world, you’re probably wearing a “mask” that hides this, but when you’re home, in your sweatpants, vegging with your dog and Duncan Hines, what do you feel? Is it subtle sadness or guilt or worthlessness or helplessness or hopelessness? Or maybe you feel absolutely nothing at all. Like your feelings have just evaporated. You feel like a robot. In general, even if your life is objectively great, you feel empty, unfulfilled, and you worry you’re wasting time in your life.
- Difficulty experiencing joy
- It might look like “going through the motions” at work, during leisure activities, with friends and family. The things that used to be exciting or funny might be boring or lame. It seems like everyone else is having fun and you’re just watching from the sidelines or wearing a mask so no one knows what you’re feeling on the inside.
- Brain fog
- It’s hard to concentrate and focus. You’re not as sharp as you once were. You might even experience subtle changes in the quality of your work or your attitude about work.
- Criticism
- It might look like constant negative thoughts. It might be personal criticism (I’m such a failure, I can’t do anything right), negativity about others (My boss is a complete idiot, My boyfriend never pays attention to me), or even the world (Nothing is ever going to get better, We’re all doomed, The world is full of selfish people). You’re your own worst critic.
- Relentless self-doubt
- Especially about your own abilities. Second-guessing yourself, wondering whether you’re in the right job or relationship. Are you prepared enough for this presentation? Did you study enough for this test? Are you smart enough to be a manager? Will you embarrass yourself if you apply for a promotion? No matter how much you’ve accomplished and how hard you work, you still doubt your abilities and talents and skill.
- Fatigue
- Feeling like you’re walking through mud to get through each day. Even though you slept all night, you’re still tired when you wake up. It’s hard to put your feet on the floor in the morning and you dread going to work. You look forward to the weekend, but then the weekend isn’t that great either, and then suddenly it’s time to go back to work. You’re exhausted at the end of every day.
- Irritability or anger
- You’re getting in stupid arguments with your partner or you’re easily insulted. You’re carrying grudges that don’t make sense. You’re overreacting to what’s going on in your life and can’t let things “slide.”
- Isolation or loneliness
- You keep to yourself when you don’t have to be around others, and even though you feel lonely, you also don’t want to be around people. It just seems like a lot of work and not much fun.
- Feeling overwhelmed
- Everything seems like a big deal. You dropped your sandwich on the floor. Your boyfriend didn’t fill the car up with gas. You can’t remember your password. Everything is annoying and you have a really hard time handling the stress. Any little thing can send you to tears and ruin the rest of the day.
- Can’t focus on the present
- You keep obsessing about mistakes you’ve made that are long gone and in general negative experiences stick with you for a while. You rehash decisions you made and wonder whether you made the “right” decision. When you’re not feeling guilty about your past, you’re worried about the future. What if you owe the IRS on your taxes? What if you can’t afford your student loan payment? What if you don’t get the job you applied for? What if you’re marrying the wrong guy? While worrying is normal, when you can’t find a second in your life to really experience what’s happening in the moment, you might be excessively worried.
- Using escape methods
- If you need a drink every night to be able to wind down or go to sleep or if you’re gambling, gaming, napping, eating, or Netflixing most of your time away just to escape or ignore your feelings, you might be experiencing high functioning depression. Also, if you just plain can’t rest and slow down and feel like you must.stay.busy, check yourself.
- Perfectionism
- You can’t stand the thought of not being absolutely perfect. You can’t let yourself down, your parents down, your boss down. You worry that a mistake would let others down. You dread the possibility of failing to meet expectations.
- Workaholism
- If you’re working all the time or you can’t ever take a break and just meditate or sit in silence, be alert to other signs of depression. If you can’t stand the thought of being alone with your thoughts and feel like you have to stay busy so your thoughts are silenced, be alert.
- Can’t imagine opening up to others about your feelings
- Others see you as competent, efficient, helpful, dependable, positive. The vulnerability associated with telling the truth about how much you’re suffering despite your occupational success is intolerable. Better to just say you’re “fine.”
- Worries and anxiety
- Although we think most often about the sadness (and irritability) associated with depression, some people also have anxiety or nervousness or they feel restless or worried much of the time.
- Body stuff
- You’ve got random aches and pains but haven’t been injured, your stomach just isn’t right, you get sick more often or for longer than you used to.
“But, Hayden, ” you ask, “If I can still get to work and take care of my family and do all the things I’m supposed to be doing, is this really an issue?” Yep.
The problem is, high functioning depression, if left untreated, can very easily turn into a more serious kind of depression. The kind where you can’t keep up with all your responsibilities. If you think you’re busy right now keeping up with all your responsibilities, imagine what would happen if your high functioning depression developed into a sleep disorder, eating disorder, alcoholism or another addiction, etc. Ain’t nobody got time for that.
Six MILLION adults had an episode of Major Depression in 2015. That’s almost 7%. Even though about 20% of Americans will have some type of mood disorder in their lifetime, only about HALF ever get treatment. HALF, folks. The other half just suffers through it on their own, never getting help for a treatable condition. Part of that is because they don’t even realize they have depression. I mean, they’re killing it at their career, they’ve got great relationships, what do they have to be depressed about?? But remember – depression isn’t something that’s just a reaction to outside events. It also comes from the inside, too. From genetics, brain functioning, hormone levels, etc. So just because your life is objectively approaching perfection doesn’t mean you might not have a treatable mental health condition. There are lots of misconceptions about depression (like that it’s the same thing as sadness, or you can control it by just looking at the bright side, etc. etc.), so check your own assumptions before you assume you don’t have depression.
Alright, alright.
So, what do I do about this?
Get yourself a good therapist. I happen to know a few 
. If you don’t live near me, find a psychologist who specializes in treating depression. Consult with your physician regarding whether medication might be helpful. The combination of therapy plus medication tends to carry the best treatment outcomes for people with depression. Also, there are several medical conditions that have depression as a symptom, so it’s good to get checked out by your doctor just to make sure there’s nothing medical going on that’s affecting how you’re feeling.
The truth is many people with high functioning depression are rightfully worried about how getting treatment for depression will affect their career, including their perceived competence. There’s still a lot of stigma about depression, and there’s still a lot of judgment professionally regarding people who have depression. So obviously the successful people who have high functioning depression are reluctant to disclose their experience. But get this. You don’t have to tell your boss or your coworkers that you’re taking medication or going to therapy. You can schedule the therapy during your lunch hour, in the evenings, or on the weekends. No one has to know. It’s your little secret.
Hayden C. Finch, PhD,
is a practicing psychologist
in Des Moines, Iowa.
