High functioning depression and what makes it invisible | by Dr. Aishwarya Rastogi - The Indian Express
When we think of depression, we think of someone who is unable to get out of bed, has lost all motivation, or has no desire to interact with others. However, many people struggle with depression without showing these outward signs. They show up on time for work, complete their tasks, engage in conversations during team meetings, respond promptly to emails/messages, and still feel emotionally drained.
These individuals are sometimes referred to as "high functioning" individuals with depression. They seem perfectly fine and capable from the outside. However, internally, they may consistently experience feelings of emptiness, fatigue, and emotional disconnection. This experience is commonly known as "high functioning depression."
Although "high functioning depression" is not an officially recognized diagnosis in the diagnostic manual of mental disorders-5 (DSM-5), psychiatrists frequently utilize this term to refer to those who continue to fulfill their obligations in daily life and have continuing depressive symptoms.
Because the individual doesn't look depressed to outsiders, this experience is commonly overlooked by both the individual themselves and by medical professionals. Therefore, it's essential to discuss this topic further.
What is high-functioning depression?
High-functioning depression refers to a situation when a person is persistently experiencing depressive symptoms such as sadness, emptiness, fatigue or loss of interest; however, he/she is able to carry out his/her daily responsibilities such as school/work/Relationship(s) effectively.
High-functioning depression often correlates closely to:
- Persistent depressive disorder (dysthymia).
- Major depressive disorder (mild/moderate severity).
- Chronic emotional burnout stemming from excessive long-term stress.
Contrary to major depression where the individual's ability to function collapses and they eventually cannot accomplish anything, individuals who suffer from high-functioning depression will continue to operate at a high level of performance - either personally or professionally; however, they will also silently endure.
Why is it frequently overlooked?
One of the greatest obstacles associated with high-functioning depression is its non-visibility.
India has a culture of productivity and the assumption that an individual's productivity directly relates to their well-being. Thus, emotional pain is frequently unperceived. Individuals who are struggling with high-functioning depression will frequently adopt assumptions such as:
- "i don't have time to let my guard down."
- "my issues are less severe than everyone else's."
- "If I am producing results then I must be okay."
According to the world health organization (who) 2022 global report on mental health and substance use, approximately 280 million people worldwide are affected by depression. However, a substantial portion of these individuals never receive a formal diagnosis or treatment. Although the prevalence rates of depressive disorders among adults in India vary based upon location and demographic characteristics, national data from the 2010 National Mental Health Survey indicated that between 5-6 percent of adults in India experience some degree of depressive disorder. Treatment gaps exist largely due to stigma and lack of awareness regarding depression among Indians. As a result, high-functioning individuals frequently fall into the treatment gap simply because they fail to exhibit symptoms consistent with "being sick enough."
Warning signs of high-functioning depression
There may be indications of depression that do not surface in One's everyday life as One might expect. Some common indicators include:
Emotional indicators
- Continuing feelings of emptiness/numbness.
- Decrease in enjoyment experienced in previously enjoyable activities.
- Increased Irritability/emotional sensitivity.
- Disconnection from oneself/others.
Cognitive indicators
- Excessive thinking/self-blame.
- Ability to focus/concentrate even though performing productive actions.
- Inability to make decisions/mind fatigued.
Physical indicators
- Consistent tiredness/inadequate rest/Sleep.
- Heaviness/Headaches.
- Changes in eating/appetite and/or sleeping habits.
Behavioral indicators
- Overwork/overfunctioning due to inability to tolerate emotional pain.
- Social isolation/appearance of normalcy.
- Using diversions (e.g., endless scrolling/binge watching).
While an individual's functioning may be intact, they will often experience a compromise in their overall quality of life and emotional wellness.
Why does it occur?
High-functioning depression is rare due to only one reason. It typically occurs through the interaction of multiple biologic, psychological and social variables.
1. Long-term exposure to chronic stress
Academic pressures/job instability/family demands create emotional exhaustion in a prolonged period of time.
2. Personality characteristics
Tendencies toward perfectionism/people pleasing/having unrealistically high expectations of oneself heightens susceptibility.
3. Suppressing emotions
Many individuals were taught to "stay strong" and suppress emotion instead of processing them.
4. Biologic variables
Serotonin/dopamine/stress hormone imbalances affect mood control.
5. Significant events/life experience
Lack of resolution concerning traumatic events/loss/emotionally invalidating environment(s) greatly contributes.
Case Study (Anonymous)
The patient, a 28-year-old male software developer from Bengaluru, presented to the psychiatrist with chronic exhaustion and reduced motivation. Despite being able to fulfill all his obligations at Work; receiving regular promotions, positive feedback, and maintaining an active online presence, he reported experiencing "emotional flatness" for approximately One year. During this time, he fulfilled all his job duties and responsibilities but never experienced any pleasure or reward from completing tasks. His weekends consisted of excessive sleep or spending hours browsing the internet without obtaining any satisfaction or enjoyment from doing so. Although he did report some fatigue associated with stress, he could not recall ever having a depressive episode so therefore believed that he was simply stressed.
Upon further evaluation by the psychiatrist, he demonstrated many of the classic behavioral manifestations of dysthymia including: low mood for over two years, emotional numbness, and cognitive fatigue. With the assistance of psychotherapy focused on cognitive restructuring and lifestyle modifications, combined with increased emotional awareness, his symptoms resolved over several months. The major breakthrough in his treatment was not necessarily the prescription of medication, but recognizing that "performing well," does not automatically equate to "feeling well."
How high Functioning depression affects your daily routine
While high Functioning depression may appear invisible to those around you, it can certainly impact your daily routine:
- Work performance: while your ability to produce remains intact, your creative spark and motivation will likely diminish.
- Your Relationships: as emotional availability decreases, miscommunication can occur in your interpersonal relationships.
- Your Self image: you may feel like you're pretending to live.
- Your long term health and well being: if left unaddressed, the Risk of burn out and/or severe depressive episodes will increase.
Many refer to living with high Functioning depression as "existing on autopilot."
When to consider seeking professional assistance?
If you are experiencing:
- Feelings of emptiness or sadness for more than two weeks
- Feeling disengaged emotionally
- Using distractions to mask feelings
- No matter how much you Rest/relax you do not regain emotional energy
- Just trying to get through each day
Seeking help is not about waiting until your situation becomes worse. It's about stopping it from becoming worse.
Treatment options for high Functioning depression
Fortunately high Functioning depression is treatable. Treatment options typically involve a combination of:
1. Psychotherapy
- Cognitive behavioral therapy (CBT)
- Inter personal therapy (IPT)
- Therapy that focuses on increasing emotional awareness
2. Lifestyle modifications
- Establishing regular sleep/wake cycle
- Engaging in physical activity (daily walking/biking etc.)
- Limiting screen time
3. Prescription medications (in extreme/moderate cases)
Antidepressant medications may be prescribed under the direction of a psychiatrist in cases where symptoms are moderate to severe.
4. Emotional awareness
Identifying and expressing emotions rather than suppressing them is essential to healing.
As opposed to achieving happiness immediately, recovering from high Functioning depression is about gradually returning to an emotional equilibrium.
Key Takeaways
- High Functioning depression exists even when everything seems fine
- High Functioning depression is frequently related to chronic stress and perfectionism
- Common characteristics include emptiness, fatigue, and decreased interest regardless of continued productivity
- High Functioning depression is frequently overlooked because we expect everyone to keep pushing forward
- Early identification and treatment can significantly enhance treatment outcomes
- There is a difference between performing well and being mentally well
- Living awarefully vs. Pressured
Living With AWARENESS – NOT PRESSURE
One of the largest shifts is going from self-judgment to being aware of yourself. Many people experiencing high functioning depression are extremely responsible individuals that have been "running" their lives emotionally without any pause.
Recognizing one's internal experiences is not weak, it is clinical awareness. Once the mind and body can finally be heard, recovery will be a possibility.
Frequently Asked Questions
Is there such a thing as "high functioning depression"? Is it a legitimate medical condition?
High functioning depression is not recognized by the mental health community as an actual diagnosis, however many clinicians recognize this description when working with people who exhibit depressed behavior, yet continue to operate at a level necessary for maintaining a career, education etc. Oftentimes, high functioning depression has overlap characteristics with dysthymic disorder (mild depression).
Are you saying someone experiencing high functioning depression can still be successful?
Many individuals experiencing high functioning depression continue to succeed in their careers, studies, and personal relationships; however, success does not diminish the existence of emotional pain and neglecting to treat these symptoms can lead to worsening of them overtime.
