High-Functioning Depression: Complete Guide

Everyone knows that there’s always another side to a person that the rest of the world doesn’t see. Sometimes the happiest person you knew from the office or class commits suicide… How could it be that they were so sad and no one knew? Well, another great question is: what is high-functioning depression? What are the signs, symptoms, causes, diagnosis, and treatments for it? How does the brain work with it and how are the cognitive skills affected? What are some tips to manage this depression?

What is high-functioning depression?

High-functioning depression, also known as a variation of depression that is much harder to diagnose than Major Depressive Disorder (MDD) because the people who suffer from it are often seen as happy all the time and high-achieving. According to a report by the Substance Abuse and Mental Health Services Administration in 2015, a minimum of 16.1 million adults 18 and over in the U.S. have had at least one depressive episode in the past year. That chalks up to about 6.7% of the U.S. population. Of that 6.7%, 1.5% suffers from a chronic low-level depression every year which is also known as high-functioning depression.

High-functioning depression is a form of chronic depression and is a moderately new diagnosis which combines both chronic major depressive disorder and dysthymia. As with any type of depression, people who suffer from high-functioning depression feel sad, hopelessness, and loss of appetite, among other things. However, people with high-functioning depression have symptoms that are less severe, but longer lasting. They can stick around for years which makes it harder to cope with.

Sometimes, people who suffer from high-functioning depression don’t seem depressed for one minute. As Dr. Mayra Mendez, a psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center, says, “Depression may inhibit the desire for activity and action, but high functioning individuals tend to forge ahead in an effort to succeed with goals. The drive to accomplish often sustains action and moves high-functioning individuals towards getting things done.” This shows that people with high-functioning depression can maintain and go about everyday life as if nothing is wrong.

Some famous examples of people who accomplished exceptional tasks while struggling with high-functioning depression are Charles M. Schultz, Winston Churchill, Owen Wilson, and Emily Dickinson.

Signs and symptoms of high-functioning depression

High- functioning depression symptoms are similar to those of other types of depression. However, this condition is chronic which means that the symptoms occur on most days for at least two years consecutively. It’s incredibly important to keep in mind that symptoms for depression, especially those for high-functioning depression, can seem invisible. Sometimes the happiest people you know struggle deep down with negative feelings on a regular basis. That said, some of the most common symptoms for high-functioning depression include:

• Low energy levels
• Concentration problems
• Lack or poor self-esteem
• Negative attitudes
• Changes in appetite
• Lessened or lack of interest in daily activities
• Issues sleeping
• Avoiding social activities
• Decreased productivity
• Rather constant feelings of hopelessness and sadness

These symptoms can appear during childhood, into adolescence, and into adulthood. Most often they appear at a young age. When it appears at a young age, children and teens often seem moody, have behavioral problems, seem irritable, have difficulty in social situations, and seem pessimistic for a long period of time.

Over the years, the symptoms can come and go with the severity of them varying over time.

Causes of high-functioning depression

While there is no exact, one-size-fits-all cause for high-functioning depression, there are certain factors that can contribute to the development of the depression. Some of these factors include:

• Physical brain trauma. For example, a concussion or stroke.
• A family or personal history of depression, anxiety, or bipolar disorder.
• Chemical imbalances in the brain and body.
• Stressful life events or trauma. For example, financial problems, PTSD, or the loss of a loved one
• Chronic physical illnesses. For example, diabetes or heart disease.

The brain and high-functioning depression

As with any type of depression, the brain is greatly affected. In fact, depression can cause brain shrinkage and inflammation and causes oxygen restriction.

Shrinkage & Inflammation

Recent research proves that the size of specific parts of the brain actually decrease in size when people go through depressive spouts. Although researchers are debating about which regions of the brain specifically shrink due to depression and how much shrinkage actually happens, several current studies have laid out that the frontal prefrontal cortex, hippocampus, thalamus, and the amygdala can all be affected.

As for the amount of shrinkage that can occur depends on the length and severity of the depressive episode. For example, noticeable changes can be seen in the hippocampus when the depressive episode lasts for at least 8 months or there are multiple shorter episodes during the span of a year.

It makes sense that when the brain shrinks, so do the neural functions that are associated with the shrunken brain part. For example, the amygdala and the prefrontal cortex work in tandem to help control the emotions of oneself and see/understand the emotional reactions in other people. This connection between the two is actually why some scientists claim that some people who have postpartum depression (PPD) can be considered to have a reduction in empathy.

There is also a lot of connection between depression and inflammation. That said, it’s unclear as to whether depression causes inflammation or it’s the other way around. In any case, both inflammation and depression occur at the same time and inflammation is directly linked to the amount of time someone has been depressed. That is to say, the longer someone is depressed, the more imflammed their brain becomes. One study showed that people who have been depressed for over ten years had 30% more brain inflammation compared to those who were depressed for less than ten years. Due to the fact that brain inflammation causes brain cells to die, there are a number of cognitive consequences that come from inflammation such as shrinkage (which is why brain shrinkage and inflammation are directly connected), neuroplasticity, decreased neurotransmitter function, and reduced brain ability to change as one ages. The combination of these can lead to negative changes in memory, mood, learning, and overall brain development.

Oxygen Reducement

Depression has also been linked to a reduced amount of oxygen in the body and brain. As with inflammation, it’s unclear as to whether the reduced oxygen levels cause depression or vice versa. There is a cellular factor that is produced in response to the brain not receiving a sufficient amount of oxygen, known as hypoxia, which is elevated in certain immune cells that are found in people with bipolar disorder and depression. When the brain lacks oxygen, it can cause inflammation and kill or injure the brain cells. Even short-term hypoxia can turn into confusion (think about high-altitude hikers and their brains). Overall, an oxygen reduction can lead to changes in mood, learning, memory, and brain development. Thankfully, it’s been proven that the use of hyperbaric oxygen chambers can relieve symptoms of depression.

Cognitive skills and high-functioning depression

Cognitive skills are greatly affected by depression. In fact, depression impairs the ability to think… to make things worse, it’s unknown whether antidepressants can help treat the cognitive skills impairment that stems from depression. Although, there is a study about it. In addition to medications (which aren’t a treatment to cognitive skill impairment), cognitive behavioral therapy (CBT) can challenge people and help them learn to recognize distorted or different thinking patterns. Problem-solving treatment can also be used to help train people how to improve their overall problem-solving skills. Some people with high-functioning depression also try cognitive remediation therapy which uses exercises to help improve memory and the executive functions.

Other cognitive functions such as motivational processing, emotional processing, and cognitive processing all require interactions between neural networks. However, depression can dysregulate and cause problems within these neural networks and the connections between them.

Diagnosis of high-functioning depression

In order to diagnose high-functioning depression, a doctor will use a physical exam. If there is nothing physically wrong, the doctor may suspect depression. They may also use a blood test or other tests to rule out any other medical conditions that could be causing the symptoms. Often, doctors use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to help diagnose. The manual lists the following as symptoms of high-functioning depression:

• Difficulty falling asleep and/or staying asleep
• Having too little or too much appetite
• Low self-esteem, self-esteem issues
• Little to no energy
• Cognitive issues such as difficulty making decisions or concentration
• Feeling depressed for the majority of the day (almost) every day

For adults, they must feel depressed most of the day, every day, or almost every day, for two years. For teens and children, they must feel depressed or irritable most of the day, almost every day, for one-year minimum.

Treatment for high-functioning depression

There are three main ways to deal with high-functioning depression. First, lifestyle changes. Second, medication. Third, therapy. Often, a combination of both therapy and medication is used and is believed to be the most effective.

Lifestyle changes are an important part of treatment for high-functioning depression since the condition is chronic and long-term. By adjusting how one lives, the symptoms can ease a little bit. For example:

• Avoiding toxic substances such as a lot of alcohol or drugs
• Seeing a chiropractor or acupuncturist
• Exercising often- three times a week if possible.
• Writing in a journal or finding a healthy way to express oneself
• Practicing relaxation therapies such as yoga, meditation, or tai chi.
• Having a healthy, natural diet full of fruits and vegetables.
• Taking supplements that boost brain health such as fish oil and St. John’s Wort.

Medication for high-functioning depression can include three types of antidepressants:

• Tricyclic antidepressants, known as TCAs, which includes drugs such as amoxapine (Asendin) and amitriptyline (Elavil).
• Selective serotonin reuptake inhibitors, also known as SSRIs, which include drugs such as sertraline (Zoloft) and fluoxetine (Prozac).
• Serotonin and norepinephrine reuptake inhibitors, also known as SNRIs, which include medication such as duloxetine (Cymbalta) and desvenlafaxine (Pristiq).

Therapy is also a beneficial treatment option for some people. Going to psychotherapy, also known as talk therapy, can help people to:

• Cope with their emotions and whatever else may be going on in their lives
• Make adjusting to a crisis or challenge easier
• Express oneself in a healthy way
• Set realistic goals for oneself
• Replace negativity with positivity
• Gain better control of one’s life
• Identify the thoughts, behaviors, and triggers one feels

Tips to manage high-functioning depression

• See a therapist. Just because you don’t often feel like you need to see someone, having someone there can help. Even if it’s not a therapist, it always helps to have a shoulder, especially one that understands what’s going on, to lean on.
• Accept your mental health. No one is perfect.
• Make some lifestyle changes such as diet and exercise.
• Understand that you aren’t lazy because of your high-functioning depression.
• Know that you can’t just “snap out of it” and that’s okay.

Let us know what you think in the comments below!

Anna Bohren

Anna is a freelance writer who is passionate about translation, psychology, and how the world works.