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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Sometimes you can’t shake that low mood that seems to linger for months. Maybe everything seems to be going fine in your relationships, work, and every area of your life. Still, you continue to feel depressed.
Depression is a complex illness, and it can affect anyone. Some people use the term high functioning depression to describe times when they experience depression symptoms while continuing to live a “normal” life.
However, the term high functioning depression can be confusing since it isn’t recognized as a clinical diagnosis.
What is high functioning depression?
For many mental health conditions, the diagnostic criteria usually include impairing one’s ability to function in daily life. That means at least one area of your life is suffering. That could mean:
- Poor grades in school
- Decreased work performance
- Failing relationships
- Withdrawing from social activities and the outside world
- Neglecting your physical health or hygiene
These criteria are also part of the diagnosis for major depressive disorder, which significantly affects one’s capacity to function in daily life. But what about people with the symptoms of depression who continue to perform well in their daily lives?
Some people consider high functioning depression to be a form of persistent depressive disorder (PDD). PDD used to be known as dysthymia and is defined as a depressed mood that lasts for at least two years and impairs daily life (Patel, 2020).
Persistent depressive disorder: long term depression
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) doesn’t recognize high functioning depression as a distinct clinical mood disorder. However, its effects are very real for people experiencing high functioning depression.
Signs and symptoms of high functioning depression
Since high function depression isn’t recognized as a clinical diagnosis, there are no clearly defined symptoms.
Commonly accepted signs of high functioning depression could include major depression or PDD symptoms without those symptoms impacting your performance in daily life. Symptoms of clinical depression include (Chand, 2020):
- Thoughts of worthlessness
- Feelings of hopelessness or sadness
- Changes in appetite or weight change without trying
- Feelings of guilt
- Loss of interest in activities or people
- Low energy or fatigue
- Sleeping too much or too little
- Low self-esteem
- Difficulty concentrating
- Thoughts of death or suicide
It’s common for people with depression to also experience anxiety. So a high-functioning person may also experience a form of anxiety called high functioning anxiety in addition to the depression symptoms.
Causes of high functioning depression
There is little research about high functioning depression because it hasn’t yet been recognized as a clinical diagnosis. However, high functioning depression may be related to changes in neurotransmitters that impact mood and major depression.
Specific events don’t always trigger depression, and the cause of major depression doesn’t boil down to one factor. Multiple factors likely impact high functioning depression, including (Chand, 2020):
- Traumatic events
- Family history of depression
- Medical conditions or other health issues
- Death of a loved one
- High stress levels
- Substance abuse
- Low socioeconomic status, including low income, less education, less skilled occupations (Mungai, 2018)
Causes of depression: genetics, environment, and others
Treatment for high functioning depression
Just because high functioning depression doesn’t have a clinical diagnosis, that doesn’t mean a mental health professional won’t be able to help you feel better. You don’t have to suffer in silence if you’re functioning normally while feeling depressed.
Clinical depression often includes medications (antidepressants) in the treatment plan, but that probably won’t be the starting place for high functioning depression. Instead, treatment will likely start with psychotherapy or talk therapy to help you build coping skills to help you manage stress and emotions.
Cognitive-behavioral therapy is a type of psychotherapy that will focus on helping you find and change negative thoughts and behaviors. It helps you change your relationship with yourself, the world, and the future (Chand, 2020).
Interpersonal therapy is another form of therapy that focuses more on your relationships with other people. It helps you communicate better with others, manage grief, and improve other aspects of your relationships.
It can take time for therapy and treatment to work. Be sure to follow medical advice for your treatment duration to help you see the full benefits of treatment.
Living with high functioning depression
If you’re living with high functioning depression, you may be feeling hopeless and like your options are limited without an official diagnosis. There is hope, though.
Research shows that lifestyle changes can boost mood and improve depression symptoms. So, in addition to talking with a mental health professional, try these tips to help reduce depressive symptoms.
Lack of sleep can increase the risk for depression, so getting enough sleep is important (Rezaei, 2018). Go to bed and wake up at the same time. Sleep in a dark, quiet room with a cool temperature. Join local volunteer groups
Working as part of a volunteer group helps your mental health, in addition to helping the community. When volunteering, you can build connections with other people and feel a sense of purpose by helping others. Connections and purpose can improve self-esteem and mood (Yeung, 2018).
Physical activity releases endorphins that boost your mood and reduce depression symptoms (Murri, 2018). It doesn’t have to be an intense workout either. Try these tips to increase your activity throughout the day:
- Go for a walk on your lunch break.
- Park farther away in a parking lot.
- Take the stairs.
- Go to the park with a friend or family member.
- Attend a group exercise class.
Start a mindfulness or meditation practice
Meditation helps you to connect with your mind, body, and emotions. Research shows a regular mindfulness practice helps reduce the symptoms of anxiety and depression (Parmentier, 2019).
Try a meditation app, video, class, or simply try some deep breathing exercises to start practicing mindfulness.
10 benefits of meditation for mental and physical health
It can feel uncomfortable to sit still when you first try meditation. It’s okay to start with short meditations, even just 3–5 minutes, while you adjust to slowing down and sitting with your thoughts. Practice yoga
Yoga combines the benefits of meditation and exercise to help improve depression symptoms. A yoga practice focuses on building the connection between your mind and body through movement. Several small studies show that yoga is effective at reducing depressive symptoms (Bridges, 2017).
If you’re new to yoga, consider attending a yoga class in person or doing a video from the comfort of your own home.
Spending time outdoors may help to improve your mental health and reduce depressive symptoms (Beyer, 2016).
You can go for a walk outside to get some exercise or meet up with a friend in a park to get the combined benefits of exercise or social support with being outdoors. Reach out for support
Even if you feel like things are going well in your life and you have no reason to feel as low as you do, you can still get support. Talking with a mental health professional can help you better understand what is going on and support your mental health.
If you or a loved one experiences thoughts of suicide or depression symptoms, the Substance Abuse and Mental Health Services Administration’s National Helpline is available 24/7 at 1-800-622-4357 to offer support and connect you to services in your area.
- Beyer, K. M., Szabo, A., & Nattinger, A. B. (2016). Time spent outdoors, depressive symptoms, and variation by race and ethnicity. American journal of preventive medicine, 51(3), 281–290. doi: 10.1016/j.amepre.2016.05.004 Retrieved from https://pubmed.ncbi.nlm.nih.gov/27320702/
- Bridges, L., & Sharma, M. (2017). The efficacy of yoga as a form of treatment for depression. Journal of evidence-based complementary & alternative medicine, 22(4), 1017–1028. doi: 10.1177/2156587217715927. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871291/
- Chand SP, Arif H. (2020). Depression. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430847/
- Patel RK, Rose GM. (2020). Persistent depressive disorder. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK541052/
- Mungai K, Bayat A. (2018). High-functioning depression among women in South Africa: An exploratory study. Journal of Psychology in Africa;28(5):411-415. doi: 10.1080/14330237.2018.1523312. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/14330237.2018.1523312
- Murri, MB., Ekkekakis, P., Magagnoli, M., Zampogna, D., Cattedra, S., Capobianco, L., et al. (2019). Physical exercise in major depression: reducing the mortality gap while improving clinical outcomes. Frontiers in psychiatry, 9, 762. doi: 10.3389/fpsyt.2018.00762. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335323/
- Parmentier, F., García-Toro, M., García-Campayo, J., Yañez, A. M., Andrés, P., & Gili, M. (2019). Mindfulness and symptoms of depression and anxiety in the general population: the mediating roles of worry, rumination, reappraisal and suppression. Frontiers in psychology, 10, 506. doi: 10.3389/fpsyg.2019.00506 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6418017/
- Rezaei, M., Khormali, M., Akbarpour, S., Sadeghniiat-Hagighi, K., & Shamsipour, M. (2018). Sleep quality and its association with psychological distress and sleep hygiene: a cross-sectional study among pre-clinical medical students. Sleep science (Sao Paulo, Brazil), 11(4), 274–280. doi: 10.5935/1984-0063.20180043. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361305/
- Yeung, J., Zhang, Z., & Kim, T. Y. (2017). Volunteering and health benefits in general adults: cumulative effects and forms. BMC public health, 18(1), 8. doi: 10.1186/s12889-017-4561-8. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5504679/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.