Mood disorders, or depressive disorders, plague at least 6.7 percent of the US adult population, and many more individuals who don’t come forward about their depressive symptoms. Chief among them are the people who struggle with “high-functioning depression”, or milder forms of depression often diagnosed as dysthymia, or persistent depression. These cases can often be chronic and last a life-time yet are not always identified as a problem due to a misconception of what depression is, and when it should be treated.
While the stereotype of melancholy includes serious issues with motivation and productivity, many hard-working men and women across the country suffer from depression without fully knowing it. Just because a depressive disorder exhibits milder symptoms does not mean that it doesn’t require attention.
Individuals with high-functioning depression or dysthymia can still develop other disorders, experience an onset of stronger and more devastating symptoms, or begin contemplating about suicide. Many individuals with high-functioning depression mask their symptoms by engaging in short-term coping behavior, with negative long-term consequences that are not immediately apparent. Identifying a case of high-functioning depression means understanding how depression is more a case of the long-term blues.
What Is High-Functioning Depression?
Dysthymia develops in an estimated 1.5 percent of the US adult population, with an average onset age of 31. More commonly known today as persistent depressive disorder, or PDD, this problem is often chronic and develops over years rather than weeks or months. PDD is diagnosed in individuals who have experienced these moderate depressive episodes and symptoms for longer than two years. Nearly half of PDD cases either develop into or begin with symptoms that are considered severe, meaning many individuals with “high-functioning” depression could develop a much stronger set of symptoms without preventive care and treatment.
Patients with PDD exhibit symptoms of depression that are not always entirely apparent, and among those who continue to be “high-functioning”, their symptoms do not get in the way of functioning relationships, successful careers, or everyday tasks. Nevertheless, they may experience various depressive symptoms on a daily basis, including:
- Relentlessly self-critical
- Self-doubt and feelings of guilt/shame
- Struggle to feel any joy
- Emotional and physical fatigue
- Struggling with procrastination
- Relying on certain coping mechanisms
- Consistently sad
- Unable to be satisfied
- Always feeling overwhelmed
- Sense of drowning in stress
- Negative outlook/pessimism
What may seem like a series of personality quirks may in fact come from a deep sense of sadness and depression. High-functioning depression is always temporary and may quickly worsen without proper attention. And because many individuals feel they don’t need any help (because they don’t feel depressed enough), symptoms do tend to worsen in most cases.
Is It Still Depression If It’s “Fine”?
Not every case of depression includes days of extreme lethargy and hopelessness. Not every case of depression includes those mornings when you don’t want to get out of bed or hop into the shower.
But every case of depression deserves treatment. We live in an incredibly demanding and hectic world, with a very competitive job market, a struggling economy, rampant political apathy as well as emotionally-charged political battles, and countless sources of information and media leading to sensory overload. Adding depression into the mix is not a sustainable way to live.
The hard part is recognizing your own depressive symptoms and seeing them as a depression, rather than something you just “need to get through”. Many individuals with high-functioning depression misunderstand their condition as a matter of mindset and willpower. It isn’t. Depressive symptoms can’t be overcome through sheer force of will – that mindset is more likely to lead to worse symptoms, as we begin to blame ourselves for feeling bad.
High-Functioning Depression Is Still Destructive
It might not be immediately noticeable, but it’s the small things. While someone with high-functioning depression continues to go to work and gets their job done, it might not be the way it was before. While they spend an hour or two with their family, the darker feelings are palpable in the air, and their partner or children might sense that something’s off. And as they cling more and more to coping mechanisms and specific rituals to help them drift off to sleep and turn off the thoughts in their mind, they have a harder time getting up the next day to go through it all again, or they find their brow furrowing and their expression darkening with every repeat of the daily cycle.
If you don’t enjoy your life, it can’t last. Many then turn towards destructive outlets as a way to cope with increasingly powerful symptoms, risking the development of dangerous comorbid disorders such as eating disorders, substance use disorders, or behavioral disorders.
High-functioning depression might not start out with the same severe symptoms as some other cases of depression, but they can be just as destructive, if not more so due to the danger of never self-identifying as depressed, and fearing the stigma attached to a diagnosis of depression.
Treating High-Functioning Depression
Like other depressive disorders, the first line treatment against depressive symptoms is to prescribe antidepressants. These aren’t problem solvers – these are non-addictive drugs with a low level of risk meant to help individuals curb certain symptoms so they can work on adapting to their disorder and living a life that promotes their mental wellbeing.
While depression is tied genetics, it is also tied to stress and lifestyle issues. And making serious changes to the way you live is hard to do when mired by depressive symptoms. Medication can give you the time you need to adjust your life for the better, and work with a therapist to identify potential causes and contributing factors for your depression.
Antidepressants do not always work, however, and when a patient has tried several different types and brands, they may be referred to other treatment methods as a way to combat their treatment-resistant depression. Alternative treatments include transcranial magnetic stimulation, assisted meditation, herbal supplements, and other treatments.