Depression is common, and according to recent government data, 8.4% of U.S. adults experience at least one episode of depression within a given year. For some people, depression can be extremely debilitating, meaning that it causes difficulty with completing daily tasks and functioning in key areas of life, such as work and school. For others, depression symptoms may appear relatively mild, falling in line with what some experts label as “high functioning depression.”

What is high functioning depression?

To be diagnosed with major depressive disorder, which is the clinical term for depression, a person must demonstrate at least five of the diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and depression symptoms must cause either “clinically significant distress” or “impairment in social, occupational, or other important areas of functioning.”

Some people may have a more severe case of depression, in which they meet most of the diagnostic criteria, and it is apparent that they are having difficulty getting through the day. On the other hand, people who have high functioning depression may show fewer symptoms of depression, and because they are still able to fulfill their duties at work and participate fully in daily life, their depression may go undetected.

Or, high functioning depression may occur in people who are overachievers. They may be the highest performers at work, constantly climbing up the career ladder, while secretly suffering from depression. Internally, they may experience extreme distress, or they might have difficulty concentrating because of periods of sadness, but they continue to function well, and no one would guess that they’re living with a mental illness.

High functioning depression may also describe individuals who live with what is called persistent depressive disorder. This is a more mild, chronic form of depression. To meet diagnostic criteria, a person must have a depressed mood that lasts for two years and is present most days, along with two additional depression symptoms. Since persistent depressive disorder is more mild, individuals with this diagnosis may be high functioning, and their depression will also go undetected.

The Danger of High Functioning Depression

While individuals who cope with high functioning depression may continue to work, care for their families, and live life as if nothing is wrong, the danger is that their symptoms are likely to go undetected, even when they are internally suffering. In some cases, the outcome can be tragic. Consider, for example, the case of former Miss USA Cheslie Kryst. Kryst died by suicide at the age of 30 earlier this year, after jumping from a 60-story Manhattan apartment building. On the outside, Kryst had it all. In addition to earning a Miss USA title, she was a successful attorney, and she worked as a host for Extra TV. Though she thrived in her public life, in private, she was living with high-functioning depression, which she kept secret even from her mother.

When people appear to be happy and successful on the outside, there is little reason to suspect that they are struggling or in need of support. People with high functioning depression may also throw themselves into work and other ventures to mask their feelings of depression, and they convince themselves that nothing is wrong, since they are so successful. On the outside, they seem fine, while struggling internally. Over time, as their symptoms go untreated, they may begin to have suicidal thoughts.

Also, consider the fact that people with the persistent depressive disorder live with ongoing symptoms of depression. They may function well in daily life because their symptoms are rather mild, but the problem with this diagnosis is that it may not respond to treatment. People continue to feel a level of low-grade depression, which can ultimately lead to suicidal ideation, even if they are relatively high functioning. After all, research has shown that people who do not respond to treatment are at greater risk of suicide.

Signs of High Functioning Depression

Knowing what high-functioning depression looks like can help you to intervene with a family member or friend who might be silently struggling. Keep in mind that high functioning depression is not a clinical diagnosis; rather, it is a label applied to individuals who have major depression or persistent depressive disorder, but continue to function well, or even thrive, in important areas, such as at work and in family life.

A loved one who is living with high functioning depression may not appear outwardly impaired by mental illness, but internally, they are experiencing depression symptoms. Some signs of this internal struggle include:

• Changes in weight or eating habits
• Sleeping more or less than usual
• Appearing tired
• Having difficulty concentrating
• Low self-esteem
• Experiencing difficulty with decision making
• Feelings of worthlessness
• Ongoing irritability or sadness

Truly, someone with high functioning depression can show all of the same signs that someone with a more severe case of depression demonstrates, but they continue to go to work every day, care for their families, and even achieve noteworthy accomplishments, like job promotions, completion of graduate school, or receiving rewards or other public recognition. Behind their successes, you may notice subtle signs of depression, such as the occasional comment about not feeling good enough, or complaints of being tired or unfocused.

If a loved one shows signs of depression, reaching out to offer support can make a world of difference. In some cases, it may even save their life. If you or someone you know struggles with depression, help is available, and it may be necessary, even if depression is high functioning. One form of treatment that can be especially effective for people who live with chronic depression that doesn’t seem to respond to treatment is transcranial magnetic stimulation (TMS). This non-invasive treatment modality stimulates areas of the brain that are responsible for mood. Pulse TMS provides this service to patients in the Los Angeles area. Reach out today to learn more or to schedule an appointment.