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What does high-functioning depression look like?

By Sakuni Weerasinghe

 

First things first, high-functioning depression is not a clinical diagnosis you can find in the Diagnostic and Statistical Manual for Mental Disorders (DSM), a guide used by clinicians to diagnose mental health conditions. However, it is a term used by people, in a colloquial sense, to refer to the symptoms of depression that aren’t fairly obvious. The fact is that depression has many faces. For some, it might prevent them from socialising and studying for their exams. You might notice that your once very extroverted friend is withdrawing from outings more and more and does not show up for examinations. But have you ever come across someone who appears to be achieving one thing after the other, but when you have a conversation with them, they tell you they feel hopeless, tired, sad, or anxious? You may even be taken aback initially. “What are they talking about? They’re successful in every measure. What do they have to be sad about?”, you may wonder. This is exactly what is referred to by high-functioning depression.

Many of us expect the signs of mental health struggles to show, much like a wound on the skin. The truth is that most of these struggles are invisible. On the outside, a person with high-functioning depression would engage in their daily lives as usual – going to school or work, hanging out with friends, dressing well, and wearing a smile on their face. This paints a different picture of someone who is struggling with depression, doesn’t it? Usually, the term itself brings up an image of someone who is crying, remains in their room all day, and doesn’t come out to socialise much. This is precisely why practitioners highlight that depression looks different from person to person. 

While ‘high-functioning depression’ is not a clinical term, the diagnosis that is closely associated with it that captures most of its characteristics is persistent depressive disorder, more commonly known as dysthymia. This is a long-lasting form of depression that can give rise to occasions of major depression from time to time. Since the term ‘high-functioning’ is associated with its symptoms, many assume that this form of depression isn’t bad or isn’t severe. However, we cannot ignore the distress it brings to those experiencing it. In fact, calling it ‘high-functioning’ may actually be minimising their experience.

Symptoms of persistent depressive disorder include:

 

  • An increase or decrease in appetite
  • Insomnia or hypersomnia
  • Feeling empty, sad, and hopeless
  • Feelings of anger, anxiousness, or irritability
  • Difficulty making decisions
  • Difficulties in concentrating
  • Fatigue
  • Self-criticism
  • Low self-esteem

 

The person may somehow be able to get themselves out of bed and proceed to have a productive day. Can you see how this person would not appear to be struggling, even in the eyes of those who live under the same roof? But internally, they may require a lot of energy to get out of bed and proceed with their day. 

The problem with this invisibility is that when it comes to intervention, these individuals are often overlooked. “If they are high functioning, do they require treatment?”, is a question that would imaginably have many perplexed. High-functioning doesn’t necessarily mean fully functioning. Although they are high-functioning, we cannot minimise the distress they bear or the impaired quality of life they experience. As such, interventions are necessary for those experiencing the symptoms of high-functioning depression.  

Besides speaking to a mental health professional and seeking psychotherapy, here are a few ways to cope with high-functioning depression:

 

Engage in appropriate self-care: Ensure you have a good sleep/wake routine and maintain a healthy diet. Additionally, it is important to get exercise, which may look like going for a morning walk or going to the gym to get your 150 minutes in per week. 

Reach out for help: If you notice any of these signs in you, please reach out to your loved ones, family, or trusted friends for help. Letting them know what you’re going through can help you to connect with appropriate resources to enhance your well-being and can help you feel supported. 

Set up daily goals: Taking small steps each day can be more helpful than taking leaps. To build self-confidence, you can set up small goals for yourself as per the SMART goal plan.

Practise emotional regulation skills: This can look like mindfulness exercises, breathing or relaxation exercises, and labelling and accepting emotions.

 

 

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