High-functioning depression: Symptoms, causes, and treatments

Reviewed by Brooks Baer, LCPC, CMHP

Written by

therapist.com team

Last updated: 09/10/2024

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What is high-functioning depression?

High-functioning depression is a term used to describe people who experience symptoms of depression while largely maintaining their daily responsibilities and outward appearance.

Similar to “smiling” depression, people with high-functioning depression may appear happy on the outside while struggling internally with depression.¹ They’re often able to maintain successful careers, relationships, and social lives, making it difficult for others to recognize their condition.

Is high-functioning depression a mental illness?

There’s currently no official diagnosis for high-functioning depression in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

It’s possible for a person to meet the diagnostic criteria for major depressive disorder (MDD) or persistent depressive disorder (PDD) while hiding many of the signs and symptoms. When this is the case, they may be informally described as having high-functioning depression.

PDD is a recognized mental health condition characterized by long-term, chronic bouts of depression. With PDD, symptoms persist for a longer duration than in MDD (typically two years or more).² People with PDD may experience periods of normal mood, but these are usually brief and don’t last more than two months.

High-functioning depression and PDD share similarities, but they’re not the same. The term “high-functioning depression” describes someone who mostly keeps up appearances despite depressive symptoms, rather than being a formal diagnosis like PDD.

If you think you or a loved one may be experiencing any form of depression, it’s important to seek professional help. A mental health expert can provide a proper diagnosis and recommend appropriate treatment options.

What does high-functioning depression look like?

Because it’s not an official diagnosis, high-functioning depression doesn’t have distinct symptoms. Warning signs of high-functioning depression, and of depressive disorders generally, can include:

• Persistent feelings of sadness or emptiness
• Difficulty concentrating or making decisions
• Low self-esteem and self-criticism
• Fatigue or low energy
• Changes in sleep patterns (insomnia or oversleeping)
• Appetite changes (increased or decreased)
• Irritability or restlessness
• Loss of interest in previously enjoyed activities
• Feelings of hopelessness or pessimism
• Physical symptoms like headaches or digestive issues
• Thoughts of death or suicide

Depression can look different for everyone, and you don’t need to hit a certain benchmark before you seek help. If you’re in crisis or having thoughts of self-harm or suicide, help is available. Call or text the 988 Suicide & Crisis Lifeline at 988 for free, confidential support 24 hours a day, 7 days a week.

People with high-functioning depression may try to hide their symptoms from others, often out of fear or shame. A person attempting to hide symptoms of depression may:

• Maintain a busy schedule to avoid confronting emotions
• Overachieve or strive for perfection to mask feelings of inadequacy
• Use humor or sarcasm to deflect from their true feelings
• Isolate themselves from social situations while citing work commitments
• Engage in activities (such as exercise) obsessively
• Use substances as a coping mechanism

Causes of high-functioning depression

Because high-functioning depression isn’t a clinically recognized condition, its exact causes are not well defined. Generally speaking, the factors that contribute to depressive disorders can include:³

• Biological factors, such as imbalances in brain chemicals or hormonal issues.
• Genetic factors, most notably a family history of depression or other mental health disorders.
• Environmental factors, which might include childhood trauma, difficult life events, or stress.
• Psychological factors, such as personality traits and negative thought patterns.

Some research suggests that high-functioning depression specifically may be linked to socioeconomic factors like lower income, less education, and less skilled jobs.⁴ Additionally, cultural factors such as patriarchy and toxic masculinity can contribute to the development of depression.

The impact of high-functioning depression

Even when people with high-functioning depression can maintain their daily responsibilities, it can still have significant negative impacts on their lives.

People with high-functioning depression may think they’re not “ill enough” to seek help, leading to prolonged suffering and potential worsening of symptoms.

The constant effort to keep up appearances and meet expectations can lead to:

• Imposter syndrome, emotional exhaustion, and burnout
• Relationships struggles, loneliness, and isolation
• Difficulty in maintaining work-life balance
• Increased risk of substance abuse
• Physical health problems due to chronic stress
• Impaired decision-making abilities
• Reduced quality of life and overall satisfaction

It’s important to recognize and address symptoms of depression as early as possible. Remember that your depression doesn’t need to reach any kind of benchmark before you seek help. If you’re in crisis or struggling with depressive symptoms, call or text the 988 Suicide & Crisis Lifeline at 988 for free, confidential support 24 hours a day, 7 days a week.

High-functioning depression diagnosis and treatment

As mentioned, high-functioning depression isn’t a diagnosable condition. However, a mental health professional can assess your symptoms and determine if they fit recognized conditions like MDD or PDD. Diagnosis typically involves a comprehensive evaluation, including medical history, physical exam, and psychological assessment.

High-functioning depression treatment options are the same as those for other depressive disorders. Proven options for managing symptoms of depression include:

• Cognitive behavioral therapy (CBT)
• Interpersonal therapy (IPT)
• Eye movement desensitization and reprocessing (EMDR)
• Medication (such as antidepressants)
• Support groups or peer counseling
• Mindfulness practices and meditation
• Lifestyle changes (including regular exercise and improved sleep habits)

Seeking help isn’t a sign of weakness. Even if coping with high-functioning depression seems possible on your own, you don’t need to manage without help. Treatment can help alleviate symptoms, improve quality of life, and prevent the condition from worsening over time.

Visit our directory to find a mental health professional near you who specializes in treating depression and related disorders.