High-Functioning Depression.

High-functioning depression is a popular everyday conversational phrase used to describe a level of depression that doesn’t interfere with maintaining daily life activities. Depressed people described as high-functioning go to work, take care of their families, and participate in social activities; but they also experience distress and unhappiness in their lives. Outwardly, they look productive and OK, but inside they are faced with sadness and worry. Two cornerstones appear to be (1) feeling empty, with the blues; (2) finding little or no enjoyment or fulfillment in activities that used to be pleasurable and satisfying. Other common symptoms include feelings of hopelessness, pessimism, or worthlessness, plus irritability, anxiety, social withdrawal, fatigue, and trouble focusing on tasks.

High-functioning depression is not a formal professional term, and you won’t find it in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). You will, however, find a condition in the DSM that sounds a lot like high-functioning depression: Persistent Depressive Disorder (PDD)—also known as Dysthymia. Symptoms include sadness, emptiness, and feeling down; loss of interest in daily activities; fatigue; low self-esteem and self-criticism; difficulty focusing and making decisions; irritable and impatient; social avoidance; appetite and sleep problems. Sound familiar? PDD sufferers are described as “silent sufferers,” and like depressed folks described as high functioning, PDD victims go to work or school, care for loved ones if necessary, and generally function day-to-day. But they have this gnawing feeling that prevents them from enjoying life like others seem to do.

Both high-functioning depression and PDD have strong cognitive components, typified by a way of perceiving and thinking about life events in a negative way. When you think negative thoughts, especially about yourself, you are going to feel rotten—you are going to avoid challenges and become more likely to add to your depression. Negative thoughts compromise positive actions, and without positive actions in your life you will never feel fully satisfied and productive.

Both PDD and high-functioning depression generate avoidance behaviors. Sufferers develop long-standing actions to avoid facing challenges and stressors. Unfortunately, these are the very stressors they must learn to confront. As a result, they get caught in a vicious cycle of avoidant action patterns that are difficult to exit, and often resistant to anti-depressant medications. The depression is accompanied by actions that rob them of energy, motivation, and positive attitudes needed to break free of the avoidance vicious cycle. As a result, the depression creates problems in many areas, such as social interactions, concentration and focus, alcohol/drug issues, etc.

A term like high-functioning depression is kind of redundant when you think about it. Why do we need it if it’s so similar to PDD? The answer to that question should be obvious: If you’re tormented by symptoms of mild depression, what would you like to say to a friend or relative: “I’m a high-functioning depressed person,” or, “I have Persistent Depressive Disorder?” “High-functioning” vs. “Disorder.” There is a lot of secondary gain to be had from using the former term, especially if someone says, “Well, at least you’re not mentally ill!”

The coping lesson here is clear: If you have the symptoms of high-functioning depression, you need to restructure your thinking and actions concerning your life, and to stop relying on avoidance patterns of action when you are faced with challenges. Describing yourself as high-functioning is only giving you another avoidance card to play: “Sure, I’m down and blue, but at least I’m not bipolar or have major depression. I have my high-functioning qualities going for me.” That sort of avoidance thinking puts you on a spiral road that takes you in only one direction: farther down. In the context of our AAHE coping model—Acceptance, Accountability, Humility, Empathy—your first task is to accept the reality that carrying baggage loaded with low self-esteem, no enjoyment in previously-enjoyable activities, and empty and worthless feelings, is not at all high-functioning.