You have trouble getting up in the morning. Sometimes it feels like you’re just going through the motions. But you can almost always push through and finish your work, figure out dinner, and play with your kids. Because you can still get these basics done, there’s no way you could be depressed…right? The case for high-functioning depression says this isn’t necessarily so. Just because depression doesn’t look or feel the way someone might expect it to, doesn’t mean it isn’t real, or not worth addressing.
As the leading cause of disability worldwide, affecting more than 322 million people — about the population of the U.S. — depression surfaces throughout many countries, cultures, and life circumstances. Because of this, there’s no way it could look the same for everyone, says Alejandro Martinez, MSW, LSW, a therapist based in Ohio.
“Unfortunately, media and society often says, ‘If you have depression, you have no energy, you’re sad, you’re stuck in your room all day,’” Martinez says. “But mental health is just much more complex than that.”
The number of people, in millions, who have depression worldwide.
“High-functioning depression” isn’t an official diagnosis but more of a colloquial term. People with high-functioning depression meet some of the criteria for a depressive disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) — the book clinicians use to officially diagnose mental health conditions — but they can appear completely healthy and meet daily responsibilities.
At the same time, it’s impossible to cleanly divide people with depressive symptoms into “high-functioning” and “low-functioning” groups. So, Martinez adds, it may be more helpful to relate “high-functioning depression” to persistent depressive disorder (PDD), a type of depressive disorder characterized by “mild or moderate depression that doesn’t go away.”
But no matter what’s it called, people who are experiencing depressive symptoms can often benefit from professional help. And just because you seem to be doing well in some areas of life doesn’t mean you don’t have depression.
Here are 7 signs of high-functioning depression to help you identify whether you could have the condition, and tips on what to do about it if you do.
What Felt Good Before Doesn’t Now
Loss of pleasure in things that you used to enjoy — such as baking, playing the guitar, or hanging out with friends — is a major sign you could have high-functioning depression, Martinez says. Many people with the condition have a difficult time tuning into other symptoms, such as depressed mood. It can be especially hard to gauge when depressive symptoms start if they’re subtle, as they often are with high-functioning depression. So, evaluating what you have historically liked doing and whether you still like to do it may help you recognize that something is wrong.
You’re Tired. So, So Tired.
Fatigue can be part of any type of depressive episode or disorder. And we’re not talking about feeling tired because you slept less; rather, it’s a pervasive loss of energy that comes up most days and doesn’t go away for at least a few weeks. If you’re getting enough sleep but still have low energy, depression could be to blame.
You’re “Going Through the Motions”
If you’re just scraping by, without moments of happiness or thriving that you may have had before, you could have high-functioning depression. “For some folks, even if they have depressive symptoms, they can still cook for themselves, take care of the laundry, fold clothes, things like that,” Martinez says. “However, maybe that’s all they have the energy to do.”
Your Weight Is Changing
It can be difficult to notice psychological symptoms, but physical changes can be a more obvious sign that something’s wrong, Martinez says.
If you’re not trying to gain or lose weight, but your weight is fluctuating significantly, the change could be a symptom of depression because biochemical changes in the body that occur with depression can result in weight gain or loss.
Weight loss can also reflect other symptoms, such as a decrease in appetite connected to loss of pleasure in food. For example, do your all-time favorite dishes not excite you anymore? Or is it just too much to even think about meal prep and eating? “A person’s appetite can grow or recede depending on their mood…and maybe they just don’t have the energy to think about how much they’re eating,” Martinez says.
Everything Is Fine, But You’re Still Distressed
Being “high-functioning” and depressed may look like being able to meet certain responsibilities, but you’re in more distress than usual while doing it. Maybe it’s the sheer act of making breakfast, chewing, and having to commute or Zoom into work. Maybe it’s a monthly hangout that you have with friends. Whatever it is, what used to feel easy or routine now brings anguish or seems overwhelming. In fact, if other symptoms aren’t causing “impairment” or undesired changes in social, occupational, or other aspects of life, then distress is often present. That “distress” counts as any sort of “mental pain” associated with symptoms.
You Don’t Bounce Back
Feeling depressed, down, or sad sometimes is a part of life. Unpleasant emotions can even be helpful; they motivate us to make changes in our lives, help us communicate more effectively, and even help us be less gullible and more analytical. But part of healthy regulation is the transitory nature of emotions — feeling sad and then also feeling not sad. If it’s hard to feel anything other than depressed mood, lack of happiness, low energy, or worthlessness, then it may be time to look for help.
People Notice You’re Acting Differently
If you’re unsure about what you might be going through, Martinez says, reach out to people in your life that you trust. Ask if they have noticed any changes in your mood, patterns, or behavior. Oftentimes, folks with high-functioning depression change in noticeable ways to those around them. “You might feel just low energy, but people tend to comment on it, notice it,” he says. They can help you notice things that you haven’t yet.
On Getting Help
Whether or not you’re ever given an official depression diagnosis, “at the end of the day, it’s just a diagnosis that is often used more so for billing purposes,” Martinez says. He has clients for whom knowing their diagnosis is helpful, and others for whom it isn’t so important. “A title doesn’t make one’s own experience with depression or depressive symptoms a monolith,” he adds. “Everyone experiences it differently.”
With all the stressors in the world — from anti-LGBTQ bills to school shootings to white supremacy — it’s important to distinguish depressive symptoms from natural and often healthy responses to external dysfunction. But Martinez says it’s always worth considering, regardless of circumstances or momentary stressors, “Is there something more underneath?”