Could you have high-functioning depression and not know it?

Many people are now more aware of what depression is than ever before, referring to it as “feeling sad all the time” or “not being able to get out of bed.” However, many people could be affected by high-functioning depression and be completely unaware. What many people may refer to as “high-functioning” depression is what mental health professionals may diagnose as Mild Depression.

As clinicians, when we assess for depression, one of the essential factors that we consider is the severity, which is based on

1) the number of symptoms the person is experiencing,

2) the intensity of the symptoms, and

3) the person’s level of functioning in social or occupational settings.

Depression severity can be specified by three levels which include mild, moderate, or severe.

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What are the symptoms of depression?

A person diagnosed with mild depression could be experiencing few depression-related symptoms and these symptoms could present as distressing but overall are manageable to where the person can function with little to no impairment. People who experience this type of “high-functioning” depression are not in bed all day; they can go to work or school full time and they are still actively socializing with others which could make it more difficult to identify and diagnose.

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How do you diagnose if a person is depressed?

Generally, when it comes to diagnosing high-functioning depression, aka mild depression, we are looking for someone that is experiencing five or more symptoms within a two-week period and at least one of the five symptoms must be either

1) depressed mood or

2) loss of interest or pleasure.

The most common symptoms of depression can include

• crying spells
• difficulty sleeping
• changes in appetite
• lack of motivation
• difficulty concentrating
• hopelessness
• isolation
• suicidal thoughts

Depression can also manifest as irritability, indecisiveness, inability to focus, indifference, and lack of energy. Although Mild or “high-functioning” depression symptoms can cause distress, they are typically manageable which is why many people affected by it are unaware.
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Example of a depressed person

For example, let’s say we have a person, Frank, that works a full-time 40-hour work week at a local retail store. Frank says that he still plays video games on the weekend with his old high school buddies and has date night with his significant other every Friday night. He tells you that he notices that it takes him longer to complete his tasks at work. He also mentions that he hasn’t been getting a full eight hours of sleep and that his sister complains that he’s ‘grumpy’ every time they chat over the phone. Frank relays that he wishes that he could get back into playing sports but just doesn’t feel as interested in it anymore. Mental health professionals can help clients like Frank to identify his depressive symptoms which include loss of interest or pleasure, indecisiveness, difficulty sleeping, irritability, and inability to focus. Although Frank is experiencing these symptoms, the severity is mild, which is why he is “high functioning” and can still go to work and interact with friends and family.

Although Mild depression symptoms can cause distress, they are typically manageable which is why many people affected by it are unaware that they could be experiencing high-functioning depression.

Yes, many of these individuals can manage mild depression on their own but not effectively. Some strategies or remedies that might help with high-functioning depression could include participating in something that you enjoy (when’s the last time that you laughed?), exercise (several research studies have proven that exercise is a natural antidepressant), and maintaining a healthy work/life balance.

Still, the best outcomes of treating mild depression are achieved when a person can work with support from a mental health professional.

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Here are three major signs that you might want to work with a therapist:

• depressed mood or loss of interest for a two-week period,
• irritability in more than one area of your life, and
• a noticeable increase in feeling numb or indifferent.

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What are the therapeutic approaches in dealing with a depressed person?

Mental Health professionals use various approaches when working with clients that are experiencing high-functioning depression. Here are just a few types of therapy approaches that can help with high-functioning depression:

• Cognitive-behavioral therapy (CBT), is an evidenced-based practice that focuses on identifying and challenging our negative thoughts to influence our emotions which can lead to a change in our behaviors.
• Interpersonal psychotherapy centers on the idea that psychological symptoms can be understood as a direct response to problematic relationships with other people and that focusing on improving interpersonal functioning can relieve symptoms.
• Mindfulness-based cognitive therapy is a theoretical approach that combines cognitive therapy with mindfulness-based strategies (meditation) to replace negative thoughts with positive thoughts that are based on reality.
• Supportive therapy focuses on creating a strong supportive relationship to help people explore and understand their current life experiences.

Contrarily, there may be instances when psychotherapy alone may not be enough to alleviate symptoms of depression. In these particular cases, mental health professionals may recommend a combination of psychotherapy and medication as another approach to treating depression. Consulting with a medical professional (i.e., psychiatrist, nurse practitioner, primary care physician, etc.) is the best way to receive an informed recommendation of the types of medications that are typically prescribed for high-functioning depression.

The bottom line is that depression is complicated. People often experience depressive-related symptoms in other life scenarios such as a recent life transition (e.g., moving to a new state away from family) or a recent loss, etc. The best way to know is to consult with a mental health professional.

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