High Functioning Depression: What It Is and How to Manage

High-functioning depression is a popular way to describe how some people who experience depression do not display overt signs of struggle in their daily lives. 

High-functioning depression is not a clinical diagnosis, but rather a way of acknowledging that appearances can be deceiving when it comes to mental health struggles. Many people seem to have it ‘all together’ on the outside, while still struggling with negative thoughts and feelings on the inside.

While ‘high functioning depression’ might sound aspirational or like a mild experience, it’s not; its very characteristics often keep people from getting the help they may need.

What is high-functioning depression

High-functioning depression differs from more stereotypical experiences of depression in four ways.

A ‘high functioning’ person’s external life does not reflect their inner life.

• • • People with high-functioning depression often appear capable and even successful. They maintain their responsibilities at home and work, as well as social relationships while concealing their emotional turmoil. For some, this appearance of being strong, in control, and ‘on top of things’ could be a habit developed in childhood; possibly in response to neglect or the need to take on themselves responsibilities usually performed by parents, such people learned they had no space to care for their own emotions.
    • Often, people struggling with typical depression find it challenging to maintain daily routines. They may struggle with work, relationships, and self-care due to the overwhelming nature of their symptoms.

A ‘high functioning’ person often conceals or denies their internal struggles.

• • • People with high-functioning depression are adept at concealing their distress. They may deny or downplay their symptoms, attributing them to stress or temporary setbacks. They may joke about their emotional turmoil. This behaviour often means the person does not get support from loved ones and delays their outreach for care.
    • By contrast, people who struggle with typical manifestations of depression are more likely to acknowledge their suffering and seek help or support from loved ones.

A ‘high functioning’ person often develops coping mechanisms that society deems ‘normal’ or ‘good.’

• • • People with high-functioning depression often cope in ways that society rewards. These can include overachievement, perfectionism, or a relentless focus on productivity (i.e. being a workaholic).
    • In more typical cases of depression, the same behaviours are too overwhelming; people typically develop other ways of coping while simultaneously struggling to keep functioning as expected in daily life.

A ‘high functioning’ person expresses their emotions in a subdued or subtle way. 

• • People with high-functioning depression may feel persistent sadness, anxiety, numbness, or a lack of motivation – emotions that often originate from their own negative beliefs or expectations of themselves. They do not express these emotions in obvious ways. Again, this habit may be the result of childhood experiences that caused them to subdue their emotional expression in order to survive. 
  • People who experience more typical depression tend to have more obvious and apparent signs of sadness, such as tearfulness, or demotivation, such as difficulty getting out of bed.

People with high-functioning depression do show signs of struggle, even if they are subtle and often attributed to other, more common, experiences. They may become more irritable. Their sleep patterns might change. Their self-care, often in terms of rest, leisure, exercise, and nutrition, may decline.

All of signs are often dismissed as the natural result of stress, overwork, and hyper-productivity, but ultimately originate from their depressed state.

Effects of high-functioning depression

The long-term effects of concealing depression can be devastating. The constant effort to function, often at a high level, and maintain an external appearance of positive emotions, can lead to burnout, exhaustion, and a sense of isolation, all of which can worsen depressive struggles.

People with high-functioning depression often find their relationships strained. They may find it difficult to open up about their inner world. Conversely, even when they do, they may not be believed due to how they appear externally. If they are believed, they may still lack support that would help them, as the people they confide in may forget or not know how to help someone that appears so capable.

What to do for high-functioning depression

Many people with high-functioning depression put off seeking care until they ‘get worse’ and their functioning declines. But therapy has no threshold for distress – it can benefit anyone – those with barely any turmoil to those with lots, those with obvious struggles to those who keep their pain hidden.

Accept your emotions and struggle. Many people with high-functioning depression minimise their distress, comparing their struggles to others who ‘have it worse,’ or reasoning away their emotions and pain. Accepting that our distress is valid and worthy of support is the first step in getting better.

Think about what ‘thriving’ would be like. People with high-functioning depression live in a constant state of survival. But take a moment to think about what it would mean to thrive – How would that feel? What would life look like? Where would you be, what would you be doing, what would your routine be like? What would you explore?

Envisioning a better, more hopeful alternative can help us take steps to enact it.

Seek professional care. Many high-functioning people who struggle with depression don’t turn to friends and family for support. Some may have difficulty trusting others to support them, some fear abandonment if they express vulnerability, and some may feel shame about depending on others (which they see as being a burden).

Seeking therapy, whether digital or conventional, may feel more comfortable and can help ‘high-functioning’ people actually function better for real, not just for appearances. 

High-functioning depression is a complicated and often hidden battle that can affect people from all walks of life. It serves as a stark reminder that mental health struggles are no less present for being invisible. 

By fostering greater awareness and empathy, we can create an environment where individuals feel safe to break through the barrier of denial and seek the help they need without fear of judgement.

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Read related articles:

• What is a Workaholic? Signs and How to Manage (Healthline)
• 11 Signs You Might Be an Overachiever (VeryWell Mind)

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Mrigaya Sinha (M.A., M.Phil., Ph.D., Post-Doc) is Mitsu’s Head of Clinical Program and a clinical psychologist with  8+ years of experience working with adults facing anxiety, depression, grief, trauma, chronic pain, interpersonal issues, and adjustment problems. She holds a Ph.D. from India’s National Institute of Mental Health and Neuro Science (NIMHANS); her post-doctoral work was complete at Staunton Clinic, USA.