High-functioning Depression: Definition And Symptoms

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What is high-functioning depression?

Medically reviewed by Timothy J. Legg, PhD, PsyD — Written by Steph Coelho, CPT on June 9, 2020

Definition
Symptoms
Treatment
Diagnosis
Triggers
Risk factors
When to seek help
Summary

Some people use the term high-functioning depression, but this is neither a diagnosis nor a clinical disorder. Many mental health professionals also disagree with the use of the term.

Some experts believe that the term comes from a lack of clarity surrounding persistent depressive disorder (PDD), or dysthymia, which is an ongoing form of depression.

PDD differs from major depressive disorder (MDD), or major depression, as the symptoms tend to be less severe but have a longer duration.

According to the World Health Organization (WHO), more than 264 million people of all ages experience depression worldwide.

In this article, we will examine the causes, symptoms, and treatment options for what people may consider to be high-functioning depression.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
Not in the United States? Find a helpline in your country with Befrienders Worldwide.
Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you’re not in the same household, stay on the phone with them until help arrives.

What is high-functioning depression?

a man with high functioning depression sat at a desk and looking pensive — Many mental health professionals may choose not to use the term ‘high-functioning depression.’

Many mental health professionals agree that high-functioning depression does not exist and that the term itself can be very misleading. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not recognize it as a clinical disorder.

The term may be misleading as it depends on how a person defines it and their attitude toward treatment. Many people may consider high-functioning depression to be episodes of depression without certain diagnostic signs and symptoms.

As this form of depression may be less debilitating than other forms and allow a person to live a relatively “normal” life, maintaining relationships and coping at work, they may consider it to be a high-functioning form of depression.

Many people may confuse the term with PDD, which involves lengthy instances of depression with periods of normal mood in between. However, PDD is a clinical diagnosis, and its symptoms may adversely affect a person’s well-being, social life, job, or other important areas of their life.

Signs and symptoms

As experts do not recognize high-functioning depression as a disorder, there are no objective clinical symptoms.

However, many people confuse high-functioning depression with PDD. PDD involves low grade depression with symptoms that persist for at least 2 years.

With PDD, a person’s depressed mood lasts for most of each day, and depression occurs more often than not.

In addition to low mood, people with PDD may also have at least two of the following symptoms:

changes in appetite
oversleeping or insomnia
extreme fatigue
low self-esteem
difficulty concentrating and making decisions
feelings of hopelessness, worthlessness, or guilt

People who have PDD may experience instances of normal mood that last less than 2 months. They are also more likely to develop major depressive disorder than other people.

Treatment

As high-functioning depression is not a clinical diagnosis, there are no specific treatment options available.

However, for PDD, treatment may be two-fold and include both psychotherapy (also known as talk therapy) and medication. A doctor may prescribe various drugs, including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and serotonin-norepinephrine reuptake inhibitors (SNRIs).

It may take some time to find the right combination of therapy and medication to treat this type of depression.

Not everyone responds to drugs in the same way. A 2011 study on dysthymia, for instance, suggests that SSRIs may be ineffective in treating apathy in older people with depression or even make it worse.

People should speak openly with their healthcare provider and let them know about any side effects or reactions that they have in response to the medication. Finding the right medication might require some trial and error.

Diagnosis

A doctor cannot diagnose a person as having high-functioning depression. However, if a person is experiencing depressive symptoms, they should speak to a doctor immediately.

Conditions that people often confuse with high-functioning depression, such as PDD, may be challenging to diagnose. People are likely to have low grade symptoms and may not be aware that they have depression.

A doctor will likely use a standard clinical interview for diagnosis. For a person to have PDD, they must have experienced chronic depression for at least 2 years and possess some additional symptoms.

Triggers

Depression does not always require a trigger. However, certain situations and factors may be more like to trigger a negative mindset.

Examples include:

financial problems
extremely high levels of stress
the death of a loved one
loneliness
major life changes

Risk factors

Potential risk factors for dysthymia may include:

genetics
epigenetics
prior mental illness
neuroticism
high anxiety levels
low sense of self-worth
psychological health
trauma
life stressors
social factors

How and when to seek help

If a person experiences depressive episodes or thinks that they may have depression, they should see a doctor.

A doctor will ask the person about their symptoms and history. They may also carry out assessments to rule out other potential causes of the symptoms.

A doctor will provide a referral to a mental health professional if necessary.

Therapy and other treatments for high-functioning depression are not one-size-fits-all. For example, a person with PDD may need to switch therapists to find the right fit.

Other resources for those dealing with mental illness include:

Substance Abuse and Mental Health Services Administration (SAMHSA)
Anxiety and Depression Association of America
Depression and Bipolar Support Alliance

Those who need immediate help and are in crisis can contact the following support hotlines:

National Suicide Prevention Lifeline: 1-800-273-8255 (TALK)
Trevor Project Lifeline: 1-866-488-7386
Crisis Text Line: Text HOME to 741741 to speak with a crisis counselor

Click here to find more links and resources for suicide prevention.

Summary

High-functioning depression is not a formal diagnosis, and many people may confuse it with PDD. PDD is poorly understood, but many consider it to be chronic mild depression.

The term high-functioning depression can be very misleading, and many mental health professionals choose not to use it.

If a person experiences symptoms of depression, they should seek medical assistance. A mental health professional can recommend treatment options to help a person manage depression.

Depression
Mental Health

How we reviewed this article:

SourcesMedical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Depression [Fact sheet]. (2020).https://www.who.int/news-room/fact-sheets/detail/depression
Dysthymia. (2014). https://www.health.harvard.edu/newsletter_article/dysthymia
Ishizaki, J., & Mimura, M. (2011). Dysthymia and apathy: Diagnosis and treatment.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130974/
Major depression. (2019).https://www.nimh.nih.gov/health/statistics/major-depression.shtml
Patel, R. K., & Rose, G. M. (2019). Persistent depressive disorder (dysthymia).https://www.ncbi.nlm.nih.gov/books/NBK541052/
Persistent depressive disorder. (2019).https://americanaddictioncenters.org/treating-depression-substance-abuse/persistent
Reynolds, C, R., & Kamphaus, R, W. (2013). Persistent depressive disorder (dysthymia). https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_PersistentDepressiveDisorder.pdf
Sansone, R. A., & Sansone, L. A. (2009). Dysthymic disorder: Forlorn and overlooked?https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719439/
Stein, S. (2019). Persistent depressive disorder.https://americanaddictioncenters.org/treating-depression-substance-abuse/persistent

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Medically reviewed by Timothy J. Legg, PhD, PsyD — Written by Steph Coelho, CPT on June 9, 2020

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Help is out there

What is high-functioning depression?

Signs and symptoms

Treatment

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Risk factors

How and when to seek help

Summary

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