Estimated reading time: 9 minutes

By: Dr. Dennis London

How often do we pause to think about what might be going on behind that surface-level exterior? How does somebody really feel on the inside? Do we just see the nice dress boot, perfectly-cuffed pant, and assume everything on the inside must match? Do we ever pause to think if their sock slipped, is bunched up, and causing discomfort?  

We often fall into the trap of making assumptions or guesses about how a person might feel based on what we perceive on the outside. 

Learn more about depression therapy in Fort Lauderdale here.

What is high functioning depression?

High functioning depression is a mood state characterized by long-term, chronic symptoms similar to, but not crossing the diagnostic threshold of, clinical depression. In high functioning depression, a person may experience symptoms such as low mood, irritability, feelings of worthlessness, lethargy, and loss of interest that do not significantly interfere with their ability to function in life. Unlike clinical depression, a person is largely able to participate in their daily tasks without significant impairment. Therefore, it’s likely that someone with high functioning depression may not come across as depressed at first glance.

Who can have high functioning depression? 

Every day, I see clients who on the outside “have it all.” They’re successful in their careers, and they balance the multiple and competing demands of their busy lives – family, work, school, leisure, etc. 

External indicators–like how one presents themselves on the outside, their job, or the house lived in–are not always reflective of their internal state. Sometimes, a person is barely getting by or holding it together. 

“Adulting” is tough; raising kids is stressful; working a full-time job, managing self-care, a social life, taking care of a household, and getting enough sleep seems impossible some days! Especially in the past several years with the stress of the Covid-19 pandemic, state of U.S. politics and other world affairs, the environmental crisis, rise of political violence and mass shootings, the world can feel like a dark place many days. 

From the data collected, we know roughly 21% of U.S. adults meet criteria for a diagnosable mental health disorder at any given time. That’s about 1 in 5. About 8.4% of all US adults in the past year experienced at least one depressive episode.

The above figures are based on adults who meet full criteria for a clinical disorder. Less is known though about the prevalence of adults who experience at least 1 symptom of depression at any given time. Although these adults may not meet full criteria for a clinical depression diagnosis, they still likely experience symptoms that can affect their quality of life.

High functioning depression vs clinical depression and sadness

High functioning depression is not an official diagnosis or clinical term. But why is it important to identify? 

Many people with high functioning depression appear to be coping well, “fine enough,” or just getting by in their daily lives, but on the inside they are struggling. The “getting by” or relative functioning is the defining characteristic of high functioning depression. 

Everyone experiences sadness. Sadness is a normal, typical emotion that is part of the human experience and typically associated with feelings of loss or grief. If we did not experience sadness, then we might not know joy. But sadness is not depression. It’s a natural, common, and temporary emotion of the human experience. 

However, when sadness is prolonged or severe, it can interfere with a person’s ability to function and enjoy life. In these cases, it may be a symptom of a more serious mental health condition, such as depression. It’s important to seek the help of a mental health professional if you are experiencing prolonged or severe sadness.

Signs of high functioning depression:

• Difficulty getting out of bed in the mornings or hitting snooze multiple times 
• Feeling tired and sluggish throughout the day but difficulty falling asleep at night
• Relying on coffee to get through the day and/or alcohol to wind down at night 
• Little interest in your usual activities or hobbies 
• More irritable than usual
• Not feeling excited about the things you used to 
• Thinking the world/life is bleak and mostly negative
• Tendency to view situations through a “glass half empty” perspective
• Low self-esteem or many critical comments about yourself 
• Feeling not like yourself or empty inside 

High functioning depression will likely look differently depending on the person, but it’s been described like:

• Putting on a “happy” or “joyful” face that isn’t representative of inner emotions
• Faking it till you make it
• Just getting through the day 

As a result, people with high functioning depression may be able to “mask” their symptoms and appear to be free of distress to others. However, they may still struggle with chronic feelings of sadness, hopelessness, and worthlessness, and may have difficulty finding enjoyment in things they once loved. It’s important to remember that just because someone appears to be functioning well, it doesn’t mean they aren’t struggling with a mental health issue.

Depression warning signs that warrant follow-up with a licensed mental health professional: 

• Experiencing sadness most of the day 
• Experiencing sadness more days than not out of the week
• Difficulty completing certain daily tasks or responsibilities 
• Isolating from others or feeling like you “don’t belong” or “don’t fit in”
• Difficulty sleeping most nights or experiencing fatigue throughout the day
• Procrastination that begins to have negative consequences 
• Feelings of hopelessness or that life will be this way forever and never improve
• Thoughts of death or dying, like life would “just be easier” if you weren’t alive

Tips to cope with high functioning depression

1. Create and stick to a daily schedule with activities you enjoy. 
   1. By creating a routine, you create a sense of regularity and continuity in your life. Be sure to include pleasant and enjoyable activities or hobbies. This will spark moments of joy and fun in your daily life and also give you a sense of purpose. What’s better, set one small goal for yourself each day or week to create a sense of accomplishment and pride. 
   2. Additionally, creating a daily schedule of activities increases opportunity for positive reinforcement (or good things to happen) from your environment. 
   3. Set a consistent sleep schedule where you wake up and go to bed at the same time every day. When your alarm clock goes off in the morning, count backwards from 5 and then get out of bed, rather than hitting snooze. This is a hack to activate a different part of your brain to help prevent hitting that snooze button.
   4. Additionally, avoid your phone first thing when you wake up. Instead, expose yourself to some sunlight first thing in the morning to help regulate your circadian rhythm and feel more alert/awake first thing. On the flip side, avoid caffeine in the afternoon.
2. Find ways to move your body that you enjoy.
   1. Daily movement will help regulate your nervous system, increase levels of serotonin which can have a positive effect on mood, and positively benefit your overall physical health. 
   2. Start with something small–like stretching every morning or going for a daily walk–and work your way up. On days you don’t feel like completing your normal routine, show up with the mindset to at least complete 10 minutes. If at the end of those 10 minutes you feel like stopping, that’s okay. However, more often than not, you will want to keep going. 
3. Eat a balanced healthy diet with lean protein, complex carbohydrates, and healthy fats.
   1. There are several foods that can have a positive effect on mood. For example, foods that are high in omega-3 fatty acids, such as salmon and other fatty fish, can help improve mood because they are essential for brain health. 
   2. Other foods that are rich in antioxidants, such as berries and green, leafy vegetables, can also help improve mood because they can reduce inflammation in the body. 
   3. Additionally, foods that are high in complex carbohydrates, such as whole grains, can help improve mood by increasing the production of serotonin, a neurotransmitter that is known to regulate mood.
   4. Always check with your healthcare provider, or consult a registered dietician, before you consider adding vitamins or supplements into your diet.
4. Connect with others regularly.
   1. Reach out to family members, friends, coworkers, even neighbors, on a regular basis even if it’s just a simple hello, smile, or quick text to check in. 
   2. Offer to help a stranger at the store, or buy someone’s coffee order. Small acts of kindness can have a positive effect on our own mood. 
5. Practice gratitude. 
   1. When we experience a specific emotional state like sadness, we tend to filter all information through that same emotional lens as if we were wearing a pair of blue glasses. Practice countering this by acknowledging 3 things you are grateful for each day. 
6. Appreciate the small joys and moments in your life. 
   1. What is it that you might experience daily that brings you joy and happiness? Maybe it’s listening to your favorite song in the car with the windows down, playing ball with your dog, going for a bike ride, or trying a new recipe. 
   2. Whatever it is, create a list of those things, and do one of them when you’re feeling down. 

Treatment for high functioning depression 

There are different treatment options available, both psychotherapy and medication. Typically, with less severe cases of depression, psychotherapy is considered the first treatment option. For more severe cases, a combination of medication and therapy is considered the most efficacious treatment.

Evidence-based psychotherapies for depression offered at TPG: 

• Cognitive behavioral therapy (CBT) 
• Acceptance and commitment therapy (ACT)
• Solution-focused therapy

If you have felt sad many days in the past few weeks, or have felt sad most of your life as you can remember, take this quiz: https://thepsychologygroup.com/quiz-do-i-have-depression/. 

Even if you can get through your day and get done what you need to support yourself and/or your family, you still could have high functioning depression. If you feel like you just “get through the day,” walk around with a mask on, have a mindset of “fake it till you make it” most days–call the office and ask for a free phone consultation with me. I’m happy to listen to your concerns and help you figure out if therapy might be helpful. 

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