It’s a mental illness that often flies under the radar because high-functioning depression can involve someone suffering invisibly.
For much of my life I held a fixed, narrow idea of what a person with depression looked like, despite having several loved ones living with mental illness.
In my naive mind, a depressed person rarely got out of bed, was always in tears, and was unable to go to work, and everybody else was just fine. That is, until I developed depression myself.
My declining mental health was a subtle downward spiral that I completely ignored for years, partly because of people close to me who appeared to be suffering so much more than I was.
Adding my own concerns and struggles to my overburdened parents or struggling friends felt like a sign of weakness and selfishness.
By forcing myself to push through my persistent low mood, I discovered that external sources of validation like good grades at school temporarily lifted the dark cloud surrounding me for just long enough to get me through until my next breakdown.
Predictably however, this strategy became less effective over time, until even the most exciting accomplishments left me feeling flat and empty.
Seeking the help of a therapist was the best thing I ever did, yet I was initially skeptical at my diagnoses of depression, generalised anxiety disorder, and post-traumatic stress disorder (PTSD). This sentiment was echoed by friends and family, who dismissed the notion as impossible.
Everyone saw me as a successful young professional in a stable relationship, which meant I couldn’t possibly have a mental illness, let alone several. Right?
What is high-functioning depression?
Despite its increasing popularity, the term high-functioning depression is not a formal diagnosis seen in clinical settings.
The term was coined to describe people who either hide their suffering or are somehow able to push through their depression to continue to fulfil their responsibilities.
High-functioning depression, also known as dysthymia, is typically understood as a persistent, low- to medium-grade depressive episode, often accompanied by fatigue and a loss of interest in once-enjoyed pastimes.
Many people experiencing dysthymia continue to put on a brave face and continue to work, socialise, or take care of their family, all while hiding their pain, feelings of disconnection, and loss of enthusiasm and pleasure in their life.
Dysthymia can affect anyone, but as depression prevalence tends to be higher among women, it’s possible that high-functioning depression disproportionately affects women and girls.
The drivers of this discrepancy include biological and hormonal factors as well as social and psychological issues like power imbalances and the objectification of women on a broad social scale.
Diagnosing high-functioning depression is tricky, as there are no universally agreed-upon criteria in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
Pinpointing dysthymia is also difficult as it is an inherently subjective experience, and what one person considers mild to moderate symptoms may be severely debilitating for someone else.
This means many people could be living with severe clinical depression without any acknowledgement or treatment.
People who have lived with dysthymia may feel chronically exhausted because of hiding their suffering, or manage to get through their workday seemingly unphased, only to crash on the couch each night with no energy reserves left for personal care, their social life, or their hobbies or interests.
This can compound the effects of their depression, such as increased isolation and loneliness and low self-esteem.
Some people with high-functioning depression may gaslight themselves into believing they are ‘faking it’ or can’t be seriously ill, just because they have ‘good days’ where they feel generally well and productive.
It’s important to remember that even the most serious mental illness can fluctuate, and that a couple of good days does not mean you are not ‘sick enough’ to get help.
If you suspect you are experiencing depression, no matter the severity, seeking treatment is the bravest, strongest, and most important thing you can do.
Even if your symptoms are currently mild, depression can become more severe over time, or following a traumatic incident or period of upheaval in your life, so don’t try to handle it on your own.
It is never too soon or too late to seek help.
Is the label ‘high-functioning’ helpful or harmful?
Labels and definitions can be useful, and my formal diagnosis definitely helped me overcome my internalised shame and stigma regarding depression.
It also helped me find the language to describe what I was experiencing, which helped give me the ‘permission’ I felt I needed to cut myself some slack and take care of my mental health.
Yet, I worry that categorising depression based on how well an afflicted person functions may trivialise the very real struggle of living with depression, no matter the severity.
It also conforms to an antiquated framing of mental illness as a binary issue, which some people have and others don’t, which glosses over the complex and fluctuating nature of mental health.
Most of us will experience poor mental health at some point in our lives, which may or may not seriously impact our productivity or ability to function.
Of course, there is a serious difference between feeling sad and having clinical depression, and we must practice caution when giving advice or support to someone who is depressed.
Strategies that may help when we are simply having a low day, like going for a walk or practising gratitude, are not likely to be helpful to someone in the midst of a serious illness.
A potential downside to the term ‘high-functioning depression’ is its potential to be used to further marginalise those who live with depression and, to no fault of their own, are not able to maintain high productivity or functionality.
The human experience, and the worth of human life, is not quantifiable, nor is it dependent on productivity or achievements.
Everyone deserves to live a meaningful, fulfilled life, but it’s important to remember that this doesn’t look the same for everyone.
There is no shame in reaching out if you need support, or in taking some pressure off yourself to be constantly productive.
It’s also important to remember that you can’t tell what someone is going through by looking at them, or from fleeting interactions.
Depression can affect anyone, regardless of their profession, status, or achievements, so it is crucial to practice compassion and kindness with everyone we meet, and most importantly with ourselves.
Do you need help?
If you need support with your mental health, or are worried about someone you know, reach out.
Lifeline offers a free, confidential phone counselling service, accessible 24/7 by calling 13 11 14.
Your GP can also provide you with a mental health plan and a referral to a psychologist or counsellor. You can find some helpful tips in our guide on how to find the right therapist for your mental health needs.
Beyond Blue can also provide information, resources and support to people experiencing mental health concerns across Australia.