How to Spot and Support High Functioning Depression

When we think of major depression, we generally think of someone who is unable to function or at least not function very well. The symptoms are usually severe enough to cause noticeable problems in day-to-day activities (work, school, home life, social activities or relationships). Those working or living with someone with clinical depression may need to help the person with their workload or support them emotionally and with basic life-care needs.  

By contrast, it is important to note that a high-functioning person can also be suffering with depression, which some classify as Persistent Depressive Disorder (PDD) or Dysthymia. Dysthymia involves almost all of the same symptoms as major depression, but not with the same severity.  Thus, the problems experienced in day-to-day activities may not be noticeable to those working or living with the person. And since the person experiencing this form of depression might not even realize they are depressed (as the symptoms have gradually increased over a longer period of time), they generally do not seek mental health treatment. People with high-functioning depression also tend to have a lot of determination and endurance to cope with the symptoms rather than seek help.

Like the name implies, persistent depression can linger for several years and cause long-term neural effects such as memory loss and impaired cognitive functioning.  This form of depression can come on slowly in childhood or adolescence (which makes it more difficult for the individual to recognize) — and it can come and go in cycles (which misleads the person into thinking that the depressed mood/feelings are situational and not intrapersonal).

The differences between high-functioning depression and major depression:

  • An assessment may reveal the same (number of) symptoms, but the intensity scale will show less for someone with high-functioning depression.
  • Major depression can be diagnosed after only two weeks, whereas two years of high-functioning depression is required for that diagnosis (PDD or Dysthymia).
  • People with major depression have a "normal" baseline mood, whereas those with high-functioning depression cannot identify when they last felt normal.

How to spot high-functioning depression:

  • Explore if your client is able to perform their obligations, but avoids personal / social engagements or events involving joyful emotional expression.
  • Ask "What do you do for fun?"
  • Ask them to rate how lonely / alone they feel.
  • The depression may be triggered by a traumatic life event. Ask your client to rate how they felt prior to the event(s) compared to a week, a month and several months later. Use a 1-5 scale, if needed.
  • Ask your client to describe the difference between what is happening with their outward functioning versus inner feelings. It's not uncommon for the individual to be not fully aware there is such a contrast.
  • Brain chemistry may also play a role. If your client is peri-menopausal, for example, the hormonal shifts could bring on the depression. Explore the emotional changes at the onset of PM.

How to support someone with high-functioning depression:

  • Invite your client to channel some of their high-functioning energy into doing something that will bring others joy. (Don't go to the holiday party, but collect food for the shelter instead).
  • Low levels of serotonin are thought to contribute to depression, so regular exercise is an essential therapy, as well as a whole foods diet, laughter, a consistent sleep schedule and avoiding alcohol.
  • Explore supplements such as L-Phenylalanine(Tyrosine), 5-HTP, Omega 3, D3 and B12.
  • Cognitive Behavior Coaching can help break the pattern of negative thought patterns and feelings.
  • Alternative therapies such as acupuncture, emotional freedom technique and meditation can help shift and balance the body's energy system.

Knowing this distinction between high-functioning depression and major clinical depression is crucial in providing best practices. When you first see this client, you may not consider that they are depressed, as they themselves may not realize they are suffering with depression, having learned to cope over the years and consider how they feel to be "normal".  They have learned to mask and push themselves into being high functioning. However, they can be reminded and made to realize that there is a much more enjoyable way to go through life.  The first step to healing and living their best life is recognition and acknowledgement.  

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Blog Post written by:

Dr. Nickerson's professional experience as a psychologist and personal passion for developing the mind-body-spirit connection have fueled her success and devotion to training individuals and organizations to foster whole wellness.

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