Identifying and Treating High-Functioning Depression | BrainsWay

High-Functioning Depression

To the outside world, individuals with high-functioning depression may appear strong and in control. But in private, they struggle under the weight of their untreated symptoms. They may worry about rejection, not being believed, or may feel pressured to keep performing at a high level.

Individuals undergoing stressful situations may mask symptoms for several reasons, but depression is highly treatable with many effective interventions available.

Read on for a high-functioning depression definition, understanding what it is, and how it may present. Then, review several effective high-functioning depression treatment options.

Depressed man with computer

What Is High-Functioning Depression?

High-functioning depression is not a diagnosis but rather an approach to coping with depression where an individual pushes their depression under the radar, hiding and masking depression symptoms each day. For these individuals, high-functioning depression at work and home truly becomes an invisible illness. Here are a few examples:

  • A young man has held his challenging but high-paying job for five years. He engages with his coworkers and supervisors as needed but does not engage socially or pursue hobbies in his free time. He has privately dealt with health challenges and lives in an expensive city, so he pushes through to keep his good job despite feeling no enjoyment in daily life.
  • A stay-at-home mother cares for her two young children while her husband works at a fulltime job. She actively engages with others and stays busy around the house. But when she is alone, she cries while struggling with relentless negative thoughts and feelings of worthlessness.

High-Functioning Depression Symptoms

Individuals with high-functioning depression live with undiagnosed depressive disorders of all types. Each individual has a unique expression for depression, so their ability to cover their disorder depends on which symptoms are more prominent and how they develop. While an outwardly sad or tearful expression is often typical with depression, this is not always the case. Signs of high-functioning depression may include individuals limiting their social interactions, taking on excessive tasks at home or work, or complaining about unexplained physical symptoms.

Depressive disorders share common symptoms that individuals may express openly or privately.

  • Low, sad, or depressed mood most days.
  • Loss of pleasure or interest in enjoyable activities.
  • Sleep disruptions, either oversleeping or insomnia.
  • Appetite changes that may result in unintended weight loss or gain.
  • Feelings of hopelessness, worthlessness, and guilt.
  • Pessimistic mindset or outlook on life.
  • Difficulty concentrating, thinking clearly, and making decisions.
  • Moving or speaking more slowly than usual.
  • Unexplained physical ailments, such as back pain and headaches.
  • Thoughts of death, suicidal ideation, feeling like everyone would be better off without them around.

Depressive Disorders

High-functioning depression is most feasible with milder depression, where individuals can more easily mask or divert attention from their symptoms. While severe depression symptoms may be more difficult to cover, individuals may adopt a high-functioning depression approach with any of the following depressive disorders.

Persistent Depressive Disorder

Persistent depressive disorder is a distressing condition defined by milder symptoms occurring more days than not for two years or more. While symptoms are typically less extreme or severe, their relentless nature can lead to significant negative health outcomes, such as an elevated risk of suicide and more treatment resistance. Because symptoms are often less extreme, high-functioning depression frequently occurs with persistent depressive disorder.

Major Depression

With major depression, individuals have a persistently low, depressed, or irritable mood more days than not and lose interest in pleasurable activities. These and other symptoms are significant enough to cause impairment at work or school, with social interactions, and with basic self-care tasks

Perinatal Depression

Individuals may experience periods of depression while pregnant or within the first year of giving birth, a condition also known as postpartum depression. Hormonal fluctuations, the physical effects of pregnancy, the stresses of caring for a newborn, and preexisting vulnerabilities to depression can impact the development of perinatal depression.

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) causes extreme mood shifts coinciding with each cycle of menstruation, with depressive symptoms presenting two weeks before the onset of menstruation. These rapid mood changes can cause severe disruption at home, work, and within relationships. Once menstrual bleeding starts, symptoms typically resolve.

Seasonal Affective Disorder

Seasonal affective disorder (SAD) is defined by periods of depression that only present during certain seasons of the year, most commonly during the cold weather months of autumn and winter. About ten percent of individuals with SAD have the opposite experience, developing depression only during spring and summer months.

Bipolar Disorder

Bipolar 1 disorder is defined by manic episodes, marked by extreme changes in mood, energy, and activity that last at least one week. Individuals may appear agitated, have an exaggerated positive mood, or may seem to have endless energy. Periods of depression may occur between manic episodes, typically lasting two weeks or more. This disorder leads to highly disruptive and risky behavior, often resulting in strained relationships and problems maintaining stable income or housing.

Bipolar II disorder is similar, but the range of symptom expression is less extreme, resulting in more manageable symptoms. A chronic type of bipolar disorder is cyclothymic disorder, where symptoms are distressing but do not meet the full criteria for manic or depressive episodes.

Depressed woman

Why Do Individuals Hide Depression Symptoms?

A key aspect of high-functioning depression is masking or suppressing the appearance of symptoms, which individuals may do for several reasons.

  • They want to avoid the stigma associated with depression, fearing rejection or criticism.
  • They go along with cultural expectations, such as appearing strong and independent.
  • They save face at work to avoid losing their job.
  • They want to avoid disrupting social activities and relationships.
  • They are uncomfortable expressing emotion and being vulnerable.
  • They do not want to appear needy, weak, or a burden to others.

High-Functioning Depression Treatment

Despite their ability to mask symptoms, individuals with high-functioning depression are still negatively impacted by symptoms. Treatments can help, and many effective treatment options are available.

Medication

Several types of medications are used as antidepressants to treat depression symptoms, including cases of high-functioning depression. These treatments may help reduce symptomatology, such as low mood, sleep disturbance, and poor concentration. Each medication has advantages and drawbacks, so trying more than one treatment is common.

The newer medications developed in the last few decades are well tolerated and effective for many.,. These include:

Older medications were among the first used to treat depression. They have more adverse effects but may provide much-needed relief when other treatments fail. These include:

  • Tricyclic Antidepressants (TCAs)
  • Monoamine Oxidase Inhibitors (MAOIs)

Psychotherapy

Several types of psychotherapy can help reduce depression symptoms. Research shows little difference in efficacy among the most commonly utilized therapies, and individual preference may be a more significant factor in producing positive outcomes.

Cognitive Behavioral Therapy (CBT)

CBT is a talk therapy examining how thoughts, behaviors, and emotions interact and result in depressive symptoms. Individuals learn about these patterns so they can respond differently.

Behavioral Activation Therapy (BA)

Behavioral activation focuses on the behavior component of CBT, encouraging individuals to become more socially engaged, do more enjoyable activities, and reduce behaviors that contribute to depressive symptoms.

Psychodynamic Therapy

Psychodynamic therapy offers an empathetic environment in which patient and therapist can look deeply into the connections between the patient’s emotions, thoughts, behavior, symptomatology, formative experiences, key relationships, and many other aspects of their past and present lives.

Deep Transcranial Magnetic Stimulation (Deep TMS™)

For those who have not had sufficient relief from depressive symptoms with other treatments, or who wish to fortify their present treatment process, Deep TMS may be an effective option. Deep TMS is a safe, noninvasive FDA-cleared treatment for depression symptoms, with results backed by years of research and technological innovation.

During each 20-minute treatment session, patients wear a cushioned helmet embedded with magnetic coils. These coils stimulate brain regions associated with depression symptoms by delivering targeted pulses, improving the regulation of neural activity in these areas.

Deep TMS has no long-term adverse effects. Deep TMS treatment continues for 16 weeks, with many noticing symptom improvements before the course is complete.

The Reality of High-Functioning Depression

The cost of hiding depression is high. Untreated high-functioning depression can persist for months or even years, impairing relationships, undermining mental abilities, and robbing individuals of their quality of life. Individuals are also at an elevated risk for suicide due to persistent symptoms influencing their mindset and emotional state, as well as health risks from conditions that commonly occur with depression, such as heart failure and stroke.

With multiple treatment options, individuals with hidden depression can learn to function well inside and out. Untreated chronic depression can be more treatment-resistant, but psychotherapy, antidepressants, and Deep TMS can provide relief as singular or combination therapies.