This Is What High-Functioning Depression Looks Like and How to Break the Stigma

There is an antiquated view of depression that persists in our culture. It is the idea that people suffering from depression must look sad and sullen, sleep in bed all day, and don’t want to talk to or interact with others.

While this view has eased thanks to society’s openness to talk more frankly about mental health, it’s still there, deeply seeded. That’s why it can be so shocking when someone who looks happy announces themselves as suffering from depression. Though it’s not an official medical term, this sort of depression is colloquially referred to as high-functioning depression, and for many, it is an invisible illness.

High-functioning depression looks like K, a 39-year-old married male from Texas who works in media. (K’s name is abbreviated at his request). K is friendly, easy to talk to, and well-liked by his peers. On days when his depression is high, K has a tough time getting out of bed.

He feels like he’s hungover and needs more sleep. His energy level is low, and all he wants to do is shut himself off from the world. But he knows he has to push through.

“[I] tell myself I have to get up and moving, and that I have stuff to get done. If I have a busy schedule ahead, I can force myself to ignore how down I am inside. I have the ability to continue day-to-day like a “normal” person in most ways, but I have to fight back a lot of anxiety and inner uncertainty and disappointment.”

K says his wife has gotten good at noticing his bad days, but he worries that it’s bringing her down too.

High-functioning depression also looks like Chelsea, a 30-year-old female from Austin, Texas, who works in tech and is friendly and fun to be around. Many days she wakes up, goes to work, sits alone at work, goes home, takes care of her dog and then goes to sleep.

“High-functioning depression is like wearing a mask because, if you were to ask my friends, I appear bubbly and bright.” She says she uses humor to cope with her sadness, but her depression can often be debilitating. She experiences both insomnia and oversleeping, she has difficulty concentrating at times, and she has trouble completing projects she is passionate about. As a survivor of suicide in her teenage years, she often thinks about dying, “but not by my own hand,” she says. “Just as a passing thought, like, ‘I could die right now and be okay with that.’”

“Some days I’ll wake up and feel as though I’m swimming through syrup,” says Kayla, a 28-year-old female from Austin who works in marketing. “There is a fogginess and physical weight to it, and I’ll know I’m in for a day of acting. I’m convincing, often enough that friends, family, and my partner have no idea that anything is wrong. After a few days of performing, I’m exhausted. That’s when I feel like a typical depressive person: It’s hard to get out of bed, [and] I’ll start crying over nothing.

I fantasize about walking into traffic, which of course isn’t an easy thing to talk about with anyone (even in therapy, a tool I’ve used for years).”

Though high-functioning depression is not recognized as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association, a person experiencing high-functioning depression most likely is suffering from a form of persistent depression.

“In the medical community, we would not use the term high-functioning depression. It’s a lay term people use to describe someone who is depressed, but able to go through the motions of their day,” says Daniel Hochman, MD, founder of Self Recovery, an online addiction recovery program. “Instead, we might use a clinical term like major depressive disorder, and simply add that the person is high functioning.”

Erin Moore, LMSW, a mental health professional at a maximum-security correctional facility in Central New York, adds: “To say someone is ‘high-functioning’ is simply to say that they are resilient. It is to say that the individual about whom you are speaking has developed internal coping strategies that have helped them attend to their activities of daily living in spite of their illness.”

Recognizing and understanding depression, and the severity of the depression, in a high-functioning friend or loved one can be difficult. The sufferer is doing their best to not let depression take hold of their life, and in doing so they might not share the feelings of sadness or emptiness they are experiencing. In fact, being high-functioning also means it may be difficult for the person suffering from depression to recognize it themselves.

“I’ve seen many patients who try so hard to maintain a high level of functioning that they actually get worse, perhaps by neglecting their own needs or refusing to accept help,” says Hochman. “I think people have this idea that it’s strong to charge on. But the truth is it takes more strength and courage to reveal your suffering than to pretend you’re OK. When you do that, you grow as a person and become less depressed.”

A good first step in understanding whether you have high-functioning depression is to talk to your primary care doctor about steps you can take to recovery, whether it be meeting with a mental health provider, taking medication, a combination of medication and therapy, or learn coping techniques.

When asked what he wants people to know about individuals with high-functioning depression, K says it’s important that friends and family understand limitations caused by depression.

“I think the biggest thing most people don’t realize is that we have to force ourselves to even function close to what is perceived as normal,” says K. “We also fear having to explain why we don’t want to do something or why we don’t go out anymore. Then people wonder ‘what’s wrong’ instead of really wondering what might be going on.”

Chelsea says that empathy is needed and appreciated. “Because high-functioning depression is very much an internal struggle, we aren’t always open to accepting help even when it’s obvious we need it.” She adds that pushing her to be open when she’s not ready to talk only pushes her further into a corner, where she feels trapped. “It’s important to be patient and kind,” she says. Loved ones and friends can offer support just by being present. “I think just being there in general, whether it’s in silence or to talk to, is very helpful.”

Though high-functioning depression isn’t a recognized clinical term, depression is very real, and it can be debilitating, exhausting, isolating and even a little bit scary. If you’re suffering from depression, whether it’s high-functioning or not, please know that you are strong and you are not alone—over 17 million Americans experience depressive episodes each year. There is support available for you. Psychology Today offers a handy therapist search tool that makes it easy to find mental health providers in your area. In addition, most insurance company websites allow you to search for nearby mental health providers that accept your insurance.

If you feel more comfortable seeking referrals, talk to your primary care doctor or friends and family about which mental health providers they recommend. Also, there may be a depression support group in your area where you can meet and talk with others who share similar experiences to you.

Depression is nothing to be ashamed of and the more we talk about mental health, the more likely we’ll rid of its antiquated stigma.