Despite being one of the most common mental health conditions, depression can sometimes be hard to spot. It can manifest differently: One person might have trouble getting out of bed while another is high-energy and always smiling.
“Seeing someone who looks like they are going through life with no problems or worries doesn’t mean they’re not hurting on the inside,” says Dr. David Tzall, a licensed psychologist in New York City. It’s an important reminder, he says, that “not all disabilities are visual.”
High-functioning depression is a term used to describe someone who has depression but doesn’t look like it’s impairing their life. Someone affected might be going out socially, maintaining meaningful relationships, and working successfully at a job — all with the added stress of maintaining the facade that everything is fine.
It can be easy to miss the subtle signs of high-functioning depression. Here’s how to recognize if you or someone you care about might be affected.
What is high-functioning depression?
While not a clinical diagnosis, high-functioning depression is a term to describe a type of hidden depression. For a range of reasons, those affected are motivated to mask their symptoms: Perhaps they fear the judgement of other people, don’t want to cause concern among their loved ones, or are even grappling with their own negative views of mental health issues.
High-functioning depression is a way for a person to avoid being stigmatized for being mentally ill than a separate depression diagnosis, explains Dr. Tzall. “It’s an adaptive form of behavior.”
Because of this, it’s hard to know how many people are affected, though over 8.4 percent of adults have at least one depressive episode annually, according to the National Institute of Mental Health—a prevalence that’s higher in women than men.
While anyone can develop high-functioning depression, some individuals may be more at risk than others. People raised in certain racial or ethnic families where discussing mental health is taboo might be more likely to not want to believe or accept they have depression, explains Dr. Jameca Woody Cooper, a counseling psychologist and trauma and culture specialist. Growing up in a family where talking about feelings was discouraged can make it challenging for someone to recognize their own symptoms and seek help. Personality factors, such as being a perfectionist, can also put people at risk, as those affected try to conceal their symptoms.
How to recognize high-functioning depression
If you’re unsure whether you or someone you care about has high-functioning depression, consider asking some of these questions: Have you been feeling sad or discouraged recently? Are you not giving yourself grace and being overly self-critical? Are these feelings because of some event or have they showed up without warning? Depression can also manifest as physical symptoms, including headaches, stomach pains, and loss of appetite or sleep.
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“You’re looking for a deviation from the norm,” says Dr. Tzall. If mood changes have been present for longer than two weeks, reaching out to a healthcare professional can help. (Not sure where to turn? Findtreatment.gov offers a range of confidential resources.)
One misconception with high-functioning depression is that it’s not serious because a person is productive and managing day-to-day activities. Dr. Tzall cautions this group can be particularly vulnerable because they are less likely to seek care, reach out to others, or admit they need help. What’s more, Dr. Cooper warns that the stress of putting up a front can worsen symptoms and make people spiral when they do experience a major depressive episode.
Many people look at depression through a stereotypical lens, adds Dr. Cooper. They may picture someone with no energy, lying in bed all day instead of an extroverted person who has been going out a little less than usual. “Depression can take many shapes and forms. It doesn’t have to look a certain way.”
How to treat high-functioning depression
The treatment for high-functioning depression is the same as clinical depression. Ideally, a person would see a mental health professional who may recommend regular counseling and discuss whether medications such as antidepressants might offer relief. They may encourage a person to make lifestyle changes, such as exercising more and eating a healthy diet.
Having social support can also play a major role in acknowledging and helping to manage depression. When supporting a friend, try to avoid language that suggests you’re judging them or trying to solve their issues, recommends Dr. Tzall, and try “active listening” instead.
“We want to be objective and validating to the experience especially because most times people want to talk about what they’re doing,” says Dr. Tzall. “They don’t necessarily want their problem solved. They just don’t want to feel alone.” Go at the person’s pace, he urges. “The more we can be there for them, hopefully over time they’ll seek professional help on their own.”
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