What is High Functioning Depression and How to Treat It

By Irmanie Hemphill, MD, FAAFP
Medically reviewed
July 20, 2021

Depression is more than just a temporary low mood or feeling of sadness. It is a serious mental health condition that affects more than 260 million people worldwide, and has symptoms that can impact your relationships, career, and physical health. 

When someone has depression, it impacts how they eat, sleep, work, and enjoy time with loved ones. People with depression report low self-esteem, negative thoughts, feelings of guilt, difficulty concentrating, physical pain, and a loss of interest in social activities they once enjoyed.

At its most severe, depression can lead people to experience feelings of hopelessness, struggle to take care of their daily emotional and physical needs, and develop suicidal thoughts and behaviors. 

Doctors characterize different forms of depression by the severity of symptoms and whom they affect. One type of depression, called persistent depressive disorder (PDD), is commonly called “high functioning depression,” because people suffering with this type of depression seem like they can function normally to the outside world.

But in reality, they’re struggling emotionally and physically on the inside. People with PDD experience relatively mild symptoms, but those symptoms can be long-lasting.

In this article, I will cover what high functioning depression is, as well as common signs and symptoms of high functioning depression. I’ll also share how you can determine whether you’re suffering from high functioning depression, some risk factors and triggers for PDD, and how high functioning depression is diagnosed.

Finally, I’ll share treatment options for high functioning depression, a test for PDD, and advice on when to seek help.

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What is High Functioning Depression? 

Depression is a medical condition that negatively and persistently impacts your quality of life.

Symptoms can range from mild to severe, impacting how you think, feel, eat, sleep, work, and spend time with friends and family members. 

Some of the most common types of depression include: 

Major depressive disorder (Clinical Depression)

Major depressive disorder, or MDD, is characterized by severe symptoms that last longer than two weeks. Patients experience intense, sometimes debilitating feelings of sadness, low self-worth, depressed mood, and a lack of interest in activities they once enjoyed. MDD can interfere with a patient’s ability to function at home or work.

Bipolar disorder (manic depression)

Bipolar disorder, or manic depression, is a mood disorder that is characterized by unusual and extreme shifts in mood. Patients experience elevated, manic periods or episodes, where they’re hyperactive and talkative, feel an inflated sense of self-esteem, and may act recklessly.

These manic episodes can be followed by lower episodes. When patients are at the low side of their emotional spectrum, they experience depressive symptoms like fatigue, and feelings of low self-worth or hopelessness. 

Seasonal affective disorder 

Seasonal affective disorder, or SAD, is a type of depression that follows the cycle of the seasons. Most SAD patients feel depressed during the winter months, but some people are triggered by early spring or summer.

The defining characteristic in SAD is that a major depressive episode is experienced at the same time each year for at least two years.

Persistent depressive disorder (dysthymia)

Persistent depressive disorder, or PDD, is a form of depression with milder symptoms that persistently affect patients for two years or longer.

Patients who have PDD can function relatively normally, and may look like they aren’t struggling to the outside world. But all patients with PDD have an abnormally low baseline mood. They are also at a greater risk of developing major depression.

When people talk about “high functioning depression,” they’re referring to PDD. But it’s only a colloquial term: Mental health professionals do not use the term high functioning depression, and it is not medically recognized as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Researchers estimate that 1.3% of American adults experience PDD in their lifetime.

High Functioning Depression Symptoms 

Everyone experiences sadness, grief, loss, loneliness, and anger from time to time: These feelings are part of being human. Under normal circumstances, these negative feelings lighten and lessen with time. 

But patients with depression, and particularly persistent depressive disorder, are impacted by these feelings over a longer period of time. While not everyone with PDD has every symptom, patients often report experiencing: 

  • A sad, low, “blue,” empty, or negative mood 
  • Low energy or fatigue
  • Difficulty sleeping (insomnia) or excessive sleeping 
  • Difficulty eating or overeating
  • Difficulty concentrating
  • Difficulty making decisions
  • Difficulty moving or talking quickly
  • Feelings of guilt
  • Feelings of hopelessness
  • Low self-esteem 
  • Social withdrawal or isolation
  • Physical aches or pains

Children and young adults may experience different PDD symptoms than adults with the same disorder. For example, they are more likely to be more irritable, rather than “low.” And younger PDD patients are more likely to experience changes to their weight and appetite than adults.

The most important diagnostic criteria for PDD is the length of time a patient has been suffering from symptoms of high-functioning depression. If you have had symptoms on most days—for most of the day—for at least two years without a consecutive two-month break in between, you may have PDD.

Signs of High Functioning Depression 

Persistent depressive disorder may not feel as severe as other forms of depression, but it is still a mental health issue that harms a patient’s well-being. People with PDD may find that they struggle to: 

  • Stay motivated at work or school 
  • Feel social or enjoy time around others
  • Maintain relationships with family and friends
  • Find joy, even in happy moments
  • Take an interest in activities that they once enjoyed

Some patients with depression experience suicidal thoughts or behaviors as a part of their mental illness.

If you have suicidal ideas or plans to harm yourself or others—or know someone else expressing these thoughts or ideas—call 9-1-1 or go to the nearest emergency room to immediately seek medical help.

Do I Have High Functioning Depression? 

If you believe you are suffering from depression, it is crucial to talk to a doctor or another qualified healthcare provider.

When depression is untreated, it can have harmful effects on your emotional and physical well-being, relationships, work, and home life. 

When preparing to talk to your healthcare provider, ask yourself questions like:

  • Do I feel sad or low more often than not?
  • Do I struggle finding joy or engaging in social interactions?
  • Do I have trouble concentrating or making decisions? 
  • Do I regularly feel worthless, hopeless, or lonesome? 
  • Have I felt this way on most days for more than two years?

If you answered yes to one or more of those questions, or have reason to believe you have PDD, take our full online assessment to better understand your mental health and begin your journey toward wellness.

Risk Factors and Triggers

Depression is one of the most common mental health conditions worldwide. According to the World Health Organization, it is the leading cause of disability across the globe.

In the U.S. alone, one in every 15 adults will suffer from depression in any given year.

People can develop PDD regardless of their age, race, ethnicity, gender, or socioeconomic status. Those who are at higher risk of developing PDD include: 

  • Women 
  • People with a family or personal history of depression
  • People who have suffered a significant loss or a trauma
  • People who have experienced a job loss
  • People who have experienced a change in their health
  • People who have experienced violence, neglect, abuse, or poverty
  • People with a history of substance abuse

Diagnosis

If you believe you are suffering from PDD or another form of depression, make an appointment with a doctor or psychiatrist so you can be formally evaluated and diagnosed. 

At your appointment, your doctor will ask screening questions to learn more about your mental health. They may also ask for a blood test or other screenings to rule out physical conditions that could be behind changes in your mood. 

Before you visit, it may be helpful to track your moods and other symptoms to tell your doctor exactly how you have been feeling.

Make notes on your personal mental health history and family mental health history, and tell your doctor about any behavioral changes you’ve noticed.

Write down any medications, herbal supplements, and street drugs that you take, and be sure to report any recent losses, changes, or other stressful experiences you might have had.

High Functioning Depression Treatment Options 

Depending on the individual patient, doctors will suggest treating persistent depression disorder with prescription medication, talk therapy, or a combination of the two.

Antidepressant Medications:

Antidepressants are prescription medications that change the chemistry in your brain to lift your baseline mood and improve other symptoms. It may take some time to find the proper medication and dosage. But once you do, you should feel better, sleep more regularly, and enjoy a higher quality of life.


Psychotherapy

Evidence-based approaches to talk therapy, like cognitive behavioral therapy (CBT), are often suggested to patients dealing with PDD. During your sessions, a licensed therapist will work with you to manage your thoughts and feelings, set goals, and learn emotional skills to cope with your depression and keep it at bay.

High Functioning Depression Test 

Depression is common, well-understood, and above all, treatable. Finding the proper medication, therapy, and other management techniques can help you feel better, live longer, and enjoy a higher quality of life.

If you believe that you or someone you know is suffering from PDD or another type of depression, take our online assessment to see if medical treatment is the right option for you. 

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When to Seek Help

Depression is a medical condition that often requires medical treatment. If you have experienced prolonged and consistent sadness, emptiness, irritability, or have felt down for more than two weeks, make an appointment to talk to your doctor about your symptoms and be screened for depression. 

Patients with depression can sometimes experience suicidal thoughts or behavior as a part of their mental illness.

If you are worried that you or someone you know is at risk of harming themselves or others, call 9-1-1 or go to the nearest emergency room to seek medical help immediately.

You can start controlling your depression and get access to the treatment you need with K Health. Starting at $19/month, get prescriptions for mental health medications plus unlimited doctor visits, through the K Health app. Start your free assessment here.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Irmanie Hemphill, MD, FAAFP

Dr. Hemphill is an award winning primary care physician with an MD from Florida State University College of Medicine. She completed her residency at Halifax Medical Center.