Let’s get this out of the way: I have had high-functioning depression for five years and was formally diagnosed a little over two years ago after finally admitting that something had to give. I determined the weak link wasn’t going to be me and my freshly budding career but my infernal stubbornness and fear that everything I believed to be wrong was all in my head. In a way, my suspicions were confirmed. Though, perhaps not in the way you may think. To this thought, we will return.
Before continuing, there are matters to be clarified. What is high-functioning depression? How does it differ from classic depression? Why do we need to discuss it?
Officially titled persistent depressive disorder (PDD), high-functioning depression or dysthymia share a number of traits with major depressive disorder (MDD) according to the DSM-5 but to a less severe degree. Symptoms include but are not limited to fatigue, difficulty concentrating, irregular sleep, irregular eating, feelings of hopelessness, altered decision-making abilities, etc. Individuals with the disorder tend to not be debilitated in everyday life by their illness. They go to work or school, pay their bills, engage socially, and care for their environs. From the outside perspective, someone with PDD is functioning without impediment, leading to the widespread use of the term “high-functioning depression.” It is the water that erodes the cliffside, a low pressure which over time leads to increasingly overwhelming issues in mental health and life stability. Said pressure will occasionally come to a head, as with me when I decided I had to get help. However, a person with PDD will confront this critical moment again and again throughout the years.
Lastly, why do we need to discuss high-functioning depression? Recent years have borne witness to a rise in acceptance and awareness of mental health challenges and getting therapy. This wave of support and engagement has altered the mental health landscape in amazing ways and generated long overdue conversations. Yet there are still numerous misconceptions which prove harmful to those affected who may be seeking information, diagnosis, and/or assistance. That being said, here are some concepts about high-functioning depression people don’t talk about enough.
#1 Is High-Functioning Depression Real?
I have already touched on this, so this section will be brief. The short answer? Yes. Slightly longer answer? PDD is a medically recognized and diagnosable disorder which can be controlled with prescribed medication and holistic life changes. By nature, the disorder is both low-level and chronic, often leading to the perception that the symptoms it manifests are solely the result of personality or circumstance rather than a chemical imbalance exacerbated by external factors.
Because the term high-functioning depression is often used to casually refer to more acute experiences, it and the disorder associated with it are seen as trendy buzzwords. This is one of the most damaging misconceptions for two reasons. The first being that those who recognize their struggles don’t seek help for fear their symptoms are not due to an underlying disorder but a mix of paranoia and personal failings. The second is that upon seeking help, they are not taken seriously and can regress to a state of mind in which their problems aren’t legitimate.
#2 It’s a Trojan Horse
HFD, in the course of finding diagnosis, presents in a number of ways. Its insidious nature means important signifiers can go unmentioned, issues being ignored as they’re attributed to other factors. Someone seeking diagnosis may find themselves wearing a few name badges including but not limited to MDD, insomnia, and eating disorders. For instance, I have been screened for bipolar disorder. Sometimes, disorders can overlap, but it’s crucial to understand where these differ from HFD. Your family health history will impact the direction your doctor or therapist investigates.
#3 You Seem Normal
For a disorder described as MDD but less severe, it’s not incorrect to think of HFD as a pervading sense of hopelessness and lack of positive feeling, but such an estimation is incomplete. Individuals with HFD can often go through daily life well and succeed in work, school, and social circles. Days in which the stereotypical mental picture of a depressed person being unable to leave bed or shower are few and far between, if one experiences such severe symptoms at all. However, the demands of forcing oneself to be “business as usual” are exhausting. Despite getting enough or even too much sleep, rest won’t take the edge off the constant fatigue.
There is little emotional real estate allotted to navigate relationships and/or high-stakes situations. Communication becomes treacherous ground as answering texts, calls, or emails start to represent harbingers of more mental/emotional investment then one is capable of in the moment. Brain fog and the inability to concentrate are common hurdles to getting work done. The goal is satisfaction; the result is good enough. All of this contributes to an overwhelming shame and low self-esteem.
All human beings, as they grow and mature, have to learn when to give themselves grace and when to push harder. In HFD, the lines are more blurred than ever, often forcing the question: “Am I struggling with mental health or being lazy?” Escaping the downward spiral sometimes feels impossible as the brutal honesty required to self-evaluate fails to be objective.
You may look normal, yet every day, before the day truly begins, normal feels next to impossible. You may think, “If I was normal, I would accomplish so much.”
#4 Low-Grade Depression is Baseline
HFD doesn’t have an upper limit, it has a baseline. Essentially, HFD means that you always feel pretty darn bad, but you may very well feel significantly worse. Symptoms can escalate to incapacitation. Said major depressive episodes are shorter than they would otherwise be in people with MDD, but the severity will be similar. The usual suspects would be present: trouble concentrating, a lack of interest in things one generally enjoys, eating too much or too little, sleeping too much or too little, feelings of guilt, suicidal ideation and actions, and erratic emotions. In some cases, an episode can incite elements of psychosis. In short, HFD, while less severe than MDD, is not harmless.
So What Now?
Now that the basics are established, let’s talk about what we can do as people struggling with HFD or supporting someone who is.
You’re a living thing.
Do you know what living things need? Sunlight. Movement. Support. Homeostasis. Sustenance. Look at your life when you catch yourself in a rough patch. You’d be surprised how often our mental state is incited to internal violence because you need a damn nap. Or a glass of water (or six). Or to sit on a park bench and get some of that delicious vitamin D straight from the source. Most of all, ask yourself if you feel off-balance and why. I won’t tell you to smile in a mirror and speak affirmations into manifestation, but it doesn’t hurt to metaphorically sit yourself down and check when last you ate a vegetable. Treat yourself like a living thing, not a machine.
A cure? No. A foundation.
What’s up, doc?
If you think you may have HFD, reach out to your or find a primary care physician. D.O.s tend to operate more holistically than M.D.s so keep that in mind if you’re looking for someone new. Don’t be afraid to seek a second opinion if you feel your concerns aren’t being heard. While I was fortunate that the first physician I spoke to recognized I needed help and referred me to a good therapist, I did not end up staying with her due to how she kind of ignored everything that wasn’t the size of my dosage. It can be intimidating, but your physician will not be offended by your switching practices. Try not to do it too often, as that can be self-destructive in and of itself, but don’t let hurt feelings stand in the way of the quality care you deserve. On that note, don’t be afraid of medication. We take antibiotics when battling infection, so take the brain pills when the brain juice has gone sour.
Be honest with yourself and others.
This applies to, well, everything, but in the context of our discussion please be honest with yourself and your social ties about your limitations. Does this mean you have to tell everyone you have depression? Most certainly not. I, personally, prefer to keep my brain imbalance in the confines of my and my doctor’s heads (ironic, I know). But consider telling your coworkers that you are taking steps to limit off-the-clock work communications. Be frank when you need a raincheck for a night out. Remember, you don’t have to lie. We don’t have to explain ourselves as much as we seem to think. Don’t justify every little thing.
Call in the reinforcements!
Being in a platonic, familial, romantic, or any other kind of relationship with someone with depression (even if you are depressed, too) can be brutal. I know this from experience on both ends. How to navigate the tundra? Honesty, maturity, and quality communication. Whatever state of mind your depressed loved one is in, both of you will benefit from treating each other like cogent adults with independent, complex internal lives. Seems obvious (at least, I hope so). It’s harder to execute.
Create a space in which your feelings and perspectives have equal rights. Respect one another’s circumstances without creating excuses. Leave blame on the wayside—discourse with the goal of determining blame rather than cultivating understanding is an argument not a conversation. Take and encourage your cohort to take personal responsibility for what happens between you. There’s a learning curve to this, but engaging with others utilizing these guiding principles will yield dividends.
Remember and remind that sometimes all that is required to be supportive is to listen. Not everything can or need be fixed, and venting, done in a healthy way, can be immensely therapeutic.
In conclusion, treat people like people. Basic respect and courtesy can do a lot, even if when it comes to mental health things never feel that simple. There are too many intersecting influences. On days like that, I can only encourage—and offer others and myself—grace.
