Last updated:

February 9, 2024


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High-functioning depression: Causes, symptoms, and treatment

Explore causes, symptoms, and treatment options for high-functioning depression, breaking stigma and offering support.



In a world that often celebrates productivity and success, mental health struggles can often go unnoticed, especially when individuals are adept at concealing their internal battles. High-functioning depression is one such condition that may not manifest visibly but can significantly impact a person's overall well-being. In this article, we will delve into the causes, symptoms, and effective treatment options for high-functioning depression, shedding light on a condition that often lurks beneath the surface.

What is high-functioning depression?

High-functioning depression, also known as dysthymia or persistent depressive disorder (PDD), is indeed recognized in diagnostic manuals such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition). It's characterized by individuals maintaining a high level of functionality while coping with persistent feelings of despair and sadness. Unlike major depression, high-functioning depression is subtle in nature, making it challenging for both others to recognize and for individuals themselves to acknowledge.

While not an official term in diagnostic manuals, "high-functioning depression" has become a popular colloquial term to describe hidden symptoms of depression that might not be immediately noticed by others and do not necessarily impair day-to-day functioning. This term highlights the invisibility of depression, which can perpetuate stigma and pressure on individuals to function at high levels. However, it's important to note that just because it's referred to as "high-functioning" doesn't diminish the seriousness of the symptoms.

Causes of high-functioning depression

Understanding the underlying causes of high-functioning depression is crucial in developing effective treatment strategies. While the exact aetiology is complex and multifaceted, several factors contribute to the development of this condition:

  • Genetic predisposition: Genetic factors play a significant role in an individual's susceptibility to depression. If there is a family history of depression or other mood disorders, the risk of developing high-functioning depression may be heightened.

  • Neurochemical imbalances: Imbalances in neurotransmitters, such as serotonin and dopamine, can contribute to depressive symptoms. These chemicals play a crucial role in regulating mood, and disruptions in their levels can lead to persistent feelings of sadness and despair.

  • Chronic stress: Prolonged exposure to stress, whether from work, relationships, or other life circumstances, can contribute to the development of high-functioning depression. The body's continuous response to stress hormones can alter brain function and increase vulnerability to mood disorders.
  • Personality traits: Certain personality traits, such as perfectionism and high levels of self-criticism, are associated with an increased risk of high-functioning depression. Individuals who set unrealistically high standards for themselves may find it challenging to cope with setbacks, leading to a persistent sense of dissatisfaction.

  • Environmental factors: Traumatic life events, such as the loss of a loved one, financial difficulties, or major life changes, can trigger high-functioning depression. These external stressors can overwhelm an individual's coping mechanisms and contribute to the onset of depressive symptoms.

Symptoms of high-functioning depression

Identifying high-functioning depression can be challenging due to the subtle nature of its symptoms. Individuals experiencing high-functioning depression may exhibit the following signs:

  • Persistent low mood: Individuals with high-functioning depression often experience a chronic and pervasive low mood that persists for most of the day, nearly every day. Low interest in activities previously enjoyed, social isolation, and thinking about self-harm, death, and suicide can also be seen.

  • Fatigue and low energy: A sense of fatigue and low energy levels is a common symptom of high-functioning depression. Despite external appearances of normalcy, individuals may struggle with daily tasks due to a constant feeling of tiredness.

  • Difficulty concentrating: High-functioning depression can impair cognitive functions, leading to difficulties in concentration and decision-making. Individuals may find it challenging to focus on tasks at work or home, affecting their overall productivity.

  • Changes in appetite or weight: Fluctuations in appetite and weight are common symptoms of high-functioning depression. Some individuals may experience an increase in appetite and weight gain, while others may notice a decrease in appetite and unintentional weight loss.

  • Insomnia or hypersomnia: Disruptions in sleep patterns are prevalent in high-functioning depression. Some individuals may struggle with insomnia, finding it difficult to fall or stay asleep, while others may experience excessive sleepiness or hypersomnia.
  • Feelings of hopelessness: Feelings of hopelessness and a pervasive sense of pessimism are hallmark features of high-functioning depression. Individuals may struggle to envision a positive future and may feel stuck in a cycle of despair. People might feel pessimistic, worthless, and guilty.

While these symptoms don’t impair daily functioning, they have a great impact on one’s quality of life. High-functioning depression can also present and perpetuate unique challenges of the need to hide symptoms. This can accentuate feelings of isolation, stress, and anxiety. The manifestations of high-functioning depression can impact motivation and self-worth, can impair relationships, and lead to internal struggles.

Treatment options for high-functioning depression

Given the unique challenges posed by high-functioning depression, tailored treatment approaches are essential. A comprehensive treatment plan may include a combination of the following:

  • Medication: In some cases, antidepressant medications may be prescribed to help regulate neurotransmitter imbalances. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed antidepressants that can be effective in managing depressive symptoms.

  • Lifestyle changes: Adopting healthy lifestyle habits can have a positive impact on mood. Regular exercise, a balanced diet, and sufficient sleep contribute to overall well-being and can complement other treatment modalities.

  • Mindfulness and meditation: Mindfulness-based practices, such as meditation and yoga, can help individuals manage stress and cultivate a greater sense of awareness. These practices promote relaxation and may alleviate symptoms of high-functioning depression.
  • Support groups: Connecting with others who share similar experiences can be a valuable aspect of treatment. Support groups provide a sense of community, understanding, and encouragement, reducing feelings of isolation.

  • Workplace support: For individuals experiencing high-functioning depression, it is essential to communicate with employers and colleagues about their mental health needs. Workplace accommodations, such as flexible schedules or reduced workloads, can contribute to a healthier work environment.


High-functioning depression often goes unnoticed due to societal expectations and stigmas surrounding mental health. It is crucial to foster an environment that encourages open conversations about mental health and seeks to destigmatize seeking help. Education and awareness initiatives can play a vital role in helping individuals recognize the signs of high-functioning depression and understand that seeking support is a sign of strength, not weakness.

High-functioning depression is a silent struggle that many individuals face, skilled at masking their internal turmoil. Recognizing the causes, symptoms, and treatment options for this condition is a crucial step in promoting mental health awareness and breaking the stigma associated with depressive disorders. We can encourage individuals to seek help by fostering a supportive and understanding community, begin on their journey to recovery, and ultimately achieve a healthier and more fulfilling life.

For personalized support in managing high-functioning depression, reach out to Rocket Health today.


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Gupta, S. (2022, July 12). “What is ‘high-functioning’ depression?” Verywell Mind.

Remes, O. et al. (2021). Biological, psychological, and social determinants of depression: A review of recent literature. Brain Sciences, 11(12).

Rottenberg, J. et al. (2018). The curious neglect of high functioning after psychopathology: The case of depression. Perspectives on Psychological Science, 13(5).