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The reality of high-functioning depression

Updated: Jun 28, 2023

As conversations about mental health are increasing and people share more and more about their difficulties, you are bound to have heard about depression. You may be quite familiar with the signs and symptoms of depression, whether you experienced them yourself or have heard from others. What you may not have heard about is "high-functioning" depression. It is not an official diagnosis, but it is terminology to describe people that experience depression but are high-functioning in the sense that they can mask it and function in day-to-day life by holding a job or studying.

Man touching hands looking at therapist

You can argue that people with high-functioning depression have less intense or fewer symptoms but my clinical experience tells me otherwise. If anything, the people I have worked with that have experienced the symptoms, have been doing so for a number of years, at least 2+. They have just found ways to appear functioning even though internally they might feel like their life is crumbling. They may seem to live a normal life and appear successful to others, but in reality, there is a real struggle with their mental health. So what does high-functioning depression actually look like?

Persistent feelings of sadness or emptiness

Even when everything seems to be going well, a person with high-functioning depression may still feel a deep sense of sadness or hopelessness. These feelings can be difficult to shake, and they may linger for weeks or even months at a time. They may say they feel sad for no reason, or they might feel so numb that they report feeling nothing at all.

Low self-esteem and self-criticism

People with high-functioning depression tend to have a strong internal critic that shames them for being the way they are. Their critic might call them "lazy", "a burden", "a lost cause" or a great number of other self-critical thoughts. They may have a negative view of themselves, believing they are not good enough or that they are a burden to others. They may be overly critical of their own performance, even when they have done well.

Tendency for perfectionism

This striving for achievement and success can lead people to push through and ignore their own feelings even if they could benefit from taking a step back and listening to their body and their needs. Others around them might reinforce this perfectionism by complimenting them for being "strong" for example, leading to a determination to live up to this image and continuing to ignore their own needs.

Feeling overwhelmed

Everyday tasks or responsibilities feel overwhelming. They may feel as though they are constantly behind or that they are unable to keep up with the demands of daily life. This can lead to feelings of anxiety or panic. It can also create cycles of self-sabotage through procrastination and putting things off which leads to a further decrease in confidence.

Physical symptoms

High-functioning depression can also lead to physical symptoms, such as headaches, stomachaches, or muscle tension. These symptoms may not be directly linked to a specific physical ailment, but they may be a sign of the person's underlying emotional distress. This is often a result of hiding their true feelings from others around them, resulting in somatic symptoms.

Difficulties with concentration

They may have trouble staying focused or completing tasks, even if they were once able to do so easily. They may feel easily distracted or find themselves procrastinating. This can also come due to low energy levels and tiredness which can be another symptom of depression or a result of changes in sleep and appetite.

Appear to be functioning to others

They may still have meaningful relationships or maintain a career or studies so they end up being overlooked by others who would think they are fine. But just because they are able to do all these, it does not mean that internally they are not struggling. People often report feeling like they were masks to hide who they truly are and how they truly feel.

Loss of interest in activities

This is one of the most common symptoms of depression in general. People may lose interest in activities they once enjoyed. They may feel a sense of apathy or disinterest in hobbies, social events, or other activities they used to find fulfilling. This can also lead to social withdrawal or isolation. Over time, this leads to further self-confidence issues which further fuels the depression.

The need to self-medicate

We all self-soothe from time to time and the behaviours we engage in can range from healthy to unhealthy to extremely dangerous. No one likes to feel so low for so long so we often learn to seek out activities that temporarily shut down or numb our emotions. This can be comfort eating but it can also include using alcohol and drugs. These might temporarily help how we are feeling but in the long term, they are bound to create other problems.

Ioana Rotaru is a London-based Psychotherapist specialising in working with people with histories of childhood emotional neglect and trauma who now want to improve their relationship with themselves and others. If you would like to explore addressing any of the issues in this article, please get in touch with Ioana at for a free 15-minute consultation about how therapy might help.

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