Although it’s not a clinical diagnosis, “high-functioning” depression is a term that is sometimes used to describe what many depressed people experience. On the outside, they look like they are coping well with life, but on the inside, things feel very different. At Highland Hospital Behavioral Health in Charleston, West Virginia, we help people who are dealing with a wide range of behavioral health conditions, including depression.
A Problematic Term
The term “high-functioning” is not ideal, as it:
- Can minimize the seriousness of depression
- Could make it seem as though all people with depression should be capable of “pushing through” their symptoms to do what society expects of healthy people
- May perpetuate the idea that you’re only depressed if there are obvious symptoms that are observable to other people
- Overlooks the impact of being chronically mentally ill
- Could unintentionally shame people with more typical presentations of depression by implying they are “low-functioning” in comparison
Struggling On the Inside
A person with depression may be able to make it to work or school most days, keep a roof over their head, the lights on, and food in the fridge. They might still maintain relationships and raise children. They might even appear to be thriving. Internally, however, they may still be dealing with many of the symptoms of depression:
- Chronic sadness and hopelessness
- Rumination
- Low energy levels and fatigue
- Heightened awareness of physical pain
- Thoughts of self-harm and suicide
- Perceived inadequacy
- Numbness and inability to feel joy
- Guilt
- Sleep and appetite changes
- Trouble completing the full range of tasks that others, without depression, can manage with ease
- Increased substance use
Can’t We Just Say “Mild Depression”?
Calling this type of depression mild isn’t necessarily accurate. When you read the list of symptoms above, it is difficult to think of someone who is having that experience as only mildly impacted, even if they manage to make it to work five days a week. The severity of the symptoms a person has could be moderate to severe, but they are somehow still managing to keep up external appearances.
The Impact of Untreated Depression
Thinking that someone only has “mild” depression because they can force themselves to function could mean that their condition is not detected, treatment is delayed, and they don’t get the support they need, despite struggling with serious symptoms. Experiencing prolonged, untreated depression symptoms can lead to:
- Substance use disorders
- Strained relationships
- Memory issues
- Problems at work
- Obesity
- Physical health issues
- Suicide
Supporting People With Atypical Depression Symptoms
By recognizing that someone might not present with the symptoms you would expect from a certain diagnosis and that this does not mean they are not suffering, you can become a good support for them.
- Be empathetic and non-judgmental.
- Offer assistance with daily tasks and encourage them to continue to perform self-care.
- Give them space when they need it, but continue to offer support.
- Recognize that you cannot fix everything and remind them that it’s okay to not be okay.
- Continue to reach out and maintain social connections.
- Encourage them to reach out for professional support – they may not believe they qualify for or deserve to receive help, because they are not as disabled by their depression as other people.
- Ask if they are having any thoughts of suicide and help them to stay safe:
- Listen without judgement
- Reassure them that they are important to you and you want to help them
- Do not leave them alone
- Ask them about what plan they have for ending their life and remove objects they are planning to use, such as pills, guns, ammunition, and sharp objects
- Help them to call or text the National Suicide and Crisis Lifeline at 988
- Help them to reach out to their doctor or therapist for an appointment
- Take them to the nearest emergency room or call 911 if you cannot keep them safe
- Follow up later to see how they are doing and make a plan to keep them connected with people who love them
At Highland Hospital Behavioral Health, we use trauma-informed care and evidence-based practices to support people who are struggling with behavioral health. Our interdisciplinary team treats each patient as a unique individual who is worthy of compassion and respect.
