High functioning depression: What is it, and what are the signs?

High-functioning depression isn’t always obvious.

To others, you may appear social and of regular energy and mood. To yourself, the reality can be quite different. While you still may be able to go about your day-to-day life while living with high-functioning depression, that doesn’t mean that you shouldn’t seek treatment — we encourage you to.

But before seeking treatment, it’s helpful to know what high-functioning depression is, what its signs are, and which treatment options are available to you. Please note that the information we share isn’t intended to replace the advice of your GP; if you would like to gain personalised, holistic medical advice, our team of board-certified doctors can help.

What is high-functioning depression?

High-functioning depression doesn’t have one official definition, but rather represents a set of symptom descriptors.

One way to look at it is this: A person with high-functioning depression engages in day-to-day life — as a person without depressive symptoms would — with long-lasting low mood, fatigue, emotional volatility, or similar.

While other depression-related diagnoses — such as Major Depressive Disorder (MDD), Persistent, Depressive Disorder (Dysthymia), Bipolar Disorder, and Postpartum Depression — are often characterised by debilitation, high-functioning depression isn’t. This means that its symptoms may not immediately interrupt or significantly hinder a person’s daily functioning, making it less visible and often overlooked.

Signs and symptoms of high-functioning depression

High-functioning depression isn’t a formal condition. This means that it isn’t present in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). With that said, there’s a couple of things to know:

• High functioning depression and ‘persistent depressive disorder (PDD)’ are often referred to interchangeably, although there are differences between the two — most notably: PDD is recognised by the DSM-5 and functions as a formal diagnosis.
• High-functioning depression may also be referred to as dysthymia — generally by non-medical professionals or individuals, but commonly so nonetheless.

Despite not being a formal medical diagnosis, individuals with high-functioning depression can still receive medical treatment. If you go about your day-to-day life while affiliating yourself with any of the following 14 symptoms, we encourage you to reach out to your GP or book a consultation with one of our board-certified doctors.

1. Feeling sad, helpless, or hopeless — often with brief, transient moments of happiness.
2. Loss of interest in activities that were previously enjoyable.
3. Changes in eating habits, whether eating too much or too little.
4. Sleep disturbances, including difficulty sleeping or oversleeping.
5. Trouble concentrating.
6. Experiencing negative thoughts about yourself and others.
7. Holding a generally pessimistic view of the world.
8. Feeling fatigued all the time, regardless of sleep quantity.
9. Crying or becoming emotional without apparent reasons.
10. Feeling overwhelmed by daily responsibilities like childcare, work, and household chores.
11. Experiencing feelings of unworthiness or impostor syndrome — coupled with a belief of not deserving happiness.
12. Being highly self-critical and struggling to accept compliments.
13. Attending social activities reluctantly or feeling as if you are forcing yourself to participate.
14. Using alcohol or drugs to cope with emotional distress.

Naturally, the above symptoms aren’t exclusive to high-functioning depression: It’s possible to persistently experience one or more of these symptoms in response to another psychiatric condition and/or situational circumstances. For this reason, we advise you to speak with a GP who can assess your condition and treat you accordingly.

Given their similarities, it may be possible that you’re experiencing PDD. This is a common psychiatric condition with 2.5% of the US adult population having experienced it at some point in their lives — 1.5% in the past year. In Australia, the figure of those who’ve experienced affective disorders (including PDD) at some point in their life sits at 7.5%.

The DSM-5 diagnostic criteria for PDD per the DSM-5 is as follows¹:

1. Depressed mood for most of the day, for more days than not, as indicated by subjective account or observation by others, for at least two years.
2. Presence while depressed of two or more of the following:
   • Poor appetite or overeating.
   • Insomnia or hypersomnia.
   • Low energy or fatigue.
   • Low self-esteem.
   • Poor concentration or difficulty making decisions.
   • Feelings of hopelessness.
3. During the two year period of the disturbance, the person has never been without symptoms from the above two criteria for more than two months at a time.
4. Persistent Depressive Disorder (PDD) can be diagnosed alongside Major Depressive Disorder (MDD) if the criteria for MDD have been continuously met for two years.
5. There has never been a manic episode, a mixed episode, or a hypomanic episode and the criteria for cyclothymia have never been met.
6. The symptoms are not better explained by a psychotic disorder.
7. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse or a medication) or a general medical condition.
8. The symptoms cause clinically significant distress or impairment in important areas of functioning.

In short, if you’re experiencing persistent feelings of depression that last for years rather than weeks or months, and these feelings include at least two of the specified symptoms, we encourage you to talk with your doctor to discuss the possibility of PDD.

Treatment options: How and when to seek help

There are two primary treatment categories to be aware of: medicine and psychotherapy. Depending on your symptoms, your GP may also prescribe natural interventions.

The treatment you receive depends on the severity and nature of your symptoms and ultimately depends on your doctor’s prescription. We advise you to speak with your GP on what medical interventions may be most appropriate for you, based on your symptoms. Beyond medications, your doctor may prescribe natural interventions:

• Exercise: 150 minutes of exercise each week notably reduces depression, as well as other common mental health symptoms². The specific number may change, though, depending on what your doctor thinks is best based on your circumstance.
• Diet changes: Similar to the mental wellbeing benefits of exercise, dietary changes display trackable improvements in mood and mental health. While foods, vitamins, and nutrients such as antioxidants, complex carbohydrates, protein, B vitamins, vitamin D, selenium, and omega-3 fatty acids can all contribute to better mood regulation, your GP will inform you on the best dietary changes for you³.
• Sleep adjustments: Healthy sleep and a health mental well being are directly associated — 75% of people with depression report having trouble falling or staying asleep⁴. If you battle with sleep, let your GP know.

These are just three other possible interventions that your GP may prescribe, depending on your symptoms, medical history and other relevant factors. GPs will commonly prescribe a mix of medicinal, natural, and therapeutic interventions. The most common of the therapeutic options for depression is Cognitive Behavioral Therapy (CBT).

During CBT, patients aim to identify and change negative thought patterns and behaviours that contribute to their depression. This therapy helps individuals challenge unhelpful beliefs or counterfeit truths and replace them with more positive, realistic thoughts, thereby improving their overall mental health.

Other forms of psychotherapy your GP may prescribe include Psychodynamic Therapy, Interpersonal, Psychotherapy (IPT), Mindfulness-Based Cognitive Therapy (MBCT), Supportive Therapy, or another.

Beyond medicine and psychotherapy, your doctor may also ask about more holistic factors: your sleep, diet, relationships, and exercise habits, among others. They’ll work with you to formulate an individualised plan, utilising the treatment option(s) that will be most beneficial.

How MedReleaf can help

Treating high-functioning depression requires a holistic approach — and our authorised prescribing doctors can help.

At MedReleaf Clinics, we prioritise patient health above all else. Our doctors are highly experienced in managing pain, sleep disorders, and mental health issues — dedicated to addressing your health concerns to enhance your quality of life.

We’re Australia-wide, offer after-hours appointments, and offer a streamlined process for you to get the holistic care you need.

Learn more about MedReleaf Clinics’ approach to primary care, team, and appointment booking details.

Reference list

1. Administration, S.A. and M.H.S. (2016). Table 10, DSM-IV to DSM-5 Dysthymic Disorder/Persistent Depressive Disorder Comparison. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t6/.
2. Singh, B. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British Journal of Sports Medicine, 57(18). doi:https://doi.org/10.1136/bjsports-2022-106195.
3. Bruce, D.F. and PhD (2023). Diet and Depression. WebMD. https://www.webmd.com/depression/diet-recovery.
4. John Hopkins Medicine (2019). Depression and Sleep: Understanding the Connection. Johns Hopkins
   Medicine. 25 Jun. https://www.hopkinsmedicine.org/health/wellness-and-prevention/depression-and-sleep-understanding-the-connection.