High Functioning Depression(A Guide)

In this article, we will discuss high functioning depression, its diagnosis and symptoms, the clinical picture, and the course of the disease, epidemiology, treatment, as well as prophylaxis.

What is High Functioning Depression?

High-functioning depression or dysthymia (dysthymic disorder) is chronic depression, a mood disorder with the same cognitive and physical problems as depression, but less severe and more prolonged.

Psychiatrist Robert Spitzer suggested the term “dysthymia.”

In the American classification DSM-5, dysthymia is known as “persistent depressive disorder.”

A diagnosis of high functioning depression can be made if the disorder lasts at least for two years.

Dysthymia most often begins at a young age, although the onset may be in middle and involutional age.

Sometimes a patient with dysthymia gets the correct diagnosis only after many years of the beginning of the disease.

If dysthymia begins in childhood, the patient believes that depressive symptoms are features of his/her character, and he/she does not speak about these symptoms to doctors, as well as to close people and friends.

The diagnosis is also complicated by the fact that in some cases, dysthymia appears simultaneously with other psychological disorders that “block” the dysthymic symptoms.

What Is Classic Depression? 

Mental health professionals characterize classic depression as a condition of extreme sadness.

Symptoms of classic depression may include inertia, persistent feelings of sadness and other influences on a person’s mannerisms, conduct and personality.

Other commonly experienced classic depression symptoms are: poor quality of sleep, weakness, low energy levels, changes in appetite, weight gain/weight loss, feelings of uselessness, self loathing, guilt, shame, indecisiveness and self-harm.

Individuals with classic depression may avoid exercise, experience higher than average levels of stress, and hide inside during daylight hours.

Diagnosis and Symptoms of High Functioning Depression (dysthymia)


The DSM-5 Guidelines for the Diagnosis and Statistics of Mental Disorders points to the following criteria needed to establish a diagnosis of high functioning depression:

  1. For two or more years, most of the time, the patient complains of a decreased mood or shows signs of low mood.
  2. During episodes of low mood, two or more of the following symptoms are observed:
  • Decreased appetite or overeating;
  • Insomnia or hypersomnia;
  • Fatigue or lack of energy;
  • Reduced self-esteem;
  • Reduced concentration of attention or difficulty in making decisions;
  • Pessimism or a sense of hopelessness.

3. Over the past two years (1 year for children and adolescents), criteria A and B have not been missing for more than two consecutive months.

4. Criteria for major depressive disorder may be present continuously for two years.

5. There was never a sign of a manic episode or hypomania, and never met the criteria for cyclothymia.

6. The disorder is better explained by schizoaffective disorder, schizophrenia, delusional disorder, or another unspecified schizophrenia spectrum disorder and other psychotic disorder.

7. These symptoms are not related to the physiological effects of substances (drugs or drugs that are abusive) and are not caused by another medical condition (such as hypothyroidism).

8. These symptoms cause significant negative consequences in the social and professional field, affect the academic performance of the individual or any other areas of his life that are important to him.


The diagnosis of high functioning depression, according to the international classification of diseases of the 10th revision, is made when the condition meets the following criteria:

  1. Constant or regularly recurring depression for at least two years; periods of normal mood last less than a few weeks, and there are no hypomanic episodes in between;
  2. Depressive episodes do not, at all or with rare exceptions, meet the criteria for mild recurrent depressive disorder;
  3. At least in some periods of depression, the condition is characterized by three or more of the following symptoms:
  • Decreased energy and activity;
  • Insomnia;
  • Loss of self-confidence or a sense of inferiority;
  • Difficulty in concentration;
  • Tearfulness;
  • Loss of interest or pleasure from sex and other pleasant activities;
  • A sense of hopelessness and despair;
  • A feeling of inability to cope with the routine requirements of everyday life;
  • Pessimistic perception of the future or deep in thought over the past;
  • Social self-isolation;
  • Less talkativeness than usual.

Are included:

  • Chronic anxiety depression;
  • Depressive neurosis;
  • Depressive personality disorder;
  • Neurotic depression (lasting more than two years).

Are excluded:

  • Anxious depression (mild or unstable);
  • A loss reaction lasting less than two years (prolonged depressive reaction);
  • Residual schizophrenia.

The typical symptoms of high functioning depression are: decreased mood decreased self-esteem, and lack of ability to have fun (anhedonia).

The clinical picture and course of the disease

The early onset of high functioning depression (till 21 years of age) leads to more frequent relapses and more associated symptoms.

The gradual overlap of pathological and affective disorders occurs already in the early stages of dynamics.

In this case, the picture is most often formed:

  • Hysterical dysphoria,
  • Chronic dysphoria.

After three years, more expressed depression disorders may join high functioning depression.

In such cases, it is about double depressions, which are observed in more than 2/3 of patients with dysthymia throughout life.

Variants of the course of high functioning depression (or dysthymia):

  • Dysthymia with the only major depressive episode (double depression);
  • Dysthymia with repeated major depressive episodes (double depression);
  • Dysthymia without a major depressive episode (“pure” dysthymia).

At least 75% of patients with dysthymia also have some chronic disease of organic nature or some psychological disorder.

Are possible the combinations of high functioning depression with the following disorders:

  • Panic attack;
  • Generalized anxiety;
  • Sociophobia;
  • Conversion disorders;
  • Somatic diseases;
  • Drug addiction;
  • Alcoholism.

People with high functioning depression are at increased risk of developing clinical depression.

Epidemiology of High Functioning Depression

  • According to some researchers, the prevalence of high functioning depression ranges from 3.1% to 6%; the average is 4.5-5%.
  • The disease usually develops in adolescence and is more common in women.

High Functioning Depression (Dysthymia) Treatment

There are some treatments for dysthymia. However, below, you can find some of them, which may be useful for you:

  • Psychopharmacotherapy – tricyclic antidepressants (TCAs): imipramine (melipramine), amitriptyline, clomipramine (Anafranil); selective serotonin reuptake inhibitors (SSRIs); and reversible MAO inhibitor of type A (OIMAO-A): moclobemide (Aurorix), which has a therapeutic effect equivalent to the action of TCA.
  • Psychotherapy – in particular, cognitive therapy, is most effective in the treatment of affective disorders. As an addition to individual psychotherapy, group therapy or support groups are useful, as they allow the patient to develop interpersonal communication skills and assertiveness, as well as increase self-confidence.


Since dysthymic disorder sometimes occurs in childhood, a necessary means of prevention is the timely detection of the symptoms of high functioning depression in children.

It is also useful to increase the child’s self-esteem and teach him/her to stay calm in stressful situations. 

s**cide and High Functioning Depression 

Since people who are experiencing high functioning depression hide it quite well, they are skilled at making sure no one knows the extent of their suffering.

This often keeps a person with high functioning depression from finding a support network when they need it most.

Those who are dealing with high functioning depression struggle to find friends or family members who they feel comfortable talking to about how they feel.

Since they don’t always look for the right kind of assistance, they often don’t seek help when they need to most.

Concealing heightened feelings of depression may increase someone’s risk for attempting or dying by s**cide. The s

The s**cide rate in the United States is expanding and shows a deep connection between depression and s**cide:

·      There are approximately 129 deaths by s**cide per day in the US.

·      s**cide is the tenth leading cause of  death in the United States. 

·      In 2017, more than 47,000 people died by s**cide.

·      In 2017, there were roughly 1.4 million s**cide attempts. 

How Might You Spot Someone in Your Life That May Be a Highly Functioning Yet Depressed? 

Most of the indications of high functioning depression are not immediately obvious.

If you’re concerned about someone, try to look for the following attributes: 

  • Increase alcohol consumption, especially in significant quantities. Alcohol can intensify depression symptoms and increase the likelihood for s**cidal thoughts.
  • The individual is very self critical
  • Significant emotional changes
  • People who are overly concerned about being successful, especially if success is a vehicle that can be used to get away from tormenting feelings.
  • People who feel that their existence is meaningless.

High Functioning Depression in Young Adults 

Young adults are also susceptible to high functioning depression. Young people with high functioning depression have interminable feelings of sadnesses or uselessness and can’t find the joy in life.

Young people may have their symptoms of depression go unnoticed, as their symptoms are less intense – yet longer enduring – than in other types of depression. 

How Might You Spot a Young Adult in Your Life That May Be Highly Functioning Yet Depressed? 

A young adult with high functioning depression appears to be irritable, ill-tempered, cynical or pitiful over a period of time.

Different symptoms can include doing poorly in school, behavioral conduct issues, causing trouble with other young adults in social settings and low self esteem. 

The degree of seriousness of these symptoms may vary widely, yet symptoms often last for two or more months.

Since high functioning depression often occurs alongside other emotional problems, this condition may be a lot more difficult to pick up than others.

People with High Functioning Depression about their Condition

“We hear a lot now about imposter syndrome, where people feel that they are just ‘faking it’ and are not as together as people think.

There is a form of this for those who deal with major depression and other forms of mental illness.

You become quite adept at ‘playing yourself,’ acting the role of the self that people around you expect to see and experience.”


“Living with high-functioning depression is very hard. Even though you can go through work and life and mostly get things done, you are not getting them done to your full potential. Beyond that, no one believes you are struggling because your life is not falling apart yet. I was s**cidal and close to ending it all in university, and no one would believe me because I was not falling out of school or dressing like a complete mess. At work, it is the same. We need to believe people when they ask for support.”


“A good day is me being able to get up before or right at my alarm, shower, and put on my face. I can push through being around people, as my job as a software trainer calls me to. I am not crabby or anxiety-ridden. I can push through the evening and have conversations with co-workers without feeling total despair. On a good day, I have focus and mental clarity. I feel like a capable, productive person.”


“I can be working on a story, and while I am typing, I have tears streaming down my face. That may work to the advantage of my client because I have so much heart and passion around meaningful stories, but it is pretty scary because the emotions run so deep.


Truths only people with high-functioning depression can understand

When we consider depression, we may envision an individual crying nonstop and unable to leave their room.

In reality, depression does not always look like this visual.

Depression manifests itself in a variety of ways-high functioning depression is no exception to this rule. 

Specialists state that high-functioning depression regularly isn’t noticeable to the vast majority of people.

On the off chance that you live with it, you might realize how self evident this diagnosis is.

Most days, you might put on a smile, exceed expectations at work and maintain what seem like good friendship.

This, however, doesn’t imply that you aren’t battling with a serious condition every single day. 

Seeking help can feel like a burdensome task

Numerous people managing high-functioning depression want to feel better and lead meaningful lives.

However, gathering the strength to look for help can feel exhausting.

Yet it’s important to keep in mind just how much the right combination of treatment might change your whole outlook on life.

It’s possible that if you haven’t thought of asking for help yet, now might be as good a time as ever to consider seeking guidance. 

How you act vs. how you feel

Karla Campos, who runs an advanced showcasing office in Tampa, Florida, and lives with high-functioning depression, said people constantly talk about how “cool, calm and collected” she acts.

In any case, appearances can be deluding. “When depression hits, all I need to do is be separated from everyone else, curl in a ball, and rest,” she said. “I can’t, however, so I have to put on a show. It feels like I’m acting.” 

“I ask myself, ‘What might Karla do on an ordinary day?’ Karla would say hi to people, she’d feel present, and she’d be full of energy,” she said. “However, on days that I’m discouraged, I would prefer not to say hi to anybody. It’s not that anyone else did anything wrong, it’s just that I need to be separated from everyone else because I feel depleted and debilitated.” 

You’re a harsh critic of yourself and others

When you battle with high-functioning depression, your merciless inner critic shames yourself and others said Valeria Skopich, a clinician at a military emergency clinic in Bila Tserkva, Ukraine. “You believe that you are a failure, your supervisor is not smart, your friend is the most irritating individual who ever lived, and life is essentially agonizing,” she said.  You can continually question whether you are on the correct path in your career, if you are in the correct relationship, what you are doing with your life and if you can ever fully adapt to being a grown-up,” she said. 

Self-care feels impossible.

“A few of my clients have shown up to my office looking like they’ve been hit by a car,” said Azizi Marshall, organizer and CEO of the Center for Creative Arts Therapy, a psychotherapy practice in Chicago. “They have kept everything together in their day by day lives ― cooperating with partners, concentrating on their activities, keeping their life partners cheerful ― and when they go to their meetings with me, they at long last have a space where they can let everything go.”

These patients often feel like they need self care or that it will do anything beneficial for their well beings. 

Self-care is one of the most important things that you can practice if you have high functioning depression.

This may look different for everyone: for some, it could be reading a book and taking long walks.

For others, it could be baking a cake from scratch or painting with watercolors.

Self care may vary from person to person but is equally important for anyone suffering from high functioning depression.

FAQs on High Functioning Depression:

How can I manage my own high functioning depression?

High functioning depression can be managed through medication, psychotherapy, or a combination of both treatment modalities.

Self-care activities, such as meditation, exercise and drawing can also help high functioning depression seem less overwhelming.

Working with a professional and understanding what works best for you are extremely important in making sure that high functioning depression is as manageable as possible. 

Does high functioning depression ever go away?

While high functioning depression never fully disappears, it does get better with time.

There are several coping mechanisms and techniques that can be used to help make your condition more manageable.

Talk to your healthcare provider if you’re interested in additional treatment options for dysthymia.

Quotes About Depression

“It is so difficult to describe depression to someone who has never been there because it is not sadness. I know sadness. Sadness is to cry and to feel. However, it is that cold absence of feeling—that hollowed-out feeling.” —J.K. Rowling

“What they do not tell you about depression is that sometimes it feels a lot less like sadness and a lot more like the emotional equivalent of watching paint dry.” —Alexis

“I was so scared to give up depression, fearing that somehow the worst part of me was all of me.” —Elizabeth Wurtzel

“Sometimes, I think depression is one way of coping with the world. Like, some people get drunk, some people do drugs, some people get depressed. Because there is so much stuff out there that you have to do something to deal with it.” —Ned Vizzini

“Our Generation has had no Great war, no Great Depression. Our war is spiritual. Our depression is our lives.” —Chuck Palahniuk

“If you are depressed, you are living in the past. If you are anxious, you are living in the future. If you are at peace, you are living in the present.” —Lao Tzu

  1. Beating the Blues: New Approaches to Overcoming Dysthymia and Chronic Mild Depression
  2. HFNE “Existential Depression”
  3. HFNE “Major depressive Disorder.”
  4. Persistent Depressive Disorders in the series Advances in Psychotherapy: Evidence-based Practice
  5. The Dysthymia Cure: How to Overcome Dysthymic Disorder and Live the Happy Life You Deserve
  6. Video – Kati Morton “The 6 Signs of High Functioning Depression”
  7. Video – 7 Signs You May Have High Functioning Depression


High-functioning depression or dysthymia (or persistent depressive disorder – PDD), is chronic depression, and a mood disorder with the same cognitive and physical problems as depression, but less severe and more prolonged.

A diagnosis of high functioning depression can be made if the disorder lasts at least for two years.

Dysthymia most often begins at a young age, although the onset may be in middle and involutional age.

It can be treated by psycho-pharmacotherapy (TCAs, SSRIs, and OIMAO-A) and psychotherapy (especially CBT).

Please feel free to comment on the content or ask any questions in the comments section below.


  1. Dysthymia
  2. What Are the Signs and Symptoms of High-Functioning Depression?

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