• Dr. Chloe Robinson

"But you always seem so happy": Leading a double life with high-functioning depression.

Updated: May 30



Think about the word ‘depression’. What does this word mean to you? What do you see when you think about depression? And importantly, how would you go about recognising signs of depression in a loved one? We throw around the word ‘depressed’ daily, and whilst most of us experience this to be a fleeting state of mind, for a minority this is a persistent, draining, weight-like feeling which doesn’t leave.


High-functioning depression is on the opposite end of the spectrum to major depressive disorder (MDD) and typically refers to depression which is persistent yet doesn’t appear to stop the inflicted person achieving goals at work, maintaining relationships and carrying out day-to-day tasks. High-functioning depression isn’t a clinical classification of a depression type, but specialists often refer to under the umbrella of dysthymia, persistent depressive disorder and/or chronic depression.


Recognising the signs of high-functioning depression isn’t always easy. Imagine a person who appears to be living their best life. They have a good job, are high-achievers, are highly-productive and yet hold down relationships, friendships and finances without any apparent struggle. They are the proverbial ‘duck on the water’; on the surface they are doing well, but what you don’t see is the hidden struggle just to keep going.


Despite the stigma around mental illnesses slowly being dissolved, some conditions are so well disguised in daily life that it makes is almost impossible for sufferers to be supported. Quite often, people suffering with high-functioning depression bury themselves in their work as a method of distraction and/or to deafen the inner negative voices. The issue with this is sufferers then attribute self-worth with work performance, which enters them into a dangerous cycle of self-hate when major depressive episodes strike and result in inability to function at work.

I have previously explored similar themes in other posts on this site, namely the ‘Soft-minded or Suffering’ and ‘Imposter Syndrome’ posts, however here I wanted to talk about the underlying illness which is intrinsically intertwined with these concepts. Many people consider academia and work place pressures as a cause for depression, as opposed to high-functioning depression being an illness which is pre-existing and that lingers and can be flared up by external pressures. When I think about my own experience with depression, I find it hard to tease apart whether my need for perfection and achievement was a trigger for depression or whether depression has always been a part of me and striving in school/university/work has been a coping mechanism.


I was inspired to write this post today because today is a bad day. Today I cannot focus, I cannot think, and I am plagued with negative thoughts. Whilst I have been super productive all week submitting manuscripts, responding to reviews, planning new research with colleagues and attending fitness classes, I am left feeling very empty today. Empty is probably the best way I can describe how I feel 95% of the time. Now those reading this who know me will probably be confused at this point, because ‘empty’ is probably not a word people would use to describe me and that is part of why I wanted to write this. “I’m OK”, “I’m really happy I managed to publish that paper”, “I loved that class last night”. They say if you say a lie again and again many times even you will end up believing it, so that is what I do. This pseudo-happiness is an exhausting feat. I envy those who feel fulfilled after a week of productivity, I envy those who find sustained joy in their activities outside of work and I envy those who know they are genuinely happy.

To aid understanding, I scoured the internet for symptoms of high-functioning depression and the most common symptoms experienced by the afflicted are:

· Relentless self-criticism and doubt

· Feeling of guilt and worry over the past and future

· Seeking perfection in work and life

· Inability to rest and slow down

· Upset by small issues


Now, this isn’t an exclusive list. Being human we are all different and all feel differently, but the above most definitely represents my daily battles in a nutshell. It isn’t so much the symptoms themselves which makes high-functioning depression such an issue, but the frequency and intensity of symptoms experienced. Below is how much each of these symptoms interrupt with the waking hours of my daily life.


Support for those who suffer with high-functioning depression is hard to come by, as quite often either they themselves do not recognise their symptoms as being depression, or they have a hard time convincing specialists that they have a problem. With Imposter Syndrome being a key demon involved with depression, sufferers end up stuck in the trap of considering themselves ‘not depressed enough’ to seek help and in these instances high-functioning depression can go unnoticed by friends and family for months or years, because it hides behind the ability to function.


Mental illnesses, much alike physical illnesses, are on spectrums and different combinations of symptoms make each sufferer experience different versions of the same illness. To continue breaking down the wall that is mental illness stigma, sharing our unique journeys with mental illness(es) is of vital importance. For those reading this who are suffering - together we are not alone. And for those reading this who do not personally suffer from mental illness – check in on your friends and family. People with high-functioning depression slip under the ‘depression detector’ with devastating consequences. Again, I ask - Think about the word ‘depression’. What does this word mean to you? What do you see when you think about depression? And importantly, how would you go about recognising signs of depression in a loved one? Challenge your own perception of depression and help de-stigmatize mental illness.


Resources and extra reading:

· 8 Things People with High-Functioning Depression Want You to Know. https://www.healthline.com/health/what-you-should-know-high-functioning-depression#3

· What Is High-Functioning Depression? https://www.talkspace.com/blog/what-is-high-functioning-depression/

· The Dilemma of High-Functioning Depression. https://www.psycom.net/high-functioning-depression/

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