What is high functioning depression?
Now depression doesn't start the day you can't get out of bed.
In reality, very few people suddenly become debilitated by depression.
Most of the times, it builds up over years of struggling to keep your head above the water while meeting all of life's expectations at the same time. So you can be deeply suffering with the symptoms of depression, even though you're still getting by doing everything that you're supposed to do.
That's why it's called high functioning depression and because outwardly everyone can see how well you're coping with life.. so it can be even harder to tell anyone because you feel this deep shame + you can't imagine how anyone would even believe you. So your suffering stays silent, but high functioning is not the same as happy & healthy.
The term 'high functioning' is not a clinical diagnosis, but depression is and the fact that you can make it to work or school every day does not mean that your mental health couldn't benefit from some work and some support.
Let’s deep dive.
High functioning depression is a term people will use to note that someone's depression is not getting in the way of their day to day functioning.
Perhaps they're able to still go to work or school or take care of their family.
And this is in contrast to a low functioning depressed person who may not be able to get out of bed or may not even be bathing or failing classes because they just can't pull it together enough to do these things.
High functioning is really more of a descriptive term and not really an official diagnosis.
But the reason it can be associated with dysthymia is because it is like having depression but the symptoms are not as severe, and they persist for a longer time (minimum of two years).So it is like having a low hanging cloud over you all the time.
That makes it difficult for you to feel enjoyment and satisfaction with your life. You may even find yourself feeling more negative than other people around you & you just don't feel happy.
One of the things that I ask patients when I'm doing an evaluation is when was the last time you felt good in yourself? People who have major depression (who have episodes that come and go), they may say “oh was about three years ago” even if they've had major depression for a long time. They can usually point back to a time in their life when they didn't feel depressed, even if it was years ago.
Whereas a person with dysthymia will usually say I don't ever remember feeling good or I've always felt this way. It is difficult for them to recognise a period of time where they didn't feel bad. And that's because the symptoms that they experience are chronic and long lasting.
In 2013 we had a new edition of the Diagnostic and Statistical Manual (DSM) and we changed the name from dysthymic disorder to ‘persistent depressive disorder’. The name is a little misleading though because the symptoms are not as severe as with major depression.
So in some ways, it really is like higher functioning depression.
Let's take a quick look at the criteria: For persistent depressive disorder, you need depressed mood for most of the day for more days than not for at least two years. (And in children & adolescents ,the mood can be irritable and not depressed lasting for a year instead of two years… to be diagnosed with dysthymia)
While depressed you must also have two or more of the following:
1.Poor appetite or overeating
2.Insomnia or hypersomnia
3.Low energy or fatigue
4.Low self esteem
5.Poor concentration or difficulty making decisions &
6.Feelings of hopelessness
[One of the big differences here between this and a major depressive episode is you need to have the six things instead of five of nine things with major depression.]
Another big thing that's missing with persistent depressive disorder as compared to major depressive disorder is the lack of suicidal thinking that you can see with major depression.
The next requirements are during the two year period (or one year for children and adolescents) is that you can't go more than two months without any symptoms.
A person can have a major depressive episode that occurs on top of the persistent depressive episode. And what that would look like is a person who's chronically depressed and they may be managing okay, but they're generally not happy and then they slip into a deeper depression. Now they have more of the symptoms that you see with a major depressive episode. These will be things like feeling worthless or hopeless or even feeling suicidal. They may even have significant weight loss or weight gain with persistent depressive disorder, or dysthymia. You may see you may have changes in your appetite but it may not translate to a change in your weight. If you get a major depression on top of your persistent depressive disorder, we call it a double depression.
When is it likely for you to develop a persistent depressive disorder?
It is something that can build up early - that can start as early as childhood, all the way up until early adulthood.
A risk factor for it developing in childhood is losing a parent or parental separation.
What is the management protocol?
Here's a brief summary of strategies for managing high-functioning depression:
1. **Professional Help:** Consult a mental health expert.
2. **Healthy Lifestyle:** Prioritize exercise, nutrition, and sleep.
3. **Stress Reduction:** Practice mindfulness, deep breathing, or yoga.
4. **Realistic Goals:** Break tasks into manageable steps.
5. **Stay Connected:** Maintain social connections.
6. **Enjoyable Activities:** Engage in hobbies you enjoy.
7. **Positive Self-Talk:** Challenge negative thoughts.
8. **Time Management:** Organize your schedule and priorities.
9. **Limit Alcohol/Caffeine:** Reduce consumption.
10. **Medication:** If advised by a professional.
Remember, individual needs may vary, so it's essential to tailor these strategies to your situation and consult a mental health professional for personalised guidance.
If you have dysthymia, one of the best approaches would be to seek therapy to remove the root cause of the issues and subsequently focus on rebuilding & rehabilitation through life coaching.
If you or anyone you know is struggling with double depression, medication is the first line of management.Medications and/or institutional care may be required to take the edge off in a crisis situation, followed by therapy & coaching to prevent relapse.