What is High-Functioning Depression and How to Know If I Have It?

W. Nate Upshaw, MD

W. Nate Upshaw, MD

Dr. William Nathan Upshaw is the Medical Director of NeuroSpa TMS®. Since receiving training from the inventor of TMS Therapy nearly a decade ago, Dr. Upshaw has been a pioneer, champion and outspoken advocate of TMS Therapy. Dr. Upshaw’s holistic experience in the field has transformed him into Florida’s leading advocate for widespread accessibility to TMS Therapy.

About Dr. Upshaw

We tend to think of psychological disorders as all-consuming and debilitating, and it’s true that they can be and often are. However, people with functional depression get up every day, get dressed, go to work or school, and often appear to be thriving, but on the inside, they’re suffering. High-functioning depression (HFD) is not a clinical term; it’s not a term a mental healthcare professional would formally use and it’s also not a diagnosis. However, the condition it refers to is called persistent depressive disorder (PDD). A person living with PDD experiences all the symptoms of major depression, to a lesser degree and less intensely than someone with major depressive disorder. However, people with PDD rarely get any respite. They live with their symptoms daily, for years at a time. A person with persistent depressive disorder may have as much as two months of a normal mood at a span, but rarely, if ever, longer.

How is High-Functioning Depression Different from Major Depression?

How As discussed above, high-functioning depression is not a clinical diagnosis or term. However, for all intents and purposes, it’s close to what mental health professionals define as persistent depressive disorder (PDD).

The primary difference between PDD and major depressive disorder (MDD) is the length and intensity of symptoms. For a person to be diagnosed with PDD, they must have had symptoms for at least two years. In contrast, the symptoms of major depression are much more intense and only need to be present for two months.

Unlike PDD, there’s no such thing as high-functioning major depression. By its definition, major depression gets in the way of even adequate performance. It is debilitating and presents a roadblock to a person’s desired functioning in all aspects of life.


Symptoms of Major Depressive Disorder and Persistent Depressive Disorder

  • sad, depressed mood most of the day, most days of the week
  • persistent and intrusive feelings of guilt, hopelessness, and helplessness
  • unusual levels of fatigue
  • increased aches and pains
  • impaired concentration and memory
  • sleeping too much (hypersomnia) or having trouble sleeping (insomnia)
  • loss of pleasure in activities that previously have been enjoyable (anhedonia)
  • unusual weight loss or gain
  • feeling like you’re moving in slow motion, having trouble speaking, problems with coordination (psychomotor impairment)
  • thoughts of death, dying
  • pessimistic outlook (“things aren’t going to change”)

 

The symptoms of high-functioning depression are similar to those of major depressive disorder. They are less severe but last longer than those of major depressive disorder.

For a diagnosis of PDD to be made, the following factors must be present:

  • symptoms must occur most days of the week for a span of at least two years
  • symptoms cannot be explained better by the presence of a physical disorder
  • symptoms cannot be explained better by another psychiatric disorder
  • the individual has not experienced mania or hypomania (unusually elevated euphoric moods that come with large amounts of energy)
  • the symptoms must cause impairment in at least one area of a person’s life

Treating High-Functioning Depression

Coping with high-functioning depression wears a person down over the years, but there are effective treatments for high-functioning depression that lead to lasting improvements in a person’s mood and mental clarity. Typically, high-functioning depression is treated with medication and psychotherapy (talk therapy).

Psychotherapy offers several kinds of approaches to treating high-functioning depression, including Cognitive-Behavioral Therapy (CBT). Cognitive-Behavioral Therapy for persistent depressive disorder involves examining how a person’s habitual, self-defeating thought patterns affect one’s automatic responses to events and situations. By learning to identify one’s ingrained thinking patterns that harm mood and ability to cope, it’s then possible to learn to adjust how one reacts and how one approaches problem-solving.

Researchers believe that depression is caused by the brain’s failure to produce correct amounts of highly specialized chemicals that are responsible for our mood, thinking, and even movement. Antidepressant therapy is a common approach that involves taking medication orally. These medicines can take four to six weeks to work, and they all have some type of side effects.


Transcranial Magnetic Stimulation (TMS) for Depressive Disorders

If you’ve been diagnosed with depression and are looking for a modern, effective treatment, consider Transcranial Magnetic Stimulation (TMS). It’s an FDA-approved treatment for depressive disorders that uses projected magnetic fields to stimulate under-active areas of the brain thought to be involved in depression. TMS is non-invasive and is conducted in a doctor’s office. Each session lasts less than an hour and requires no sedation.


This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.


Works Cited

Ishizaki, J., & Mimura, M. (2011). Dysthymia and Apathy: Diagnosis and Treatment. Depression Research and Treatment, 2011, 1–7. https://doi.org/10.1155/2011/893905

Patel, R. K. (2020, October 7). Persistent Depressive Disorder. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK541052/.

Persistent depressive disorder (dysthymic disorder). (n.d.). Retrieved April 17, 2021, from https://www.nimh.nih.gov/health/statistics/persistent-depressive-disorder-dysthymic-disorder.shtml

Saltiel, P. F., & Silvershein, D. I. (2015, March 31). Major depressive disorder: mechanism-based prescribing for personalized medicine. Neuropsychiatric disease and treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386790/

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