High-functioning depression may sound like a bit of a misnomer, especially if you have a certain idea of what depression looks or feels like. Likewise, if you’re suffering from high-functioning depression, you may not even realize it because you may not have classic symptoms of depression. But there’s some debate if high-functioning depression is an actual diagnosis or not, according to Alex Podowski, LPC, an intensive outpatient program therapist at Texas Health Behavioral Health Center in Uptown.

“It is just depression. The term ‘high-functioning’ is really more of a social phrase than a [professional] diagnosis,” she explains. “In fact, high-functioning depression actually meets the qualifiers for a major depressive disorder diagnosis. Where the difference lies is whether the diagnosis is deemed mild, moderate or severe, and your acknowledgment of the condition.”

She adds that someone with high-functioning depression may only have one episode of depression versus persistent depression, which can make it harder to identify as something more than just a bump in the road during a stressful time.

“In short, ‘high-functioning’ depression is depression that we have just socially accepted and not stigmatized as harshly,” she says.

While high-functioning depression is depression, Podowski adds that the trendy name may actually take away from the severity of the situation — for both the person suffering and those observing.

“[The name] seems to perpetuate our hustle culture and/or the idea of, ‘if you are still functioning, your depression must not be that bad’ — which is false,” she explains. “I, oftentimes, lean into the idea of just because you CAN do something, does not mean you SHOULD be doing something. Ultimately, people can function with different levels of depression, but that does not always mean the outcome will be continued forward momentum in that person’s life.”

What “High-Functioning” Depression Can Look or Feel Like

The disregard we as a society may give to high-functioning depression can cause more harm than good. The idea of ‘pushing through’ often creates a higher risk of more severe depressive episodes in the future, Podowski adds.

But it can be difficult for someone to identify mild depression or “high-functioning” depression within themselves or others since there can be such a wide range of symptoms and many can seem vague or similar to other conditions, such as stress, that we as a society have normalized. Because of this, you may not even realize you’re having a depressive episode and therefore don’t seek help while the depression is still in a mild form.

Some symptoms of depression include:

• Reduced daily functioning
• Reduced appetite or Increased appetite
• Panic attacks
• Isolation
• Poor focus
• Poor concentration
• Decreased interest in things, especially things that previously brought you joy
• Poor sense of self-worth or a negative internal dialogue
• Reduced sleep or increased sleep
• Suicidal ideation
• Feelings of hopelessness or helplessness
• Increased agitation
• More “bad days” than “good”
• Crying spells

Podowski adds that living with high-functioning depression is much like living with depression, except the difference is downplaying the severity by adding the “high-functioning” tag to it. With that comes the potential to keep pushing yourself to your capacity, creating an increased risk of burnout while minimizing the pain, sadness or hopelessness you may be feeling on a daily basis.

To add to it, she says those who suffer from “high-functioning” depression are more at risk for feeling an overwhelming sense of shame when their body shuts down and they “fail” at pushing past what they’re feeling.

Lifting the Stigma and Asking for Help

Even today, the stigma around mental health is still incredibly alive, according to Podowski, which leaves people functioning from a dangerous and unsustainable space much longer than needed.

“The lack of sleep or increased sleep, high levels of stress, abnormal eating habits, isolation and burnout due to perfectionism and overworking are not vague, but rather seen as socially acceptable,” Podowski explains. “I think that is why depression for most individuals goes unchecked for a long time. We continue functioning until our bodies basically shutoff for us, which leads to a much more severe depressive episode than if individuals had been given the agency to seek care earlier.”

She adds that normalizing the idea of “burning the candle at both ends” makes anything less than that seem as if someone is being “lazy,” which is a common and harmful stigma associated with depression. It’s why, she says, behavioral health professionals are seeing more and more cases of high-functioning depression or depressive symptoms.

“Most individuals who are presumed ‘lazy’ are actually burnt-out or just attempting to learn how to self-soothe, decompress or relax,” Powdowski explains. “Lack of motivation and energy towards things that used to feel compelling or engaging can be an indicator that we need a break. I would encourage people to shift the narrative from ‘lazy’ to needing a break, needing increased balance or helping them realize that they are in a state of high stress, anxiety and fear, which can lead to avoidance.”

Lifting the stigma on depression, high-functioning or not, can open the door for many who are struggling to seek help. Getting help early and often can help you manage thoughts and symptoms while they are still mild or are starting to increase in severity from “life’s little stressors” to something more overwhelming. Podowski adds that getting help while in the early stages also means you can potentially receive care at the outpatient level, such as seeing a licensed professional a few times a week or bi-monthly, versus needing more intensive care that requires treatment in an inpatient facility.

“If you push through just because you are still ‘functioning’ then you have the risk of not intervening until you are at a severe risk to yourself or others, which would require a higher level of care (inpatient care),” she explains. “Also, it is important to realize that the term ‘functioning’ has a really wide scope/definition. What functioning looks like to me can be different than what functioning means to you. The term is too ambiguous, which can lead people into thinking they are doing just fine in life when, in reality, the person is suffering silently. The term ‘high-functioning’ depression has done that to us — increased the risk of suffering in silence.”

Getting the Help You Need

Podowski adds that the beauty of treatment is the abundance of options, especially now as the pandemic has normalized telehealth services that make getting behavioral health treatment even more accessible to more people. The pandemic has also brought up the importance of taking care of our minds versus just our bodies.

“I personally believe outpatient treatment options can be beneficial for anyone — learning about boundaries, healthy communication, cognitive distortions, balance, and emotional intelligence can be helpful in arguably ‘all’ settings,” Podowski says. “Texas Health Behavioral Health even has evening programs to offer care for individuals who are hesitant or do not need to take leave from work.”

Podowski encourages people to start the dialogue early, saying it’s never too early to get help, even if that help just looks like carving out an hour of your time once a week to talk about your stressors with someone that can help you increase your coping skills and relieve your stress.

“If you are starting to feel discomfort, give yourself permission to need support,” she adds. “If we continue shaming people over needing help, we are going to continue the idea that it is ‘ok’ to be miserable/sad/scared/overwhelmed/hopeless, because you can still make it to work, clean your dishes or pick your kids up from school. I will always advocate for all levels of care, but it is beautiful to see people step into treatment at the lowest level of care possible, first.”

If you are starting to feel burnout, high levels of stress or see dysfunction in your day-to-day, Texas Health Behavioral Resources are offered at 18 locations throughout North Texas. For additional information or to find resources, call (682) 626-8719.