It's easy to think about mental illness in terms of stereotypes. People with anxiety have panic attacks at the thought of a social obligation. People with PTSD go catatonic at a car backfiring. People with bipolar disorder bounce between sadness and a chipper mania like a yo-yo trick.

The reality is, these depictions are far from the truth, and in some cases are actively harmful to the people they ostensibly represent. Mental illness takes on many different forms, and it's not always obvious, even to close friends and family.

High-functioning depression is one of these difficult-to-recognize mental health issues. People with high-functioning depression often appear fine on the outside, and sometimes don't even recognize that they themselves are suffering. Yet it's still dangerous, a struggle that can lead to intense burnout, less high-functioning depression, and a whole range of coping mechanisms from self-harm to drug abuse and more.

So, whether you're worried about a coworker, a family member, or even yourself, it's a good idea to learn what high-functioning depression looks like, how to spot the telltale signs, and what you can do about it when you recognize it.

DISCLAIMER: This article is for informational and educational purposes only and should not be considered medical or psychological advice. The information presented here is not intended to diagnose, treat, cure, or prevent any mental health condition or replace professional therapeutic care. Every individual's experience with trauma and mental health is unique. Please consult with a qualified mental health professional, therapist, or healthcare provider to determine the most appropriate treatment approach for your specific situation. If you are experiencing a mental health crisis or emergency, please contact your local emergency services or crisis hotline immediately.

What Does High-Functioning Mean?

The term "high-functioning" is used throughout discussions of mental health. It was originally coined all the way back in the 80s as a way to differentiate people with autism: the lower-functioning individuals who struggle with everyday tasks, and the higher-functioning individuals who face smaller challenges and can appear outwardly neurotypical.

Since that time, particularly in the 90s and early 00s, use of the term greatly expanded as more open discussions of mental health started to happen. You may have heard or seen references to people who are:

• High-functioning alcoholics
• High-functioning depression
• High-functioning autism

Surprisingly to many, however, it's not actually a clinical term. There's no official medical definition of high-functioning. Instead, it's a more casual term used to describe a subset of people with specific mental illnesses or neurodivergences.

Doctors, nurse practitioners, psychiatrists, and psychotherapists don't use the term high-functioning to describe or diagnose their patients. You won't find it charted on a medical sheet or listed on an official diagnosis.

Instead, the term high-functioning is more of a self-appellation. People use it to describe themselves when they recognize the symptoms they're experiencing, but want to minimize the impact.

There are a few possible reasons this has come up more and more over the last decade or so.

Openness, Shame, and Empathy

One theory is that it's a reflection of more frank and open discussions of mental health in casual settings. Mental health disorders are often a stigma, viewed as a personal failing, with shame attached to them. People don't like to discuss ways in which they aren't perfect and healthy, especially mentally.

Attaching "high-functioning" minimizes the severity of a mental health disorder. A high-functioning person with anxiety gets nervous around new experiences but doesn't cancel plans or suffer from agoraphobia. A high-functioning person with depression feels sad from time to time, but doesn't shut themselves in their bedroom until they lose their job.

Some people view this as a sort of stolen valor for mental illness. It's adopting the terminology of mental health, without truly suffering from the disorders they claim to have.

Indeed, this is part of why mental health professionals don't use the term in their diagnoses. Part of having a diagnosed mental health disorder is that it affects life in tangible, negative ways. Being "high-functioning" by definition is minimizing that impact. It's sort of like claiming a car that runs fine is a "high-functioning junker" and saying it doesn't run when it's stopped.

It's a way to showcase being open and frank when discussing mental illness. A way to say "hey, I know what you're talking about" while still being able to claim the status of an effective, industrious employee, one unaffected by these mental struggles.

To be clear, that's just one way of looking at the term, and it's one of the more negative viewpoints.

Coping and Masking

Another possibility is that it's a reflection of coping strategies. A person with depression can work with a therapist, learn to handle their depression, and build up a set of coping mechanisms that are healthy and effective for them. It doesn't mean they don't suffer from depression, but it does mean that they know how to handle it when it gets bad. They don't let it rule their life. The function despite it.

To a therapist, that's not a special label. Instead, it's more of a descriptor of success. Mental health is an ongoing battle with no terms for victory, just a win each day.

Is this a good way of looking at it? Maybe. Mental illness isn't exactly something that can be cured, only managed, and someone who achieves a "high-functioning" state while managing it is someone who is seeing success.

The caveat here is that not everyone who maintains that high-functioning state is someone who has healthy coping mechanisms. Plenty of people cope with mental illness through unhealthy means, most visibly through substance use, but in other ways as well. You could bet that if he were alive today, discussions of Robin Williams' mental health struggles would characterize him as high-functioning.

Viewed through a certain lens, being high-functioning with depression is a lot like masking the symptoms and struggling alone in silence.

Recognizing the Symptoms of High-Functioning Depression

Regardless of why the term is being used, the reality is the same. A person with high-functioning depression is someone who is suffering from depression, but who isn't showing it outwardly. The more obvious symptoms of severe depression, such as anhedonia, irritability, outbursts, brain fog, fatigue, withdrawal from friends and family, decreased or poor performance at work or school, and high-risk behaviors, are hidden.

We've put together this list of signs and symptoms for two purposes.

One is for self-evaluation. Many people, especially people who have lived with depression for their whole lives and who were raised in an environment that was not conducive to an open discussion of mental health, end up masking and hiding their feelings until they can no longer be effectively hidden.

It's important to be able to recognize the signs in your own behavior and feelings, so you can know when it's time to seek help. No matter how high-functioning you feel like you may be, it's always better to get professional assistance, establish proven and effective coping strategies, and even seek out medication if necessary. Even if you've been handling it alone for years, you can still benefit from assistance even now.

The other is for the evaluation of others in the workplace. Seeing the signs in a coworker may be an opportunity to say something and help someone take the next step towards seeking treatment. Some people don't realize how they're coming across to others, and may not be quite as high-functioning as they think they are.

So, what are the symptoms to watch for?

Persistent low energy, low mood, and fatigue. Depression saps your energy and your will, and that means even when you can do your job, you might not do it with "pep in your step" or as quickly as you used to. Motivation is lower, you don't do as much above and beyond the minimum, or you just constantly feel like you're operating on a low battery. It is, after all, a type of mood disorder.

Low self-esteem and frequent self-criticism. Perhaps one of the more obvious signs, when you recognize it for what it is, is the self-critique common among those with higher-functioning depression. Low self-esteem and self-criticism are easy ways to shift the attitude and blame away from an underlying illness.

Loss of interest or joy in pleasurable things. Clinically known as anhedonia, this depression symptom is the lack of joy or pleasure. Maybe you used to have fun at work, social mixers or milestone parties, and now you can't bring yourself to smile. Maybe the hobbies you used to enjoy have fallen by the wayside as you have no energy to partake. Maybe you just don't tell the jokes you used to around the water cooler.

Difficulty in concentrating and making decisions. While this is frequently more of a symptom of anxiety than of depression, it can manifest with both. With depression, it's less about forecasting all of the things that could go wrong and more about just not having the desire to make a choice. You wonder why it matters, why it needs to be done at all.

Overall sleep and appetite changes. Depression affects the mind and body. A depressed mood makes it harder to find the will to regulate your diet and sleep. Feedback loops with neurotransmitters that fall out of balance will cascade.

Some people sleep too much, maybe coming in late to work or leaving a little early, and are still tired all the time. Others sleep too little, burning the candle from both ends, even though their workplace productivity is no higher than before.

The same with diet; you might eat too little, even skipping lunch breaks, and finding no joy in food. Or, you might eat too much, finding it difficult to make it through the day without a snack at hand. The microdoses of dopamine from a candy bowl are all that keep you going.

Physical aches, pains, and digestive distress. Depression isn't all in the mind; it's physiological. Moreover, the previous symptoms of diet and sleep also affect physical health. If you always feel sore and achy, especially if you have no real reason to feel that way, it's worth watching.

Recognizing the symptoms in someone else can be difficult. Someone who is tired all the time could be suffering from depression, or they could just not be sleeping well for unrelated reasons in their lives. We live in a time where burnout and stress are very common, and depression isn't always at the root of it.

Recognizing the symptoms in yourself is also tricky, since it requires introspection and the ability to be open, at least in your own mind, with the reality of the way you feel. Often, we build up a framework of justifications and rationale, explaining away everything through a complex web of excuses, when it could all be summed up with an admission of depression.

There's a reason that depression with high functioning or effective masking is called the invisible struggle so often, and why those who we lose to the illness are often described as though it came out of nowhere.

What to Do When You Recognize High-Functioning Depression at Work

What happens if you do some thinking and you recognize several of these symptoms?

If you're recognizing them in yourself, then you're already taking the first step. As they say, admitting you have a problem is the first step to solving that problem. Acknowledging that you're struggling with depression, no matter how high-functioning you feel like you are, is necessary to start to seek help.

At BMC-Troy, we see many people who struggle with depression at all levels of severity, and we're here to help. From an initial assessment to ongoing therapy to medication, we can help you navigate the way you feel and help you move from high-functioning to functional.

Things get trickier if you think you're recognizing the symptoms in someone else. Sometimes, you're right, and saying something can be the push they need to seek help. Other times, it simply causes them to withdraw even more. There can also be underlying causes you don't know about; a coworker with the symptoms of depression could have a spouse going through serious health issues they don't want to discuss. The reason is there, you just can't see it.

Even so, it can be valuable to speak up. Look for ways to be supportive and have a discussion with them. Check if your workplace offers any kind of assistance, and offer a tip (anonymous if necessary) to get the ball rolling.

If you think it's time to seek the assistance of a professional, we encourage you to reach out to our office. You can fill out a new patient intake form right here. Call our office at 248.528.9000 if you have any questions on how to get started.