In an article about high-functioning depression, a person in bed

High-Functioning Depression: A Dismissed Mental Illness

Despite its name, the disorder is associated with significant functional impairments. Yet, these challenges are often overlooked or misattributed, leaving the illness undetected.
August 23, 2022
9 mins read

Depression is a highly prevalent mental illness that affects individuals of all identities and demographics. In 2015, roughly 6.1 million adults in the United States had at least one depressive episode within the last year, accounting for approximately 6.7% of the nation’s population. However, depression is not always an obvious condition, and many people suffer from it in silence.

When most people imagine what depression looks like, they visualize a person who sleeps all day, is unable to hold a job or maintain a social life and often is a threat to their own safety. While some individuals with depression present in this stereotypical way, depression is a highly complex disorder that manifests very differently from one individual to the next. In many cases, depression presents more subtly, often going entirely undetected.

Oftentimes, depression is only identified once it has progressed to a very severe level, rendering a person unable to function. However, the vast majority of cases are relatively mild and often go unnoticed. This is often the case for people who experience persistent depressive disorder (PDD), which is classified as a mild to moderate form of chronic depression. More colloquially known as “functioning depression” or “high-functioning depression,” PDD is an ongoing mental illness that persists for years at a time, taking a serious toll on an individual’s mental health and quality of life. While PDD is not the most common form of depression, it still affects about 3% of the U.S. population.

Nevertheless, this disorder can be difficult to identify, as the signs and symptoms are subtle; oftentimes, individuals with PDD experience fatigue, hopelessness and low self-esteem. Others with PDD have trouble concentrating, sleeping or eating. These symptoms can be severely detrimental to individuals’ physical health and wellness, leading to malnutrition, sleep deprivation and chronic pain. Furthermore, serious chronic illnesses — including heart disease, cancer and diabetes — are more likely to develop in individuals who experience ongoing depression. Unsurprisingly, PDD is also linked to greater utilization of health care.

Notably, people with PDD are more likely to experience unemployment and use public entitlements, such as welfare programs. Despite being known and referred to as “high-functioning depression,” PPD is associated with significant functional impairments. Moreover, people who struggle with PDD may find it difficult to establish secure connections and maintain romantic relationships. Still, these challenges are often attributed to other factors, leaving PDD undetected.

Undoubtedly, the impact of depression on individuals’ physical and mental health can be extremely debilitating, presenting a wide variety of negative complications. Still, many individuals with depression do not receive proper treatment or support. Although depression greatly interferes with a person’s ability to live a fulfilled life, the symptoms are likely to be dismissed as insignificant. Even worse, these symptoms are often attributed to a person’s laziness, carelessness or intrinsic lack of motivation.

Since the symptoms of PPD are less severe than typical depressive episodes, individuals experiencing it are likely still able to carry out their daily obligations and move through their normal routines. In fact, many people with PDD cannot recall the onset of their depression. Some people with PDD may even experience periods of normal mood and mental stability, which can last for up to two months.

For the most part, people with PDD can manage to fulfill their work responsibilities, perform well in school, engage in social gatherings and participate in their typical hobbies and activities. From the outside, people with PDD often seem completely fine, despite needing treatment and mental health support. Internally, however, people with high-functioning depression are suffering.

Given the nature of PDD, many individuals with milder forms of depression are more likely to minimize their experience, and consequently, avoid seeking professional consultation and refuse psychiatric medication. Again, many people falsely believe that depressive symptoms must be severe to qualify as a depressive disorder. As a result, some people with PDD may even feel guilty about seeking treatment, especially if they do not think their symptoms qualify as a serious mental health disorder.

After PDD is diagnosed, various treatments are available that have been proven to reduce depressive symptoms and help individuals enjoy their lives more fully. Specifically, individuals with PDD are advised to begin outpatient therapy, which allows people to process their emotions more effectively, develop healthier coping mechanisms and understand their thoughts and behaviors more fully. Moreover, antidepressants have been shown to lift mood and minimize symptoms of PDD in many individuals.

Aside from medical interventions, living a healthy lifestyle and engaging in greater self-care can mitigate the impact of depression. Specifically, individuals with PDD are likely to benefit from following a healthy and nutritious diet and incorporating greater movement into their daily lives. Additionally, reducing alcohol consumption and avoiding illegal substances may also reduce the symptoms of PDD. However, it is important to note that lifestyle changes are most effective when done in tandem with other treatments, such as regular therapy and antidepressant medication.

Individuals who suffer from depression — regardless of the severity — deserve adequate treatment, care and support. Despite its connotations, PDD is a real and valid mental health condition that warrants proper intervention. Furthermore, without treatment, mild forms of depression are far more likely to escalate. In fact, most people with PDD also have at least one episode of major depression.

To increase acknowledgment and treatment of high-functioning depression, there must be greater awareness of PDD. More immediately, by increasing awareness of PDD, individuals who may be suffering from the illness will be more likely to recognize the signs and symptoms in themselves. Given that PDD is often missed by a person’s friends and family, self-recognition is essential. Furthermore, seeking treatment for milder forms of depression, such as PDD, must be normalized. With proper treatment, people with PDD can establish practical coping mechanisms and identify the best medications for themselves. By seeking treatment for less severe forms of depression, people can more effectively prevent the escalation of their depressive symptoms and gain control over their mental well-being.

Without treatment, PDD can be crippling. However, with the proper resources and treatment, the illness is highly manageable. In fact, people with PDD can recover and go on to live meaningful, fulfilling and contented lives. To minimize its impact, people must be aware of the breadth of mental health challenges and recognize the symptoms of all forms of depression, ranging from mild to severe. Moreover, seeking treatment for depression — including milder forms — must be accepted and perceived as normal. While PDD can be an obstacle, there is great hope for individuals with high-functioning depression.

Nora Weiss, George Washington University

Writer Profile

Nora Weiss

George Washington University
Political Science, Psychology

Nora Weiss is a rising junior at George Washington University. Writing has been a lifelong passion and tool for self-expression for Nora, and she is very excited to be part of the Study Breaks team.

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