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What is High Functioning Depression?

High-functioning depression isn’t a true medical diagnosis. You won’t find it listed in the Diagnostic and Statistical Manual of Mental Disorders, the bible of the mental health profession. But it is popping up on treatment center websites and mentaL health blogs as a way to characterize individuals with low mood, low energy, and anxiety, experts say.

Some experts believe that the term comes from a lack of clarity surrounding persistent depressive disorder (PDD), or dysthymia, an ongoing form of depression. PDD differs from major depressive disorder (MDD or major depression, as the symptoms tend to be less severe but have a longer duration.

People with high-function depression are typically diagnosed with having persistent depressive disorder (PDD). Common symptoms of PDD include a lack of energy or constant fatigue. Those with PDD or high-functioning depression experience the symptoms for at least two years.

High Functioning Depression
According to the World Health Organization (WHO), more than 280 million people of all ages experience depression worldwide [1].

Former Miss USA Cheslie Kryst hid her high-functioning depression from “everyone” until right before her death, her mother said. She was identified as the woman who jumped out of a New York building on January 30, 2022. People with high-functioning depression may resist acknowledging vulnerability and seeking help. If you’re battling alcoholism due to or that is causing depression, please reach out.

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What it Feels Like to Live with High Functioning Depression?

The symptoms of high functioning depression are not as severe as those of major depression. Major depressive disorder (major depression) is also referred to as clinical depression. But they can still be very disruptive to a person’s life. People with high functioning depression may find it difficult to concentrate, stay motivated, or enjoy activities that used to bring them pleasure. They may also experience problems with sleep and changes in appetite.

Your high functioning depression may have you, and your friends and family members convinced that you are not suffering from the disorder. However, if you exhibit any of these symptoms for two weeks or more and at least one of your symptoms is depressed mood or loss of interest or pleasure, you may have a major depressive disorder. These symptoms will be a noticeable change in your previous ability to function.

If you think you may be suffering from high functioning depression, it is important to seek professional help. There are many treatments available. These can help improve mood symptoms and allow you to live a fuller life.

High Functioning Depression Symptoms


This is the most common symptom of high functioning depression and can be accompanied by feelings of emptiness, hopelessness, or worthlessness. Sadness can also take the form of grief, as people with high functioning depression often have difficulty dealing with loss and may become depressed after losing a loved one or experiencing some other type of significant life change.

Lack of Energy

People with high functioning depression often have a low energy level and feel chronically fatigued. This can make it difficult to get out of bed in the morning, complete everyday tasks, or participate in activities that used to bring joy.

Poor Concentration

People with this depression often have difficulty concentrating and may feel like they are “wasting their time” when they try to do anything other than relax. This can lead to feelings of frustration and self-criticism.


Many people with high functioning depression experience problems with sleep, either insomnia (not being able to fall asleep) or excessive sleeping (sleeping for more than eight hours per night). Irregular sleep patterns can further aggravate mood symptoms.

Changes in Appetite

People with high functioning depression may experience changes in appetite, either losing their appetite or overeating. Appetite changes can lead to fluctuations in weight, which may contribute to a poor self-image.

Low Self-esteem

People with high functioning depression may struggle with feelings of worthlessness, inadequacy, and guilt. This can lead to a lack of motivation.

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High Functioning Depression Causes


People who have a first-degree relative, such as a parent or sibling, with major depression are at increased risk for high functioning depression. If you can trace your family tree back several generations and notice that almost everyone struggled with some type of mood disorder over the course of their lives, it may be helpful to explore whether there is any genetic component to this pattern.

Stressful Events

Life events that are especially stressful can contribute to high functioning depression. This may include a death in the family, a job loss, or a divorce.

Chemical Imbalance

It is believed that chemical imbalances in the brain may be partially responsible for high functioning depression. Furthermore, serotonin and norepinephrine are two neurotransmitters that have been linked with mood disorders.


Some medications can contribute to feelings of depression. For example, steroids and some blood pressure medications have been linked with mood changes that may lead to low energy, sadness, irritability, or other symptoms associated with high functioning depression.

Substance Abuse

People who struggle with substance abuse may be at increased risk for high functioning depression. Drug and alcohol use can alter the way neurotransmitters function in the brain, which may increase feelings of sadness or irritability.

Do I Have High Functioning Depression?

The diagnosis of high-functioning depression requires that all of the following criteria be met:

  • A depressed mood most of the day, nearly every day.
  • At least four of the following symptoms must be present:

The medical professional will also look for signs that the person is able to function well in most areas of life. This includes having a job, being able to take care of oneself, and having supportive relationships.

There are different tests that can be used to determine if high-functioning depression is present. These may include the following:

Zung Scale

This questionnaire can measure the severity of depression symptoms.

Beck Depression Inventory (BDI)

The BDI is a test that measures how depressed a person feels. It includes 21 items, such as “I feel hopeless about the future” and “I have difficulty making decisions.”

Hamilton Rating Scale for Depression (HRSD)

The HRSD is used to measure the severity of depressive symptoms over time. It includes 17 items, such as “Insomnia or hypersomnia nearly every day” and “Pessimism about the future.”

High Functioning Depression
Depression and substance abuse share many common factors and can cause one another. Both of these disorders affect similar parts of the brain and can be both caused by previous trauma.

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How to Manage High-Functioning Depression

Changes in lifestyle are very often helpful for people who are coping with any form of depressed mood. These lifestyle changes may include changes in diet, exercise, sleep routine, use of substances, and involvement with a social support network.

Since it is common for people with depression to have difficulty initiating new behaviors, a recommended first step is to seek the help of a mental health professional who will be supportive and help you make the changes that will be the most beneficial.

Here are seven lifestyle changes that have been shown to lessen depressive symptoms for most people:

  • Contact a psychotherapist and schedule an initial meeting as soon as possible
  • Add exercise of any kind (under physician’s advice) to your daily routine. Physical activity has been strongly linked to improved mental health and mood for all ages. This is particularly true for persons with chronic mild depression such as PDD, and for depression related to chronic anxiety.
  • Set daily goals, preferably simple ones that are easily reached, in order to boost self-confidence and sense of accomplishment.
  • Begin to make improvements in diet which coincide with more energy, less sluggishness, and improved focus.
  • Establish a routine for sleep and waking.
  • Limit or omit the use of alcohol and other drugs depending upon personal health risks. Seek support for recovery from substance abuse if needed.
  • Reach out to family, friends, or members of the local and online community for emotional support.

Connection Between Alcohol and High Functioning Depression

There is such a strong connection between alcohol consumption and risk factors for high functioning depression. Many depression sufferers, especially ones who have not been properly diagnosed, often turn to alcohol to escape. Desperate to feel better or numb the pain, even for a little while, individuals with high functioning depression often use the sedative effects of alcohol for that purpose. Alcohol abuse is rampant among people suffering from depression. At least 30%-40% of alcoholics also experience a depressive disorder.

People are often seduced by the sedative effects of alcohol and use it to self-medicate and help distract them from persistent feelings of despair. Alcohol may appear to relieve some of the symptoms of depression temporarily. However, it ultimately worsens high functioning depression on a long-term basis. As consequences of alcohol abuse persist, high functioning depression worsens. This often leads to a damaging cycle of abusing alcohol to self-medicate symptoms of depression while the high functioning depression worsens due to the continued alcohol abuse.

Alcohol is a central nervous system depressant (CNS) that slows the body down. Studies have consistently shown that alcohol use increases both the duration and the severity of depressive episodes. It also increases the likelihood, frequency, and severity of suicidal thoughts. If a person struggling with high function depression turns to alcohol to make themselves feel better, a vicious cycle has started that can be extremely difficult to break out of.

Alcoholism can also cause depression in some circumstances. Prolonged alcohol abuse can drastically change and rewire the brain, as well as impact many other chemical balances in the body. This is particularly true of the brain’s neurotransmitters, which send electric and chemical impulses and control a great deal of the body and mind’s functioning. These systemic changes can cause depression.

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High Functioning Depression Treatment

To determine the most effective ways to cope with high-functioning depression it’s crucial to first get an accurate assessment of all the symptoms. When the symptoms have been evaluated by a mental health professional, it may be determined that another form of depression is present and needs a particular type of treatment. Very often, some combination of psychotherapy, medication, and/or lifestyle changes are effective for coping with functional.

Psychotherapy for Depression

Several different modalities of psychotherapy have been used in the treatment of depression including:

  • Cognitive Behavioral Therapy (CBT) – an effective treatment that involves making changes in both the patterns of negative thoughts and the behavioral routines which are affecting the daily life of the depressed person.for various forms of depression.
  • Person Centered Therapy – a strategy that allows and encourages clients to understand and resolve their concerns in a safe, support environment.
  • Solution Focused Therapy – an approach interested in solutions which can be quickly implemented with a simple first step leading to further positive consequences.

Medication for Depression

Some individuals who experience high-functioning depression may have symptoms severe enough to warrant antidepressant medications.

There are five basic types of antidepressants, categorized as follows:

  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
  • Tricyclics
  • Monoamine Oxidase Inhibitors (MAOIs)
  • Atypical Antidepressants

It is not unusual for the first trial of medication to be unsuccessful either, due to lack of effect for that person or due to intolerable side effects for that particular person. It is very important to be open to a second or even third trial of antidepressants to find the most beneficial one.

If you or a loved one are struggling with long-term substance abuse and a co-occurring mental health condition such as high functioning depression, contact one of our helpful treatment specialists today. We Level Up NJ can provide information on dual diagnosis and detox programs that may fit your specific needs.

high functioning depression
Dual diagnosis is the treatment of mental illness, like high functioning depression, along with substance use disorders.

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[1] WHO –

[2] NIMH –