The Dilemma of High-Functioning Depression

High-functioning depression, or dysthymia. may be harder to detect than major depressive disorder (MDD) because the people living with it are often high achievers who make you think everything is all right all the time.

I had a difficult time beginning this piece because the topic hit very close to home. I’ve suffered from depression pretty much my entire life.

I have supportive and loving friends, family, meaningful work and engaging hobbies. I have a good appetite and sleep through the night—albeit with a few pee breaks and the occasional need for melatonin gummies. While there are periods I exist in a miasma of sadness, more commonly my daily experience is a slight impairment of an ability to fully enjoy life. There is an ever-present emotional chalkboard scrape reminding me that to live means to co-exist with knowledge of human and animal suffering that I cannot prevent. Which is why I won’t leave home without my daily anti-depressant. (I’ve been taking medication for more than a decade.)

Dealing with High-Functioning Depression

My situation is far from rare. Over 6.7% of adults in the United States—16.2 million!—endure at least one major depressive episode annually. My brand of misery—dysthymia, known as chronic low-level depression, occurs in 1.5% of adults in the United States annually.

While the stigma against seeking mental health treatment is lessening, there remain some dangerous myths. Such as that if depression isn’t severe and persistent—involving frequent bouts of uncontrollable weeping, emotional paralysis, and suicidal thoughts—then there isn’t a real problem and one should just tolerate pain with stiff-lipped silence.

ndeed, the catch-22 of high-functioning depression is that sufferers often believe that since they can push through their sadness while barely missing a step, it would be indulgent to seek help. But that’s like believing one’s own happy-on-the-surface social media status updates.

Therapists, Therapy, and Therapists in Therapy

Ashley has extensive professional and personal experience in coping with high-functioning depression. The Nashville-based therapist admits, “I started therapy as an adolescent and began taking psych meds as a young adult.” Ashley, who started her private practice 10 years ago, adds, “The meds allow me to feel normal, like myself.”

The therapist has many friends, including mental health professionals who take psych meds and/or are in therapy for depression and anxiety. She explains, “Many of my patients are high-functioning. You’d see them on the street and not know something is wrong.”

Awareness of what depression and anxiety feel like helps Ashley get into the psyche of her patients. But she suffers bouts of self-stigma over what sometimes feels like a clash between her professional and personal selves. She admits, laughing, “Once I mentioned to my shrink I felt shame about being a therapist and in treatment. My therapist said, “Ashley, I’m in therapy too.”

Overcoming Mental Health Stigma

Myths and misinformation about mental illness delayed Claire’s depression diagnosis until age 20. “I had certain characteristics of depression as a teenager, such as irritability and crying jags, but my parents wouldn’t take me for help. They figured, ‘Oh, you’re a girl. You’re just emotional.’”

Now, at age 26, Claire manages to hold down a high-stress job as a legal office manager for a multimillion-dollar law firm despite battling not only a depressive disorder but also type 1 diabetes and kidney disease.

She says, “There are times when depression affects my productivity because it’s so intrusive. I’m fine, until all of a sudden I’m not. I try to stay on top of my meds as much as possible.”

Therapy has helped her identify triggers such, as “negative thought trains” and lethargy, that signal a potential oncoming depressive episode.

Another major trigger is her physical health. “I can run a million dollar law firm but I sometimes feel as if I can’t make my body work,” Claire sighs adding, “I might be having back pain, kidney stones, and/or unstable blood sugar.” Summer is especially difficult for Claire: “When the weather’s nice and everyone is outdoors enjoying physical activity or socializing and I’m not well, I feel really left out.”

Combatting Depressive Episodes

Claire now has an array of coping mechanisms, such as journaling, to help forestall major emotional slides. Other helpful activities that relax and focus her include cooking and exercise. “I’ve heard meditation is very good for depression, but I’m afraid it will turn into rumination. That can be a slippery slope for me. I’d rather distract myself.”

Claire’s primary “distraction” is burying herself in her consuming job. “I work 11 hours a day. For me, being productive gives me a purpose, which helps mitigate some of the depression.” (Other common forms of distraction people might resort to as a way to avoid tough emotions include hobbies, playing video games and drinking or using drugs.)

She has good days and knows how to handle the bad ones. Still: “I know I’m never going to wake up and say, ‘I don’t have depression.’”

Other Coping Methods

*Ellen calls herself, “A high-functioning person who also has bipolar disorder.” Seven years ago, the now 36-year-old, experienced a bout of mania as a reaction to an anti-depressant she was taking. Being a problem-solver, the financial executive, wife, mother and perennial volunteer leaped into action to find a way to “bail out the leaky ship.”

These days she employs “a variety of techniques” to keep herself well. “I can tell the difference when I slough off. It’s not recovery, but an ongoing journey.”

She goes to therapy (psychodynamic and occasionally EMDR, a type of therapy involving eye movements) sees her psychiatrist, exercises, gets acupuncture and allows herself to sleep more than average knowing fatigue is a side effect of the psych meds. Ellen says, “I have occasional bouts of depression but over-all I’m doing really well.”

Accepting Your Mental Health

The secret ingredient to Ellen feeling content, she says, is acceptance of her illness. When depression bites at her, Ellen is gentle with herself. “I enjoy my fast-paced life and normally being busy helps combat the sadness, but when I need to I give myself permission to slow down, play with my daughter, take a day or two off from work…

She explains, “I can hide my depression so well that people around me have no idea what I’m dealing with unless I clue them in. What I wish everyone realized is that allowing yourself to reach out for help is half the battle. The other half is continuing to help yourself because depression can always be there waiting to trick you with these awful, untrue thoughts like: ‘You’re worthless,’ ‘You’re no good,’ ‘No one cares.’”

Seeing is Believing: The Challenge of an Invisible Illness

For people with high-functioning depression, the “invisible illness” aspect of the mental state can feel particularly searing. A few years ago, after shoulder surgery, my arm was in a sling. People fell over themselves to cluck with sympathy at my pain—socially sanctioned pain. It felt good to be the object of so much caring.

But on the days when listening to the sorrows of others exacerbates my own and I feel spent, I typically stay silent, not wanting to advertise my own vulnerability. Why is it so much easier to let others in on pain when it’s physical?

It was difficult to begin this article, but writing it has helped free me from a shame-shackle: My name is Sherry and I’ve suffered from depression pretty much my entire life. And I’m okay with that. My mental struggles have made me a more insightful, caring person and a better therapist than I would have been with fewer cracks beneath my emotional veneer.

By Sherry Amatenstein, LCSW

Besma (Bess) Benali, Clinical Social Work/Therapist, MSW, RSW, Counselling Ottawa Nepean. I am trained in Cognitive Behavioural Therapy (CBT), Brief Psychodynamic Therapy, ACT, and mindfulness. Clients come to me because they are struggling and feel like they are trapped in a darkness that no matter what they have tried (and many have tried therapy before) they can’t pull themselves out. I help my clients understand themselves in ways no one has ever taught them before allowing them to see positive changes.