High-Functioning Depression Symptoms

According to psychotherapist and author Jodi Aman, “Depression affects all personalities and can look very different in various people.” A  person with high-functioning depression symptoms can be suffering invisibly. Many mental health experts point out that, although statistics show how common depression is, the ways that people experience symptoms are varied.

Depression may not be obvious to people around you. High-functioning depression symptoms may be more difficult to detect than major depressive disorder because the people living with it are often high achievers. They make you think everything is alright, all the time.

Are High-Functioning Depression Symptoms Real?

Because experts don’t recognize high-functioning depression as a disorder, there are no clear-cut clinical symptoms. But, many people confuse high-functioning depression with PDD (Persistent Depressive Disorder). PDD involves low-grade depression with symptoms that persist for at least two years. 

When you have PDD, the depressed mood lasts for most of each day and occurs more often than not. Along with low mood, people with PDD may also have at least two of the following symptoms:

  • Changes in appetite
  • Insomnia or oversleeping
  • Extreme tiredness
  • Low self-esteem
  • Problems with concentration and decision-making
  • Feeling hopeless, worthless, and guilty

In addition, those who have PDD may have periods of normal mood that may last less than 2 months. They are also more likely than other people to develop major depressive disorder (MDD).

What’s High-Functioning Depression?

High-Functioning Depression Symptoms

High-functioning depression is merely a term and not a clinical disorder or a diagnosis. In fact, many mental health professionals disagree with the use of the term. There are some experts that believe the term comes from a lack of understanding about persistent depressive disorder (PDD), also called dysthymia. PDD is an ongoing form of depression. PDD is different from major depressive disorder (MDD), or major depression because the symptoms of PDD are less severe but have a longer duration.

Depression may affect your desire for activity and action, but high-functioning individuals tend to push ahead, trying to succeed with their goals. Their drive to accomplish often sustains action and moves high-functioning people towards getting things done. 

This means that some people who have depression can still continue every day, sometimes exceptional, tasks. Some successful people who have claimed to have depression are Winston Churchill, Charles M. Schultz, Owen Wilson, and Emily Dickinson.

Moderately Severe Depression and High-Functioning Depression Symptoms

Depression is one of the most common mental health disorders and it commonly coexists with substance use disorder (SUD). Typical symptoms of depression include:

  • Downcast mood
  • Hopeless and guilty feelings
  • Appetite, sleep, and weight change
  • Suicidal thoughts
  • Low energy
  • Physical aches and pains with no clear reason
  • Difficulty concentrating
  • Pain, anger, and reckless behavior (mostly in men)
  • Lack of enjoyment of anything

Types of Depression

Major Depressive Disorder (MDD)

A loss of interest in things you used to enjoy and a sad or depressed mood are the main symptoms of MDD. One or both must be present as well as 3 or 4 of the other depression symptoms. The symptoms must be severe enough to interfere with daily life.

Persistent Depressive Disorder (PDD)

This is sometimes called dysthymia and is a type of depression that lasts at least two years or longer. The symptoms may improve or get worse but they must be present throughout that time.

Bipolar Disorder

Bipolar disorder is a disorder in which depressive symptoms alternate with manic periods. While in the depressive phase, you may have any number of general depression symptoms. 

Seasonal Affective Disorder (SAD)

SAD typically begins during the winter months and subsides in the spring. It’s believed to be related to the amount of natural light available during the day. Common symptoms are social isolation, weight gain, and oversleeping.

Postpartum and Perinatal Depression

Perinatal depression happens to a woman when she is pregnant and postpartum depression occurs after she has given birth. These types of depression have symptoms of MDD and the most common are anxiety, sadness, and fatigue which can become serious enough to interfere with the mother’s ability to care for her child.

How Common is Depression?

A 2015 report by the Substance Abuse and Mental Health Services Administration (SAMHSA), estimated 6.1 million adults 18 and over in the U.S. had at least one major depressive episode in the past year. This represents 6.7 percent of all U.S. adults. The World Health Organization (WHO) reported that 264 million people of all ages experience depression worldwide. 


Depression doesn’t always need a trigger. However, there are certain situations and factors that may be more likely to trigger a negative way of thinking. Some examples include:

  • Financial problems
  • Intensely high levels of stress
  • Death of a loved one
  • Loneliness
  • Major life changes

Risk Factors

Possible risk factors for dysthymia (PDD) include:

  • Genetics
  • Prior mental illness
  • Epigenetics (influences on behavior that are not genetic)
  • Neuroticism (a personality trait that tends toward anxiety, and other negative feelings)
  • High levels of anxiety
  • Low feelings of self-worth
  • Psychological health
  • Trauma
  • Life stressors
  • Social factors

Depression and Substance Use Disorder (SUD)

What’s High-Functioning Depression?

It’s common for people struggling with a depressive disorder to also have a SUD. Depressed individuals often turn to drugs or alcohol as a way to lift their moods or numb painful thoughts. As a result, depression and substance use feed into each other with each condition making the other one worse.

When a person has a mental disorder and also a substance use disorder, it’s called a dual diagnosis. It may be any combination of mental disorder and SUD. In fact, more than 50 percent of people with serious mental illnesses also have an addiction.

Which Condition Happens First?

Mental health issues like anxiety and depression are closely associated with alcohol and drug use. Although one doesn’t directly cause the other, using substances such as marijuana and methamphetamine can cause extended psychotic reactions. And alcohol use can make depression and anxiety symptoms worse. 

Alcohol and drugs are often used to self-medicate the symptoms of an undiagnosed mental problem and individuals with high-functioning depression are frequently undiagnosed. Sadly, medicating with drugs or alcohol can cause side effects that only worsen the symptoms in the long run. Or they may trigger new symptoms.

On the other hand, drug and alcohol use can increase any underlying risk for mental disorders. If you are already at risk, substance use can push you over the edge. Likewise, there is evidence that people who are struggling with opioid addiction are at a higher risk for depression.

Alcohol and Serotonin Deficiency 

Many studies have proven that depression increases the likelihood of drinking and eventually developing an alcohol use disorder (AUD). It is not guaranteed, but because of the way depression affects the brain, the likelihood increases rapidly. Research suggests that those with depression lack serotonin. 

When an individual with depression drinks to relieve symptoms, it affects the neurotransmitters in their brain. This means that the chemicals in the brain (like serotonin) that control their emotional state and reward system will experience quick fluctuations. This is bad for anyone and especially bad for someone who is already trying to cope with depression. After a while, the consumption of alcohol can make the symptoms of depression worse instead of providing the relief that many people are seeking as they drink.

Symptoms of a Substance Use Disorder

Substance use disorders can mean substance use or substance dependence. Symptoms of substance use disorders may include:

Behavioral Changes Such As:

  • Drop in attendance and performance at school or work
  • Getting into trouble frequently (fights, accidents, illegal activities)
  • Using substances in physically dangerous situations, such as while driving or operating a machine
  • Taking part in suspicious or secretive behavior
  • Appetite or sleep pattern changes
  • Unexplained change in attitudes or personality
  • Sudden mood swings, irritability, or angry outbursts
  • Bouts of unusual hyperactivity, unrest, or carelessness
  • Lack of motivation
  • Appearing anxious, fearful, or paranoid for no reason

Physical Changes Such As:

  • Bloodshot eyes and abnormally sized pupils
  • Sudden weight gain or loss
  • Decline in physical appearance
  • Unusual smells on body, breath, or clothing
  • Slurred speech, tremors, or impaired coordination

Social Changes Such As:

  • Abrupt change in friends, favorite gathering places, and hobbies
  • Legal problems related to substance use
  • Unexplained financial problems or need for money 
  • Harmful use of substances even though it causes problems with relationships

Treating a Dual Diagnosis

Symptoms of a Substance Use Disorder

An individual struggling with addiction may not even be aware that they are suffering from a mental health disorder too.  Your best chance for long-term recovery is to get treatment for both issues at the same time by the same treatment provider or team. 

Treating SUD

Substance use treatment typically includes:

  • Detox – As the harmful substance withdraws from your body there may be extremely uncomfortable and possibly dangerous symptoms as your body goes back to normal. It’s wise to have medical monitoring during the withdrawal process.
  • Treatment programs – The purpose of detox is to prepare you to enter a treatment program. There are many factors that influence what treatment program is best for you. Typical programs offered are residential or inpatient, partial hospitalization, intensive outpatient, standard outpatient, sober living/aftercare
  • Behavioral therapy – There are evidence-based behavioral therapies that are frequently used in the treatment of SUD as well as mental health disorders.
  • Group and individual therapy – Working with trained professional therapists can help you uncover the deep reasons why you may have been using drugs or alcohol.

Those Suffering From High-Functioning Depression Symptoms Need Treatment Too

Just because you have been getting by doesn’t mean you don’t need help. But because high-functioning depression is not a clinically recognized diagnosis, there aren’t any specific treatment options.

However,  treating PDD may include both: 

Psychotherapy (Talk Therapy)

Therapy is the best place to start treatment if you’re experiencing bouts of depression. A therapist can help you recognize the negative thoughts, beliefs, and habits that may be adding to your feelings of depression.

Also, it could include things like learning mindfulness skills and participating in activities linked to improving mood, such as exercise. Research has found that crafting may have promising benefits for people dealing with depression.


A doctor may prescribe drugs including selective serotonin reuptake inhibitors (SSRIs) and other antidepressants. SSRIs work by increasing the levels of serotonin in the brain. Serotonin is one of the chemical messengers that carry signals between brain nerve cells. Some commonly used SSRIs are:

  • Celexa
  • Prozac
  • Paxil
  • Zoloft

Are You Carrying a Weight?

You may be successful and a leader in your profession, but one high-functioning sufferer said it was “like running a race with a 100-pound weight tied around your waist.” If you can relate to that, or worse, you have been treating your depression by harmful use of substances, then you deserve to have that weight lifted. 

Think what your life would be without the constant daily battle. At Sana Lake Behavioral Wellness Center, we are experienced in treating a dual diagnosis like this. Our certified professionals and licensed therapists have helped many people overcome problems like these. We have several treatment programs and can create a plan as unique as you are. Contact us now. You don’t have to bear this alone.