7 Signs of 'High-Functioning Depression,' According to a Columbia-Trained Psychiatrist
"You don't seem depressed," is a comment nobody with depression wants to hear. It doesn't change the reality of how you're feeling, and the skepticism doesn't offer any actual support. If anything, this type of statement might make you feel like something else is wrong with you or cause you to self-gaslight. However, you might be experiencing signs of high-functioning depression (HFD), according to a psychiatrist.
"Just because someone isn't crying or sad doesn't mean they aren't struggling," Dr. Judith Joseph, MD, MBA, tells Parade.
For example, "Anhedonia is a common symptom of HFD," she continues. "It is a lack of pleasure in things that once brought you joy."
Not enjoying something that you used to love might be easy to ignore or disregard. You're busy, after all! But it's worth paying attention to and flagging.
We live in a world where productivity is prized and staying busy can look like a successful life. However, even if things "look good" from the outside, if you're living out of an abundance of stress, your mental health is likely suffering.
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Related: 7 Signs of Depression Most People Miss, According to Mental Health Experts
How To Explain Depression to Someone Who Doesn't Have It
"Depression results in a sad mood or 'anhedonia,' which is a lack of interest and pleasure in things," explains Dr. Joseph, author of High Functioning (April 8). "Additionally, depression must have at least five of the following symptoms (below), and the symptoms must cause a decrease in functioning or distress."
"High-functioning depression is the same," she continues. "However, instead of losing functioning or being in distress, people tend to over-function."
Related: This Is the #1 Early Depression Sign Most People Miss
7 Signs of High-Functioning Depression (HFD)
1. Fatigue
"High-functioning depression often brings with it unrelenting fatigue," Dr. Joseph shares. "It's not the kind of tiredness that a good night's sleep can fix. Even when you've rested, you still feel physically and mentally drained. This exhaustion can affect your performance at work or your ability to enjoy your hobbies and time with loved ones."
2. Difficulty Concentrating
"Concentrating on tasks or making decisions can become unexpectedly challenging," Dr. Joseph tells Parade. "You might find it harder to focus at work or even choose what to have for dinner. This cognitive fog can be frustrating and lead to feelings of inadequacy."
3. Irritability
"High-functioning depression can make you more irritable than usual," she explains. "You might find yourself easily annoyed or agitated by small things that wouldn't have bothered you in the past. This change in your emotional responses can affect your relationships and work life."
4. Changes in Appetite
"Pay attention to your eating habits—high-functioning depression can lead to significant changes in appetite," Dr. Joseph warns. "Some people may lose interest in food, leading to weight loss, while others may turn to food for comfort, resulting in weight gain. These changes are often linked to emotional distress."
5. Sleep Disturbances
"Your sleep patterns may also be disrupted," she shares. "You might struggle with insomnia, making it difficult to fall asleep or stay asleep throughout the night. Conversely, you might find yourself oversleeping, unable to muster the energy to get out of bed."
6. Physical Symptoms
"High-functioning depression can manifest as physical symptoms, such as unexplained headaches, digestive problems, or various aches and pains," Dr. Joseph says. "These symptoms can sometimes be the body's way of expressing the emotional distress you're experiencing."
7. Social Withdrawal
"One of the telltale signs of high-functioning depression is social withdrawal," she explains. "You might begin to isolate yourself from friends and family, even if you were once outgoing and sociable. The effort required to engage in social activities can feel overwhelming."
Related: Psychologists Are Begging People To Pay Attention to These 11 Early Signs of Loneliness
The Difference Between Depression and HFD
"Our current healthcare system requires physicians, therapists and insurance companies to require a significant loss in functioning or emotional distress before you can code and bill for depression," Dr. Joseph explains. "You need to have symptoms of depression like changes in sleep, mood, energy and a significant loss of functioning (or significant distress) to meet criteria for clinical depression."
Unfortunately, this can make it more difficult for individuals to get the help and support they need.
"There are millions of us who don't meet criteria for clinical depression, despite having symptoms of depression, because we are still functioning," she continues. "We push through pain, and instead of breaking down and losing functioning, we are pathologically productive. We overwork and overproduce to distract from negative emotions."
Just because HFD looks different than "typical" depression doesn't mean it doesn't need to be addressed.
"We know from evidence-based science that constant mental stress leads to poor physical and mental health outcomes," Dr. Joseph explains. "We have a choice: we can wait and react when people break down, or we can proactively prevent these negative outcomes from happening."
Related: 11 Phrases That Signal a Person's Lonely, According to Psychologists
Risk Factors of HFD
"Since publishing the research, I have had several people from academic institutions around the world reach out to inquire about the risk factors of HFD," Dr. Joseph shares. "What I have found in my study that trauma is a risk factor. A prestigious trauma institute in Europe was curious about the types of traumas that makes people prone to HFD. While we need more research in this area, it is likely that people use overworking and staying busy as a trauma response to avoid coping with past emotional pain."
The trauma may lead to people-pleasing tendencies in individuals with HFD as well.
"People pleasers tend to bend over backwards and put other people's joy ahead of themselves," Dr. Joseph says. "They may experience anhedonia, because they do not prioritize their own joy and put other people's interests ahead of themselves."
"People with HFD tend to overwork in all areas of their lives," she continues. "This tendency to overwork and people please may stem from unprocessed trauma. Feeling unlovable and unworthy are trauma responses, and perhaps unresolved trauma leads these people to busy themselves to feel worthy of acceptance and love as well as approval."
Up Next:
Related: The Unexpected Depression Sign a Geriatrician Is Begging People Over 50 to Pay Attention To
Source:
Dr. Judith Joseph, MD, MBACourtesy Dr. Judith Joseph
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