We are just shy of 8 billion people inhabiting the globe. Approximately 280 million worldwide suffer from depression. 

While there are many different kinds of depression and varying levels of seriousness, this mood disorder plagues a considerable number of people all over the Earth. Learning about it and its treatment can help you or someone you love down the road.

The Modern-Day Silent Struggle

We live in a world that glorifies overworking, undersleeping, and packed schedules. The more you can take on and contribute to society and relationships, the more you will be viewed as a successful person. 

The more others see you as a successful, the more your value tends to go up in your own eyes, too. But at what cost? 

Lingering stigmas from previous generations persist, sometimes unconsciously influencing our minds at a young age. Many trade their wellbeing and happiness to keep up with societal expectations, allowing room to disrespect personal boundaries.

Our world is slowly learning to gain empathy for those struggling with severe mental health disorders. While we may seem to be in the renaissance of mental health awareness and treatment, we still have a long way to go. 

Magnitudes of people suffer in silence with high-functioning mental health disorders. The inability of an outsider to visibly observe an illness is just one of the many barriers to breaking down mental health stigmas, validating people’s struggles, and receiving effective treatments.

Persistent Depressive Disorder (PDD)

Depression is the most common mood disorder internationally. 3.8% of the population is affected, and a substantial amount of these people never receive treatment. 

Mental health disorders are already challenging to recognize and diagnose. Those in the “high-functioning” sphere are even more so, as they are easy to mask and remain virtually undetectable to others. 

There are different forms of depression and varying levels of severity. One form is high-functioning depression, clinically known as Persistent Depressive Disorder (PDD) or dysthymia. PDD has similar symptoms to Major Depressive Disorder (MDD) but usually less severely and over a prolonged period.

High-Functioning Depression

Someone experiencing PDD will most likely appear perfectly “normal” on the outside. They may keep a job, study at a university, or care for a family. They're able to have meaningful relationships or partake in social activities and get-togethers. 

People with PDD keep up with their responsibilities and fulfill their obligations. They might even be considered perfectionists, as they do so at a high level of achievement. To the outside observer, those with PDD live like everyone else without noticeable struggle. To the individual, though, they are just getting by. 

Those with high-functioning depression, and even high-functioning anxiety, fulfill their duties because it’s what’s “expected.” However, the energy required to keep up is nearly overwhelming. They have been dealing with PDD for so long that they have adapted, and their internal feelings will seem like a new normal. 

Is Smiling Depression Different From PDD?

Individuals with high-functioning depression can express themselves in all sorts of ways. Some may have a gloomy disposition and a more negative outlook on life and the future, while others may appear happy and upbeat. 

Smiling depression is another term for high-functioning depression and PDD, as many people hide behind a smile and a false positive attitude. However, the smile is a facade and defense mechanism. It distracts others while shielding the individual from realizing and identifying their inner feelings.

Can You Have High-Functioning Depression and Not Know It?

With the person’s ability to live what seems to be a typical day-to-day life, they may not even be privy to their condition. Individuals may fall for their own facade, believing they are going through life like everyone else in terms of actions and accomplishments. 

Those with PDD may overschedule themselves, so they stay busy and have no time to consider their feelings or low energy levels. Or maybe they are just getting by fulfilling their essential responsibilities but not having the energy to do anything outside of those crucial roles. 

They might go to work with a put-together appearance and a can-do attitude, but at the end of the work day, all they can do is lay around or sleep when they get home. Likely, they are mentally exhausted and don’t have the energy to do anything else.

Symptoms of High-Functioning Depression

To receive a clinical diagnosis for PDD, a person has to have experienced a combination of depressive symptoms most days for two or more years. 

Some signs and symptoms of PDD include, but are not limited to, the following:

  • Changes in sleep patterns
  • Difficulty making decisions
  • Feelings of guilt or powerlessness
  • Feelings of hopelessness, emptiness, or sadness
  • Lacking energy or feeling fatigued
  • Loss of appetite or overeating
  • Low self-esteem
  • Negative thoughts about the future
  • Oversleeping or insomnia
  • Suicidal thoughts or acts of self-harm
  • Trouble focusing
  • Unintentional weight loss or gain    

While many of the above are also symptoms of Major Depressive Disorder, people with PDD will experience these symptoms less severely but for an extended period.

Barriers to Seeking Help

Asking for help seems to be difficult across the board. When it comes to high-functioning issues, the challenge becomes exacerbated. 

A person with PDD can function at a high level, flying under the radar of others who may recognize signs of struggle. This strategy allows those with high-functioning depression to hide in plain sight and avoid addressing the problem. 

If and when they ask for help or vocalize their concerns, it’s common to minimize the severity of the problem. But remember, just because someone is functioning at a high level does not mean they are functioning fully. 

Why don’t people with PDD ask for help? 

There are many reasons people with high-functioning depression and anxiety don’t ask for help. For one, they might not think or realize there’s a problem. Other times, they don’t want to appear weak or feel guilty for getting help when “other people have it worse.” 

Sometimes, when someone reaches out and talks about their internal struggles, people will dismiss their feelings because the adverse effects aren’t visible. Others may question how someone could be depressed if they still come to work daily, have a social life, or live in seemingly ideal circumstances. 

Unfortunately, it’s common for others to say that someone with PDD doesn’t “look depressed.” They may attribute depressed feelings as a standard bout of sadness or burnout that will surely pass. When others invalidate someone’s emotions like this, the person needing help tends to retreat within themself.

The person may begin to question their feelings, convincing themselves they are not depressed. After all, how could they be when they appear to be doing fine?

Advocating for yourself and others

It is easy to disregard things we cannot see or feel ourselves. Because of the nature of high-functioning depression and anxiety, it's an easy disorder to dismiss and overlook the necessity of treatment. We must reframe the mindset. 

Consider how a person with alcohol or substance use disorder (SUD) may seemingly function in everyday life. They may maintain a job or relationship, but that doesn’t mean there isn’t strain on their life. 

Over time, substance abuse wears on a person’s life, work, and relationships. It can lead to more significant problems in the future, both physically and emotionally. It can progress from functional to dysfunctional and can eventually become fatal. 

The same is true for those dealing with high-functioning depression. A person with PDD may be getting by, but that type of living is not healthy or sustainable. 

What appears to be functional may eventually become debilitating. Chronic depression affects an individual’s mental, emotional, and physical health. When left untreated, it can escalate to contemplation and acts of self-harm and suicide. 

Is There Treatment for High-Functioning Depression and Anxiety?

If you have been struggling with high-functioning depression and anxiety, you may have forgotten what it is like to live without it. The chronic, prolonged nature of the disorder means that you may have been dealing with it and adapting for years. 

It may seem like your low mood and fatigue will never go away, and this is your new normal. However, it is possible to rid yourself of these feelings and manage them more effectively. 

Treatment will look different for everyone but may include lifestyle changes, therapy, medication, or combinations of the three. Psychotherapy is the most realistic starting point, as your mental health professional can recommend the best options to further your treatment goals. 

Regardless of your stage, utilizing your support system and taking time for yourself is essential. These may seem like small things, but starting and sticking with these changes can be challenging after dealing with depression for so long. 

How Can I Help Myself or Someone with PDD?

The mental health field has made much progress in tearing down the stigmas attached to mental disorders and treatment. To keep the ball rolling in a positive direction, we must continue to dissolve the false beliefs that depression and anxiety stem from laziness or weakness. 

If someone opens up to you about their inner struggles, believe them, listen to them, and ask how you can support them. Mental illnesses can affect anyone. While we can’t control who they affect or when they will flare up, we can encourage those with mental health struggles to seek professional help. 

You Don’t Have to Feel Alone

Roughly 2.5% of adults experience Persistent Depressive Disorder at some point in their lives. The number of adults who struggle alone and in silence is overwhelming. 

At Inner Balance Counseling, we understand that opening up about mental health can be difficult. It’s okay to feel scared or ashamed or not know how to ask for help.

You may have high-functioning depression or anxiety, but that doesn’t mean you must be stuck with low-quality days forever. Our team of mental health professionals is uniquely qualified to provide the relief you deserve. Request a consultation today!

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Katy Kandaris-Weiner, LPC

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