Decoding high-functioning depression: Signs, causes and ways to treat it

Individuals with high functioning depression may not outwardly appear depressed and often perform at high levels, effectively masking their internal struggles  (Unsplash/Ángel López)
Individuals with high functioning depression may not outwardly appear depressed and often perform at high levels, effectively masking their internal struggles (Unsplash/Ángel López)


High-functioning depression is a complex condition that masks mental suffering with outward productivity and success. A multi-pronged approach is needed to treat it

Neha Borkar, a 33-year-old Mumbai-based mechanical engineer, has been battling with high-functioning depression for nearly two decades. “It's like being a duck—calm on the surface, but paddling furiously underneath," she says of the mental condition that has been spoken about by celebrities too. Content creator-turned-actor Kusha Kapila has revealed in interviews about high-functioning depression being a highly misunderstood condition as it gets hidden under the veneer of success and a vibrant social life. Kapila has talked about relentlessly battling with feelings of emptiness and disinterest that remain invisible to the outside world.

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Understanding high-functioning depression

High-functioning depression, though not a clinical diagnosis, is a term that resonates deeply within the mental health community for its depiction of individuals who struggle silently while maintaining a facade of normalcy. According to Dr. Amit Malik, founder & CEO of Amaha Health in Mumbai, the condition aligns closely with Persistent Depressive Disorder (PDD), where individuals experience chronic but less severe symptoms of depression. This, he says, allows them to function daily without significant disruptions. “These individuals might not outwardly appear depressed and often perform at high levels, effectively masking their internal battles," he explains.

Shruti Puri, a clinical psychologist at Karma Care, Delhi emphasizes the complexity of recognizing high-functioning depression. “Symptoms of the condition — chronic fatigue, sadness or decreased interest in pleasurable activities — are often attributed to a busy lifestyle or temporary stress, rather than being recognized as indicators of a persistent depressive disorder," Puri states. There are other trickier symptoms.

“Patients with high-functioning depression may show subtler signs like perfectionism, an overwhelming sense of responsibility, or a decline in personal satisfaction from achievements that would previously have brought joy," notes Dr. Kedar Tilwe, consultant psychiatrist at Fortis Hospital, Mumbai. These nuanced symptoms can make it difficult for healthcare providers to diagnose and treat high-functioning depression effectively.

Recognising the condition

Individuals with the condition often excel in their professional and personal lives, masking their struggles with a competent façade. Malik highlights the importance of context in recognising this form of depression. “It’s crucial to notice when someone maintains composure during overwhelmingly stressful times without visible strain. This might be a sign they are internally struggling," he explains.

“High-functioning individuals might meet all their deadlines and show up at every event, but persistent sadness, loss of interest in activities they used to enjoy, or subtle withdrawal from social interactions can be telling signs," notes Puri. Her colleague Akhil Nair, a counselling psychologist, places strong emphasis on the word ‘persistence’. “The symptoms of high-functioning depression are not typically episodic; they persist over time, subtly eroding the person’s mental health. This persistence, despite a veneer of normalcy, is what friends, family, and colleagues need to be attuned to," he says.

Causes and contributing factors

Understanding the causes and contributing factors of high-functioning depression is essential for addressing and supporting those affected. Malik lists “genetic predispositions and stressful life events" as the causes noting that the condition “is often exacerbated by societal and workplace pressures that compel individuals to mask their struggles." Tilwe notes that personality traits can also play a crucial role. “Individuals with high-functioning depression often have perfectionist tendencies, which can lead to a relentless pursuit of unrealistic standards, exacerbating feelings of inadequacy and depression," he adds.

According to Nair, workplace factors can specifically contribute to this condition. “High-functioning individuals often face enormous pressure to perform at optimal levels consistently. This can lead to significant stress, particularly in highly competitive or high-stakes environments, where admitting to struggles with mental health can be seen as a weakness or liability," he explains.

Therapeutic approaches

Effectively addressing high-functioning depression requires a multi-faceted therapeutic approach that combines psychotherapy, medication, and lifestyle changes. Puri recommends Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) for their effectiveness. “CBT is instrumental in helping individuals recognize and change unhelpful thought patterns that contribute to depression. IPT focuses on improving interpersonal relationships, which can significantly impact one's emotional health," she elaborates.

Lifestyle modifications including regular physical activity, adequate sleep, nutritious diet, and mindfulness practices are all recommended to treat the condition. Expounding on their benefits, Malik says, “Incorporating regular exercise and balanced nutrition can dramatically improve mood and reduce symptoms of depression. It's about creating a holistic treatment plan that caters to the physical and emotional needs of the individual." While psychotherapy and lifestyle changes are vital, Nair notes that some cases of high-functioning depression may also require pharmacological support. “Medications like SSRIs (Selective serotonin reuptake inhibitors) can be effective in managing the biochemical aspects of depression, especially when combined with therapy."

The symptoms of high-functioning depression are not typically episodic; they persist over time, subtly eroding the person’s mental health

Support from social circles

Besides individual treatment, it's important for people with high-functioning depression to receive support from their professional settings and personal social circles as well. Nair emphasizes the need for creating robust mental health frameworks within workplaces. “Creating an environment that prioritizes flexibility and understanding is crucial. Workplaces should be spaces where individuals can thrive without the fear of judgment," he says. This includes the implementation of comprehensive training programs aimed at recognizing signs of mental health issues and providing the necessary resources to support employee well-being. 

Malik feels that companies can reduce stigma around discussing mental health challenges by integrating mental health awareness into their core values. “They can do this by having regular workshops, dedicated mental health days, and offering employees access to counseling services," he says.

Puri talks about the role friends and family members can play here. “Friends and family need to be educated about the signs of high-functioning depression so they can offer appropriate support. Often, just being available to listen without judgment can make a significant difference," she says. “Open communication" and the “provision of a safe space where individuals feel comfortable sharing their struggles" are essential elements in offering support, Puri observes.

As no condition is the same in every person, Manavi Khurana, a psychologist from Karma Care, stresses the need for tailored support systems that accommodate the unique needs of each individual. “Supportive practices need to be adaptable. What works for one person might not work for another, so flexibility and personalization of support are key," she notes. Some ideas for this could involve customizing work tasks, adjusting work hours, or providing mental health days to ensure that individuals can manage their health without compromising their professional responsibilities.

High-functioning depression is a complex condition that masks significant suffering with outward productivity. By understanding its nuances and fostering supportive environments, we can better support those who battle this hidden struggle. As awareness grows, so does the potential for early intervention and effective management, allowing individuals to not only function but truly thrive in all aspects of their lives.

Divya Naik is a Mumbai-based journalist and writer.

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