High-Functioning Depression: what is it?

Not all forms of depression are the same¹. The so-called high-functioning depression includes a set of symptoms and issues related to the mental health sphere that can have a significant impact on a person’s quality of life². As with other mental health conditions, understanding and debunking common myths about depression is crucial to fostering awareness and promoting appropriate support. High-functioning depression does not involve a recognized diagnosis or an actual clinical disorder, but a range of symptoms and problems, including depressed mood, lack of energy, self-depreciation and feelings of emptiness, masked by normal or near-normal external functioning².

What is high-functioning depression?

People with high-functioning depression study, work, and have social relationships, even though they often hide very strong negative feelings inside². High-functioning depression differs from major depressive disorder (MDD), also known as clinical, endogenous or unipolar depression, a disease which is only diagnosed as such when the symptoms and their severity and duration register specific levels and characteristics³. High-functioning depression is more similar to persistent depressive disorder or dysthymia, in which symptoms persist for at least two years with a generally lower severity than that of a major depressive episode⁴.

High-functioning depression: key signs and symptoms

Although not a clinical disorder, at least in the official sense of the term, high-functioning depression can involve several symptoms of depression². People with high-functioning depression may frequently experience marked sadness, a sense of hopelessness and apathy, a tendency towards perfectionism, fatigue, poor levels of concentration and problems with sleeping⁴. In some cases, only some of these signs may actually occur, and they generally fluctuate as regards duration and intensity⁴. 

Causes and risk factors

Scientists agree that depression may be caused by psychological, social and cultural factors and also by genetic and epigenetic factors (i.e. the way that genes express their functions)⁴. Factors that can increase the risk include previous mental illnesses, traumas or adverse life events, low self-esteem, deep anxiety and neuroticism⁴, one of the fundamental personality traits according to the well-known Big Five model⁵.

Impact on daily life

Even if the individual “functions” well, at least outwardly, the condition can have a considerable effect inwardly, with an impact on daily life that in some cases can be highly significant⁶. Daily tasks are completed with greater fatigue and slowness, and the person concerned may feel that they are acting without a real interest in life and are unable to interact satisfactorily with others². Furthermore, a vicious cycle can develop whereby all these effects on one’s daily life can in turn fuel and increase sadness and self-depreciation⁷. In addition, depressive symptoms that are not addressed effectively or promptly can lead to full-blown clinical depression⁸.

Seeking help and treatment

In view of this, it is important to act as soon as possible, without feeling ashamed or afraid to ask for help⁹. Talking to loved ones or friends and explaining your difficulties in confidence can be an important way to avoid isolating yourself and to improve your general mood¹. In the case of high-functioning depression where some depressive symptoms occur, you should not be afraid or ashamed of asking for medical help⁹. You could first talk to your family doctor who can refer you to other specialists. If depression is diagnosed, preferred actions generally include medication and psychological treatment, such as psychotherapy¹⁰.

Lifestyle and prevention strategies

Finally, to prevent the development or recurrence of depression, your lifestyle can also play its part¹⁰. Adopting regular sleep schedules, eating a balanced diet, exercising regularly, and having good social interactions are healthy habits that can lower the risks¹⁰.

References:

1. WHO, Depressive disorder (depression), 31 March 2023
2. National Alliance of Mental Illness (NAMI), “The Reality of “High Functioning” Depression”, 13 October 2023
3. Bains N., Abdijadid S., “Major Depressive Disorder”. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559078/
4. Patel R.K., Aslam S.P., Rose G.M., “Persistent Depressive Disorder”. [Updated 2024 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541052/
5. McCrae R.R., John O.P., “An introduction to the five-factor model and its applications”. J Pers. 1992 Jun;60(2):175-215. doi: 10.1111/j.1467-6494.1992.tb00970.x. PMID: 1635039
6. Istituto Superiore di Sanità (ISS), “Screening e gestione della depressione: efficacia nella pratica”, 18 February 2021
7. Centre for Clinical Intervention (AU), “The vicious cycle of depression”, https://www.cci.health.wa.gov.au/
   (https://www.cci.health.wa.gov.au/~/media/CCI/Mental-Health-Professionals/Depression/Depression---Information-Sheets/Depression-Information-Sheet---04---Vicious-Cycle-for-Depression.pdf)
8. Halfin A., “Depression: the benefits of early and appropriate treatment.” Am J Manag Care. 2007 Nov;13(4 Suppl):S92-7. PMID: 18041868. https://pubmed.ncbi.nlm.nih.gov/18041868/
9. ISS, “La depressione si supera con la volontà?”, 15 February 2022
10. Cui L., Li S., Wang S. et al., “Major depressive disorder: hypothesis, mechanism, prevention and treatment”. Sig Transduct Target Ther9, 30 (2024). https://doi.org/10.1038/s41392-024-01738-y