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What is High Functioning Depression?

High-functioning depression, also known as persistent depressive disorder (PDD) or dysthymia, is a form of depression that is less severe than major depressive disorder (MDD) but lasts for a longer period of time.

People living with high-functioning depression often appear to function normally in their daily lives but struggle internally with a pervasive sense of sadness, fatigue, and lack of enjoyment. This duality makes high-functioning depression hard to identify and treat, as individuals may not believe their symptoms are those of depressive disorder or may downplay their severity.

Types of Depression

Depression is a complex and multifaceted mental health condition that adversely affects one’s quality of life. There are many forms of depression, each with their own set of symptoms and characteristics. Common types of depression include:

Major Depressive Disorder (MDD) or Clinical Depression

Characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in daily activities. Symptoms typically last for at least two weeks and can significantly impair daily functioning.

Persistent Depressive Disorder (PDD) or High-functioning Depression

A chronic form of depression characterized by a consistently low mood and a diminished interest or pleasure in activities. Symptoms persist for at least two years, often fluctuating in severity but rarely reaching the intensity of a major depressive episode.

Seasonal Affective Disorder (SAD):

Commonly occurs during the winter months when there is less natural sunlight and is characterized by a persistent low mood, lethargy, increased sleep, and carbohydrate cravings. SAD often improves with the arrival of spring or exposure to light therapy.

Psychotic Depression

A severe form of depression characterized by the presence of psychotic symptoms such as hallucinations or delusions. Individuals experiencing psychotic depression may have false beliefs or perceive things that aren’t there, alongside typical symptoms of depression like persistent sadness and low energy.

Postpartum Depression

Postpartum Depression is a mood disorder that affects women after childbirth and is characterized by heightened feelings of sadness, anxiety, and exhaustion, often accompanied by difficulty bonding with the newborn.

Signs of High-Functioning Depression

Many symptoms of high-functioning depression are similar to those used to diagnose major depression but are generally less severe, including:

  • Persistent Sadness: A continuous feeling of sadness or emptiness that lasts for most of the day, for more days than not, over a period of at least two years.
  • Fatigue: Chronic tiredness and lack of energy, even after adequate rest.
  • Low Self-Esteem: Feelings of inadequacy, self-criticism, and a general sense of worthlessness.
  • Poor Concentration: Difficulty concentrating, making decisions, or remembering details.
  • Loss of Interest: A reduced interest in activities that were once enjoyable.
  • Sleep Disturbances: Problems with sleeping, including difficulty falling asleep or sleeping too much.
  • Appetite Changes: Change in appetite, including significant increase or decrease, leading to weight changes.
  • Feelings of Hopelessness: A persistent feeling of hopelessness about the future.

Causes and Risk Factors

The cause of high-functioning depression is unknown, but it is believed to result from a combination of various factors, including genetics, environmental, and psychological.

  • Genetics: Those who have a family history of depression or other mental health disorders have a higher risk of developing depression.
  • Biological Factors: Imbalances in the brain such as serotonin and dopamine can contribute to depressive symptoms.
  • Psychological Factors: Chronic stress, trauma, or a history of substance abuse can increase the likelihood of developing high-functioning depression.
  • Personality Traits: People who suffer from perfectionism or a tendency to be overly self-critical, may be more susceptible to developing a depressive disorder.

The Impact of High-Functioning Depression

While individuals with high-functioning depression may not appear to be struggling, the condition can have significant effects on one’s mental and physical health.

One of the defining characteristics of high-functioning depression is the ability to maintain a facade of normalcy. People with high-functioning depression often continue to perform well in their professional and personal lives. This ability to “function” can mask the severity of their internal struggles and delay diagnosis and treatment.

  • Emotional Toll: Persistent feelings of sadness and hopelessness can lead to emotional exhaustion and burnout over time.
  • Physical Health: Chronic depression is linked to a range of physical health problems, including heart disease, weakened immune function, and stomach issues.
  • Social Relationships: The lack of interest and low self-esteem associated with high-functioning depression can hinder one’s relationships with family, friends, and colleagues.
  • Productivity: Those with high-functioning depression may maintain their performance at work or school, but often do so with great difficulty, which can lead to decreased satisfaction in their academic interests or career.


High-functioning depression can be quite challenging to diagnose, as the symptoms are often more subtle than those of Major Depressive Disorder. Those who believe they are dealing with high-functioning depression must undergo a thorough evaluation and provide a detailed assessment of symptoms, their duration, and their impact on daily functioning, which a mental health professional will then analyze to determine diagnosis and treatment.


Treatment for high-functioning depression involves a combination of psychotherapy, medication, lifestyle changes and holistic therapies.


Evidence-based practices, such as cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and mindfulness-based cognitive therapy (MBCT), are standard forms of psychotherapy used to treat depressive disorders. These therapeutic approaches are designed to help individuals identify and change negative thought patterns and behaviors contributing to their mood disorder.

Medication-Assisted Treatment

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are often prescribed to those struggling with high-functioning depression to help manage symptoms. Medication should be used alongside therapy for the best results.

Lifestyle Changes

Lifestyle changes such as regular exercise, a healthy diet, a sufficient sleep schedule, and stress management techniques play a significant role in alleviating depression symptoms by promoting the release of endorphins, reducing inflammation, and enhancing overall brain health.

Holistic Therapy

Mindfulness practices like meditation, yoga, and deep breathing can help manage stress and improve mood. Additionally, engaging in enjoyable activities and fostering supportive relationships with friends and family can provide a sense of purpose, belonging, and emotional support, all of which are essential for managing high-functioning depression.

Help is Available

Living with depression can be emotionally exhausting, and we know it’s hard to ask for help. Here at Mandala Healing Center, we believe that by understanding the symptoms, causes, and impact of depression, we can help those affected to lead healthier and more fulfilling lives.

Our team is dedicated to helping individuals unlock their full potential. If you or your family member is struggling with depressive disorder, contact us today to learn more about your options and how we can help you.


  1. Harvard Health Publishing: Six common depression types
  2. National Institutes of Health (NIH): Depression
  3. NIH: Risk Factors for Adult Depression: Adverse Childhood Experiences and Personality Functioning