For some people, the symptoms and signs of depression are obvious. They often seem sad or discouraged. They don’t have the energy or interest in getting out of bed or participating in activities they once enjoyed. They struggle with work and other responsibilities.
But for others—those with a condition sometimes called “functional depression”—there are fewer apparent signs of what may be troubling them inside. Functional depression is also known as “high-functioning depression” because the condition isn’t severely affecting their day-to-day obligations. Individuals with functional depression also may appear to have a positive outlook much of the time. Friends and family members may be surprised to learn that a loved one is actually coping with depression.
What Is Functional Depression?
In simple terms, having functional depression means you have chronic depressive symptoms but are outwardly stable and productive.
“The term ‘functional depression’ is not an official medical diagnosis, but it is a term people often use to describe a person who continues to work, care for their family, and who is able to meet daily responsibilities adequately while quietly struggling with symptoms of depression,” says David Mischoulon, MD, PhD, director of the Depression Clinical and Research Program at Massachusetts General Hospital.
Recognizing functional depression is important because even though everyday functioning may be mostly unfazed, the person experiencing the condition is still struggling. And without treatment, that person soon develops more severe depression and unhealthy coping mechanisms, such as substance use.
Functional Depression vs. Major Depression
Dr. Mischoulon explains that, in many cases, someone with functional depression may meet the criteria for major depressive disorder (also called major depression), while others may have a milder and/or more persistent form of depression.
Masking depression by appearing productive, successful, and even happy at times may allow people to thrive at work and take care of others, but it can lead to problems down the road. Someone exhibiting more obvious signs and symptoms of depression may be more likely to get help or find support from family and friends than someone who is masking their depression.
“One key difference is how much a person’s symptoms are visible to others,” Dr. Mischoulon says. “Someone with functional depression may appear to be doing well on the outside, yet experience persistent sadness, loss of enjoyment, fatigue, poor concentration, or feelings of hopelessness. Because they continue to function, their suffering is often overlooked by others, and sometimes even by themselves, which can delay seeking treatment.”
Another difference between major depression vs. high-functioning depression is that a major depressive disorder usually involves acute and intense episodes of depressive symptoms that last at least two weeks. The symptoms can affect work, sleep, relationships, and other aspects of everyday life.
Functional depression is typically experienced as a more ongoing or continuous state. It may be more aligned with a condition called persistent depressive disorder (PDD), which is characterized by a lower-grade depressed mood that can linger for years.
Common Signs and Symptoms
The most common symptoms of functional depression are essentially the same as those seen in major depressive disorder, according to Dr. Mischoulon. They can include:
- persistently low mood
- loss of interest or pleasure in activities
- fatigue
- difficulty concentrating
- changes in sleep or appetite
- feelings of guilt or worthlessness
“Patients also often have a sense that everyday life requires much more effort than it used to,” Dr. Mischoulon says. “Suicide-related thoughts or preoccupation with death may also be present. The main difference we see is that people with functional depression often continue to meet their work, school, or family responsibilities despite feeling this way. They may appear successful and dependable to everyone else, but they are often expending tremendous energy just to keep up appearances.”
He adds that because the outward signs and symptoms of functional depression are less obvious, friends, family members, and even the person experiencing the symptoms may not recognize that depression is the underlying problem.
What Causes Functional Depression?
Because functional depression isn’t a separate condition, the causes and risk factors are generally the same as they are for other forms of depression, Dr. Mischoulon says. “Depression usually develops from a combination of factors, including genetics, life experiences, ongoing stress, and changes in brain function,” he explains.
Genetics can play a major role in high-functioning depression. Having a family history of depression or other mental health disorders raises the risk of developing some form of depression. Likewise, imbalances in brain chemistry, hormonal fluctuations, and other conditions affecting brain health and function can sometimes lead to depression or anxiety.
Individuals who experienced trauma, either as an adult or child, may be more likely to develop depression. Traits such as excessive self-criticism and feelings of inadequacy and social isolation are among the characteristics and experiences that are associated with depression.
It’s not always clear how some people develop what you might think of as familiar or traditional depression vs. high-functioning depression. An individual who is a high achiever and perfectionist may be able to use those traits as a shield to keep from succumbing to some of the more debilitating aspects of depression.
Why Functional Depression Often Goes Unnoticed
If you have depression but many of your needs are being met and your environment allows you to succeed, you may be able to go through life with functional depression for some time. People tend not to look for depression in others who seem to be thriving. The same is also true with people examining their own mental health.
“Functional depression often goes unnoticed because many people assume that if they are still getting through the day, they must not really be depressed,” Dr. Mischoulon says. “They may attribute their symptoms to stress, a busy schedule, or just feeling worn out. Friends, family members, and coworkers can make the same assumption, especially if the person continues to perform well at work, cares for others, and maintains social commitments.”
Combating mental health stigmas and wanting to live up to the expectations of society—as well as the expectations and hopes of family and friends—can discourage individuals from confronting their own symptoms. “Many people with functional depression also become skilled at hiding their emotional struggles because they don’t want others to worry about them, or they may fear being seen as weak,” Dr. Mischoulon says. “As a result, they might suffer in silence for months or even years before seeking help.”
When to Seek Help
It’s not always easy to know when to talk with someone about your depressive symptoms or even know how to start the conversation. If you sense that something is wrong, stop and take the time to examine your feelings and how they are affecting your life. Be open to a friend or relative asking about signs of depression they may have noticed.
“It’s time to seek help if feelings of sadness, emptiness, or loss of interest persist for more than a couple of weeks, or if they begin to interfere with your quality of life, even if you are still managing to meet your daily responsibilities,” Dr. Mischoulon recommends. “Other warning signs include feeling exhausted all the time, withdrawing from people you care about, having increasing difficulty concentrating, or feeling hopeless, guilty, or like you’re simply going through the motions each day.”
He adds that it’s especially important for anyone who is experiencing thoughts of death, self-harm, or suicide to seek help immediately. “Depression is a highly treatable condition, and the sooner someone reaches out, the sooner they can get the right treatment and start feeling better,” Dr. Mischoulon says. “You don’t have to wait until things become unbearable before asking for help.”
And the sooner you can begin therapy and other types of treatment, the sooner you can start to feel better and improve your quality of life. By contrast, delaying treatment may allow your depression and its many potential complications to worsen.
Practical Steps to Manage Functional Depression
Treatment for functional depression is much like that for other forms of depression. In addition to starting therapy or discussing the use of antidepressant medications with your healthcare provider, you can try some simple strategies that may be helpful.
For example, try to get at least 20 minutes of physical activity in every day. It could be a brisk walk or bike ride, as well as dancing, a game of tennis, or a strength-training workout at the gym.
You also might find that building a routine of small, manageable tasks can help take down your stress levels and give you a sense of accomplishment and control.
Two other strategies include journaling and challenging negative thoughts. Keep a simple journal, in which you record thoughts and feelings (positive, negative, and in-between), as well as ideas or events that you’d like to remember or write about for any reason. And when you catch yourself ruminating or catastrophizing about anything, stop and consciously try to replace those negative thoughts with more balanced, realistic alternatives.
But never feel as though you have to be on your own coping with depression. As Dr. Mischoulon notes, depression is a treatable condition.
“Effective treatments may include antidepressant medications, psychotherapy, regular physical activity, healthier sleep and dietary habits, and strengthening of social connections, among many options,” he says. “The most important step is recognizing that someone can be struggling with depression even if they appear to be functioning well. Seeking help early can prevent symptoms from worsening and improve both quality of life and daily functioning.”
