Thu. Jul 25th, 2024

What is high-functioning depression? Here are symptoms to look for.

Mental health counselor Jeffrey Meltzer sees clients nearly every day who suffer from “high-functioning” depression, so he decided to post a video about it on TikTok. He struck a nerve. The video now has more than 8 million views and more than 5,000 comments.

“This describes me to a tee,” one wrote.

“Does it go away at some point?” another replied.

“Can someone tell me how to fix it?” wrote a third.

Meltzer, who meets with clients in-person and virtually in Bradenton, Fla., said it’s not always obvious if someone suffers from depression. “There’s a myth” that somebody with depression can barely get out of bed in the morning, he said. “They can function, they can go to work, they can do all these things. But deep inside, they’re feeling really down, they’re feeling quite empty or lonely.”

The response to Meltzer’s video is “a huge signal about unmet mental health need,” said Jon Rottenberg, a psychology professor at the University of South Florida who has studied the course and prognosis of depression.

The term high-functioning depression “is really resonating with the fact that depression can be quite hidden,” Rottenberg said. “People can harbor it for a long time before they get help.”

High-functioning depression is not a clinical diagnosis

High-functioning depression is not a diagnosis or a recognized clinical disorder, and it doesn’t appear in the Diagnostic and Statistical Manual of Mental Disorders, the authoritative guide to mental health disorders.

Exactly where the term started isn’t clear, but “high-functioning depression” is a popular topic on TikTok and YouTube that attracts millions of viewers. It gained traction on social media in 2022 after Cheslie Kryst, a former Miss USA, died by suicide. In statements to the media, Kryst’s mother said her daughter was dealing with high-functioning depression, “which she hid from everyone.”

Some health professionals say the term can be misleading and may stem from a lack of understanding about different mental health disorders. But other therapists and mental health experts say the term has helped people realize that depression isn’t always obvious.

It can help people think of depression in ways that “may be different” from the stereotypical symptoms people associate with the disorder, said Vaile Wright, a psychologist and senior director of health-care innovation for the American Psychological Association.

“There is no one-size-fits-all depression,” Wright said. “In children and adolescents, it looks much more like irritability. Same with men; it looks a lot more like anger and substance abuse.”

Signs of high-functioning depression

In the viral TikTok video, Meltzer offers seven signs that he said may signal high-functioning depression. Other mental health experts say Meltzer’s video does identify many of the feelings that could be symptoms for depression.

“The doctors that I work with and others, even myself sometimes, can feel those things,” said Srijan Sen, a professor and the executive director of the University of Michigan’s Eisenberg Family Depression Center. “Highlighting that and making people know they’re not alone in feeling that is valuable.”

The seven signs of high-functioning depression highlighted in Meltzer’s video include:

  1. Isolating from friends and family.
  2. No longer finding joy in the activities you loved.
  3. Persistently criticizing yourself.
  4. Frustration with small irritations or setbacks.
  5. Turning to mindless habits for hours on end.
  6. Always feeling low on energy.
  7. Managing day-to-day tasks but feeling empty inside.

Getting help from professionals

Depression is “a collection of symptoms” with some degree of sadness or melancholy, said the APA’s Wright. Sleeping too much or too little, an inability to concentrate, eating too much or too little, and “a sense of hopelessness” can all be signs of depression.

Pankhuri Aggarwal, the Madigan Family Clinical Research Fellow at the Family Institute at Northwestern University, said she doesn’t want people to self-diagnose based on a list of signs or symptoms they find online. “It’s really important for them to come and talk to a mental health professional,” she said.

She noted that there are two criteria that are “considered the crux of depression.” Either you’re feeling low — or “blue” — or you’re not finding joy from activities you once considered fun.

“If you used to enjoy swimming before, a whole lot, now you still go swimming, but you just don’t find the same level of pleasure that you used to once before,” Aggarwal said. “You keep doing the same activity. It just doesn’t bring you the same level of excitement, energy, that it used to.”

Aggarwal said the term high-functioning depression refers to people who feel depressed but who aren’t displaying signs to friends or family — they may be fighting to suppress their depression because “they don’t want to place this burden on other people.”

“Maybe it’s not safe for you to express depression in the setting, or the community or the group that you’re in,” she said. “You can’t necessarily go walk up to your boss and say you’re depressed.”

A term of ‘hope’ when talking about depression

Isabella, a 25-year-old graduate student who was diagnosed with depression a decade ago, said she first heard of high-functioning depression in high school while watching videos on YouTube. Now, she uses the term to explain her diagnosis to friends and therapists. She asked that her full name not be used to protect her medical privacy.

The term provides a sense of comfort “that this is something that I can get through,” Isabella said. “I can do this, and I can be successful.”

“The whole aspect of being high-functioning, it gave me a lot of hope,” she said. “I can be this normal person who goes through their life, and has their successes, and the depression is, kind of, the afterthought.”

Sen said he recommends people seek help from a clinician when stress, depression and anxiety start to affect daily life. Wright said, “for most people,” that’s going to start with their primary care physician.

Social media videos can be useful to help people recognize their symptoms and realize that depression “isn’t just one thing,” Rottenberg said. Self-diagnosis through watching videos on TikTok could be “an important first step” to seeking professional help, he said.

“Two different people can have depression, and they can look very different,” Rottenberg said. “From the person who’s flat on their back to the person who can report to work and put out a first-rate product, they’re both depressed. They’re both struggling.”

If you or someone you know needs help, visit or call or text the Suicide and Crisis Lifeline at 988.

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