I never felt like I deserved to have depression, as if it was a luxury I had not earned with misfortune. I was going through all the paces, more than that I was overachieving. I was scoring well in my classes, organising prom and various events, going to parties and keeping up my social agenda. That’s what everyone saw, complete with a big smile and a body I kept small by overexercising. But behind that mask? There were nights just spent crying; there were symbols of my pain scattered across my body; there was the wish for it all to finally be over. Years later, I would be able to recognise that I suffer from high functioning depression. I would understand that just because I manage to leave my bed and hide my pain, it doesn’t minimise my struggle.

I have high functioning depression, among other things, and maybe you or someone you know does as well. How would you spot it? What will you look for?

The general symptoms of depression

First, let’s consider the symptoms of depression as a disorder. This is what a psychologist or trained health professional would look for when talking to the individual, and would allow them to diagnose depression. As we know, depression can have many different forms, including high functioning depression, but these would be the basis:

• Lowered self-esteem
• Difficulty making decisions and concentrating
• Decreased appetite or overeating
• Feeling sad and hopeless
• Insomnia or oversleeping
• Lack of energy and fatigue

Individuals must also meet the following criteria for all of the above symptoms, as otherwise, a diagnosis of depression is not possible:

1. The individual has never experienced a period of mania or hyper mania, which consists of an unusually euphoric and energetic mood (could be indicative of Bipolar disorder).
2. There is no other mental illness, medical condition or substance abuse that could explain the symptoms better.
3. The symptoms and depressed mood have caused impairment in one or more areas of normal functioning and led to significant distress for the individual.
4. The depressed mood in the symptoms, as mentioned above, must occur on most days for at least two years without any relief longer than two months during that period.

But wait… does that mean someone can’t be treated for their depression until they’ve been struggling for two years? What about post-partum depression or after the death of a loved one? No, it merely means that Persistent Depressive Disorder or Major Depressive Disorder cannot be diagnosed correctly until two years of symptoms. This is to rule out situational factors or see if it passes. You can still be depressed and deserve treatment and recognition for that, but it doesn’t yet apply as a depressive disorder.

Specific symptoms of high functioning depression

This includes the symptoms mentioned but in the specific manners in which they present with High Functioning Depression. It will be far too easy to miss the hints in this individual as they are devoting all of their energy into hiding it and masking their symptoms. But the truth lies in the physical evidence that is harder to hide. It lies in the cracks between their facade. This is how you spot high functioning depression:

1. Someone who has had major life changes recently. Really observe their behaviour and be available for anything they need to share. Such life triggers include financial problems, death of a loved one, significant life events, high stressors or loneliness.
2. They do everything they need to, maybe even going above and beyond, but they’re always exhausted. They may sleep a lot but still be tired.
3. They may struggle to concentrate and stay focused.
4. They force themselves to engage in social activities, so they could seem unwilling or uncomfortable being present. Maybe they gravitate to the back of a group, maybe they fall silent.
5. They may have a smaller appetite, not think about eating and miss meals or overeat without intention.
6. They may overuse substances. They get too drunk at parties frequently, or they are reckless with their drug use.
7. They have a low sense of self-worth. Even if they are overachieving in all areas of their life, they think very little of themselves, and this is apparent.
8. They have a constant low mood. This can be hard to spot as a smile can cover anything, but it will be visible in the cracks, in the moments of real stress.
9. They feel hopeless. This can lead to them crying a lot. This likely happens in private, but perhaps the substance abuse or moments of stress will show it as well.
10. Signs of self-harm. Again, someone with high functioning depression will do a great job of covering this up. But if you see anything unusual, it may be time to discuss their self-harm. Remember that self-harm isn’t just cutting, it can include bruising, scratching, burning and more.
11. They may mention feeling like they’re ‘faking it’ or that they’re just observing their own life. This can also lead them to look like they’re in a daze, almost daydreaming or out of it.
12. They keep incredibly busy, perhaps as a distraction, but don’t seem to gather joy from these activities and tasks. It almost appears like they’re going through the motions.

There is no definite answer. And it can be so relative. I have people who appear incredibly shocked when they hear about the severe depression that stole seven years from me - “but you seemed so fine!”. I also have friends who said they could see something was wrong, that I seem far more myself now. Which is great in retrospect, but at the time I really needed someone to notice. And so, my advice is this:

If in doubt. Ask. Open that line of communication with them, one where you can discuss difficult and highly personal topics. Even if they brush it now, they will come back when they’re ready as they’ll know you’re waiting. Even if they’re completely fine and you misread all signs, they’ll be flattered that you care and know that they have support when needed. Because one day they will need to talk, and you’ll be there. Even if they exhibit these symptoms without depression, they have something going on that is worth opening up about.

There is never harm in asking, only in being too embarrassed to talk about mental health.

References

https://www.bridgestorecovery.com/high-functioning-depression/signs-symptoms-high-functioning-depression/

https://www.healthline.com/health/depression/this-is-what-high-functioning-depression-looks-like#The-road-ahead

https://www.healthline.com/health/what-you-should-know-high-functioning-depression#8.-Asking-for-help-is-the-strongest-thing-you-can-do