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Suffering in Silence with High-functioning Depression

By Marybeth Kotrodimos, University Health Partners of Hawaii

We all know the usual signs that tell us when people are suffering from depression. We notice them withdrawing from social interaction.  We detect a marked lack of enthusiasm for things that used to bring them pleasure. We hear a sad, resigned tone in their speech. Sometimes they withdraw completely, or try to harm themselves or seek solace in drinking or drugs.  If the situation goes unchecked, they may become unemployed or experience a breakdown of personal relationships.

But there is another form of depression which is harder to detect in the people around us. According to the National Institute of Mental Health (NIH) for people with persistent depressive disorder or high-functioning depression (formerly dysthymic disorder) the symptoms are less severe and less visible, but more long-lasting than those attributed to classic depression. Symptoms must persist for at least two years in order for someone to be diagnosed with high-functioning depression. (By contrast, to be diagnosed with classic depression, the symptoms must be present for a minimum of two weeks.) For those who suffer from high-functioning depression, episodes of major depression might be present along with periods of less severe symptoms. Because they are able to hide their depression from others, they tend to suffer in silence and often fail to receive help. The resulting sense of isolation intensifies feelings of sadness, which greatly increase their risk of suicide.

High-functioning depression doesn’t usually cause people to experience the kind of paralysis that can come with classic depression.   It is not uncommon for them to go through their lives and daily routines without showing any signs of sadness or lack of energy, when actually, they are going through the motions without experiencing joy or satisfaction.  Those with high-functioning depression frequently use the word “numb” to describe how they are feeling.

Some signs of high-functioning depression are:

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

Risk factors for becoming depressed include:

  • Personal or family history of depression
  • Major life changes, trauma, or stress
  • Certain physical illnesses and medication

All types of depression, even the most severe cases of major depression, can be treated successfully, and the earlier treatment is started after the onset symptoms, the more effective it will be.  The first step for anyone experiencing symptoms of depression is to talk with a primary care provider to obtain a referral for a doctor who is experienced in treating this very complex disorder.  Depression is usually addressed with medications and psychotherapy, or a combination of both.

During the past year, due to the social isolation we practiced as a result of the pandemic, many people have been experiencing increased feelings of sadness, anxiety, and loneliness.  If these feelings persist even after you have emerged from isolation and resumed social activities, seek help from your primary care doctor or behavioral health professional. Depression can deeply impact your happiness, quality of life, and ability to effectively provide for yourself and your family.  Don’t let it go untreated. 

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