Demystifying High Functioning Depression
A patient recently came into our clinic and said "I think I have high functioning depression. Can I still be successful?"
It's a common misconception that success and mental health are directly correlated. We often assume that those who have achieved a high level of success must be happy, fulfilled, and free of mental health challenges. However, the reality is far more complicated. Many high-achieving individuals, including executives, entrepreneurs, and professionals we have treated struggle with high functioning depression, which is also known as persistent-depressive disorder or dysthymia.
High Functioning Depression is a chronic form of depression that affects millions of people around the world. Unlike major depressive disorder, which is characterized by severe episodes of sadness and hopelessness that come and go, the condition involves persistent low mood over a longer period of time. However it's important to note that it's possible to be diagnosed with High Functioning Depression and Major Depressive Disorder at the same time.
The causes of High Functioning Depression are not fully understood, but research suggests that a combination of genetic, environmental, and social factors may contribute. Studies have shown that people with a family history of depression or who have experienced trauma or chronic stress are more likely to develop the condition. Additionally, certain personality traits, such as perfectionism, may increase the risk.
What are the Symptoms of High Functioning Depression?
The signs and symptoms of high functioning depression may vary from person to person, but the most common symptoms include:
Persistent sadness or feeling of emptiness
Loss of interest in daily activities or hobbies
Fatigue or lack of energy
Difficulty sleeping or oversleeping
Difficulty concentrating or making decisions
Feelings of hopelessness or worthlessness
Appetite changes or weight changes
The condition, also known as Persistent Depressive Disorder is defined as a consistently depressed mood for at least two years, along with at least two of the symptoms mentioned above. In some cases, these symptoms may be mild, while in others, they can be more severe and interfere with daily life.
Even before the pandemic, studies have shown that as many as 6% of the population of the US experienced an episode of Persistent Depressive Disorder at some point in their lives. Because it can last for years, the impact the condition can have on relationships, employment, education, and other daily activities, can be even more severe than clinical depression.
The Impact of Untreated High Functioning Depression
Most patients with this disorder are undertreated because their symptoms are not as acute as those associated with clinical depression, such as suicidal ideation or not being able to get out of bed. People may exhibit all the symptoms that would qualify for a high functioning depression diagnosis but may believe this is just who they are and how life is, especially because the pandemic/ politics/ economy/ the environment, or any remotely contentious issue provides such a ready explanation. Oftentimes, the stigma of mental health care can prevent people from seeking help.
Untreated depression of any kind, however, can be devastating. A large percentage of patients with the disorder also have a chronic physical illness or another psychiatric disorder such as anxiety, drug addiction, or alcoholism and can seriously impact those around them.
To illustrate this point, consider the following scenario: A successful executive who has climbed the ranks of her company is seen as a model of professionalism and competence. However, behind the scenes, she struggles with feelings of worthlessness and hopelessness. She wakes up each day feeling as if she's simply going through the motions, and she finds herself constantly exhausted, even though she's accomplished more in a week than most people do in a month.
This executive is an example of how this condition can manifest in a successful individual. Despite her accomplishments, she's still fighting an internal battle that she or others may not even be aware of but it may affect them as the executive’s perception that her struggles are normal can set the tone for the culture of the team and the wider company. Her team may be getting things done but the burnout and attrition rate on the team is high, not to mention the mental health cost of those around her. Soon, their mental health begins to suffer, and they may start abusing alcohol or other substances to cope, but don’t seek help because it’s explained as just being part of the culture. Attrition and burnout become the norm and the company and employees suffer as a result.
Living with high functioning depression can be challenging. But there are several treatment options available including:
Therapy: Psychotherapy, also known as talk therapy, can be an effective treatment for many mental health challenges. This type of therapy involves working with a mental health professional to identify negative thought patterns and behaviors and develop coping strategies to manage symptoms.
Medication: Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), can be used to treat the disorder. These medications work by increasing the levels of certain neurotransmitters in the brain, such as serotonin and norepinephrine, which are believed to regulate mood.
Lifestyle Changes: Making lifestyle changes, such as getting regular exercise, eating a healthy diet, and getting enough sleep, can also help manage symptoms.
Ketamine Assisted Psychotherapy: Combining ketamine therapy with psychotherapy can accelerate healing from depression and anxiety. Because so many people who suffer from this disorder are career driven, they often need speed and flexibility with treatment. Ketamine Assisted Psychotherapy can help professionals deal with a persistent depression diagnosis and with less disruption to their day-to-day lives.
How To Help A Loved One with High Functioning Depression
Supporting someone with a mental illness, especially with someone who doesn't think they have one can be tough. But there is hope. Chris Perez, Axis Integrated Mental Health’s co-founder and clinical director said it best: “Looking normal and feeling normal are two separate things. We need to acknowledge that for many of our friends and family, the post-traumatic stress of the last few years is real and they may be needlessly suffering. Encouraging our loved ones to seek the help they need with empathy and compassion helps not only them, but all of us to return to true normalcy.”
Here are five suggestions that may be helpful when dealing with High Functioning Depression in a loved one:
Build a trusting relationship: It's essential to build a trusting relationship with the person, so they feel comfortable opening up to you. Listen to them and avoid judgment. Show empathy and compassion to help build that trust.
Educate them about their condition: Many people with mental illness may not understand what is happening to them. Educate them about their condition, so they have a better understanding of what they're going through. This information may help them feel more in control and less afraid.
Encourage self-help: Encourage the person to take small steps towards self-help. This might involve getting enough sleep, eating well, exercising, and engaging in enjoyable activities. These steps can help the person feel better and more in control.
Offer support: Offer to go with the person to appointments or support groups. Let them know that you are there for them and want to help. Knowing that someone cares can make a significant difference.
Respect their decision: Ultimately, it's up to the person to decide whether or not to seek help. Respect their decision and don't push them to do something they're not ready for. However, continue to be there for them and offer support if and when they are ready to take that step.
If you feel your loved one is suffering from high-functioning depression, you are likely suffering as well. One additional way to help your loved one with their issues is to seek some form of therapy or lifestyle changes yourself. So many times, we find ourselves treating spouses of current patients because they can do for their partners what they can't do for themselves. Once they start treatment, they often find that the results are so beneficial that they continue the treatment.
The Best Medications for High Functioning Depression
Treating high functioning depression can include medication and lifestyle changes. However, the best medication for the condition can vary depending on the individual's specific symptoms and medical history. Generally, antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed. These medications work by increasing the levels of neurotransmitters in the brain, such as serotonin and norepinephrine, which can improve mood and reduce feelings of sadness and hopelessness. Other medications such as bupropion, tricyclic antidepressants, and monoamine oxidase inhibitors may also be prescribed in certain cases. It's essential to consult with a qualified mental health professional to determine the best medication, as well as the potential side effects and risks associated with these medications.
It's also important to note that there are non-pharmacological routes to treatment such as psychotherapy, acupuncture, diet and exercise, and transcranial magnetic stimulation (TMS) to help patients recover with fewer side effects. A lifetime of psychiatric medications is not necessarily the outcome of seeking mental healthcare.
Conclusion: Happier, More Productive Lives are Possible With Recovery
Success is possible with or without a diagnosis. But recovery can lead to even greater success. Many people who have recovered at our clinic report back to being able to not only live happier lives, but more productive and successful careers. Some have gone as far as to say that they wished they came in sooner. At Axis Integrated Mental Health, our team of experienced mental health professionals can help test for High Functioning Depression and provide treatment using evidence-based therapies and medications. If you or someone you know is struggling with your mental health, don't hesitate to schedule an appointment with us today.