HEALTHY LIVING High-Functioning Depression
Do you go about your daily activities, but feel empty inside? :: BY CHRIS ILIADES, M.D.
H
igh-functioning depression is not a medical diagnosis, but if you search on the
internet, you will find thousands of articles and explanations of the disorder. A recent TikTok video on the seven
signs of high-functioning depression got over 8 million views. “High-functioning depression is in
vogue now on social media,” explains Robert Cavera, a clinical health psychologist at Mount Sinai South Nassau Family Medicine in New York. “The medical diagnosis for this
condition is called dysthymia, or persistent depressive disorder (PDD), although ‘high-functioning’ is a better description of this type of depression.” Dysthymia was first considered
to be a type of depressive personality disorder in the 1968 edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). In 1980, DSM changed the definition of dysthymic disorder to a mild chronic depression lasting longer than two years. In 2013, the name was changed to PDD to describe a type of depression that is milder than major depression but longer lasting. Many people with PDD just assume
that depression is part of their nature and don’t recognize it as a treatable disease. Because it is often missed, it is hard to say how common PDD is. In one study of close to 4,000
people, more than 10% met the criteria for a PDD diagnosis. “PDD is more common in women
and there is often a family history of depression or a personal history of major depression episodes in the past.
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This condition usually starts early in life, and early treatment works best,” says Cavera. Early stressful life events may also
raise the risk of PDD. Because it starts early and is long lasting, people may get used to it and assume it is normal. They go about their day-to-day activities and can be highly functional but feel empty inside. “It’s like the duck that looks calm
on the water surface, but its feet are paddling hard to stay afloat,” says Cavera.
DIAGNOSIS To diagnose PDD, according to the DSM, a person must have a low mood for at least two years along with at least two of these other symptoms: change in eating or sleeping (either too much or too little), low energy, low self-esteem, difficulty concentrating, or a feeling of hopelessness. The social media list of seven
symptoms also includes loss of ability to feel pleasure, frustration, a feeling of emptiness, and spending too much time doing mindless things, like watching TV or doing nothing.
TREATMENT Treatment can include talk therapy
(psychotherapy) and antidepressants. Either can be used alone but studies suggest both treatments used together work best. “Psychotherapy is important
because it teaches lifetime skills you can use to recognize and deal with depression. Pills may also be important, but pills aren’t skills,” says Cavera. If you are feeling low and struggling with symptoms of depression, Cavera recommends healthy lifestyle changes that include getting quality sleep, eating a healthy diet that prioritizes whole and organic foods, and exercising regularly. Avoid drugs and alcohol, and
spend time with other people; do not isolate yourself. “If you continue to struggle with
signs of PDD, talk to your primary care doctor or a mental health provider,” Cavera says. “You should also talk to friends and loved ones for support. “It’s OK not to be OK. High- functioning depression may not be the actual name of this condition, but the response on social media is positive because it brings attention to a mental health condition that often goes unrecognized,” he adds.
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