High-functioning depression is a hidden struggle that often goes unnoticed in the lives of many individuals. While the term “high-functioning” may imply that everything is perfectly fine on the surface, beneath the facade of productivity and normalcy lies a complex and challenging battle with depression. 

Health-e spoke to Dr Ayanda Mbuli, General Manager for the Health Policy and Clinical Advisory at Afrocentric Group, who says “high-functioning depression is a deceptive adversary.” Dr Mbuli says unlike its more overt counterpart (major depressive disorder), it disguises itself beneath achievements, responsibilities, and seemingly ‘normal’ lives.

What are the signs of high-functioning depression?

Persistent feelings of sadness, overwhelming fatigue, decline in interest and pleasure, difficulty concentrating, disrupted sleep patterns, appetite changes, feelings of guilt or worthlessness, concealed emotional turmoil, social withdrawal, physical symptoms such as headaches, muscle aches, and digestive problems.

Could you explain what the difference is between clinical depression and high-functioning depression? 

There are different types of depression (e.g. major depressive disorder, persistent depressive disorder, postpartum depression to name a few) where you need to meet specific clinical criteria to be diagnosed. Clinical depression is the most common For all types of depression, the common symptom across is a depressed mood for most of the day.  

Can you be medically diagnosed with high-functioning depression, and if so, what is the process? 

No, high-functioning depression is not a clinical diagnosis and cannot be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) which is a handbook used by health professionals. The term is a colloquial term which has become increasingly popular over the last few years. The term has sparked a lot of debate amongst experts.

How aware are people of the term ‘high-functioning depression’; is it something that is widely known? 

It has become popular in the last few years. This was sparked by cases like Miss USA 2019 who [died by] suicide and her mother came out to say her daughter finally confided in her and told her she had high-functioning depression a few days before she died.

Studies and statistics have shown that women experience depression more than men. When it comes to high-functioning depression, is there a specific (age, race and ethnicity) group of women that are mostly affected? If so, why are they most affected? 

As mentioned, because it has not yet been adopted as a clinical diagnosis there are no scientific studies on the subject. However, some experts in the USA have found it is more common in population groups where depression is still very much taboo like in African American females. 

It is also said to be prevalent in successful individuals because they have a nice car, nice house etc. they should have it all together and therefore cannot be depressed.

Could you explain the relationship between adverse childhood experiences and high-functioning depression? 

Trauma can be both a risk factor and a trigger for depression. Mental illness is bio (medical), psycho and social condition and needs a bio, psycho and social approach to management.

What impact does one’s socio-economic status have on high-functioning depression? 

Like trauma, socio-economics are also risk factors and triggers. Life stressors and social factors have an impact on your mental health.

The high cost of therapy can make access to mental health services inaccessible for some South Africans. What could potentially happen if someone who has been suffering from high-functioning depression for an extended period, cannot afford to seek help from a mental health professional? 

High- functioning depression being seen as a less severe form of depression can be misleading because it doesn’t look at the effort it takes to function. A psychologist in the USA made a great analogy. Say we all are driving on the highway at 120km/hr but to maintain that speed I have my foot flat on the accelerator and struggling. 

On the outside I’m keeping up but on the inside it’s taking everything I have to keep to that speed. Eventually that will not be sustainable and what we term high functioning now can lead to major depressive disorder or worse the complications of depression like harm to yourself or harm to others.

Has South Africa seen any rises in high-functioning depression cases? 

Post Covid globally there has been a rise in mental health illness because high-functioning depression is not a clinical diagnosis we don’t have specific statistics.

How do we move from seeing depression as one singular mental health condition to teaching people that there are conditions like high-functioning depression that fall under the umbrella of ‘depression’? 

My view is twofold. On the one hand I believe depression is depression. The term high functioning can worsen the stigma about depression because we seem to be quantifying it and as mentioned above the term can be misleading because it doesn’t look at the effort it takes to function. 

On the other hand it can help people feel they are not alone, that they don’t need to feel there’s something wrong with them or wait till they are not functioning to get help. So in my opinion if adding it to the DSM allows more people to be diagnosed and get help then let’s add it.

Tell-tale signs of high-functioning depression

Persistent feelings of sadness, overwhelming fatigue, decline in interest and pleasure, difficulty concentrating, disrupted sleep patterns, appetite changes, feelings of guilt or worthlessness, concealed emotional turmoil, social withdrawal, physical symptoms such as headaches, muscle aches, and digestive problems.

If you or anyone you know needs help, reach out to groups like SADAG who offer various mental health support groups.- Health-e News