High-functioning depression isn’t an official diagnosis, but you could be experiencing symptoms of persistent depressive disorder.
“Why do I always feel sad? I can’t shake this funk I’m in.”
If you’ve ever said this to yourself, you’re not alone. Worldwide, more than
But maybe you can still go to work, maintain relationships, and go about your daily responsibilities — even if something doesn’t quite feel right. Some people call this “high-functioning depression.” Do you relate?
While some use the term high-functioning depression, this isn’t a medical diagnosis. It can also be misleading since there isn’t an actual list of symptoms for it.
On top of that, this term can contribute to some stigma surrounding depression.
Many people use the term high-functioning depression, when what they’re actually describing is persistent depressive disorder (PDD), previously called dysthymia. So when we talk about symptoms of high-functioning depression, we’re usually talking about symptoms of PDD.
Since high-functioning depression isn’t a diagnosis, it doesn’t have set symptoms. But persistent depressive disorder does, and it’s often what people mean when they talk about high-functioning depression.
But what is PDD? While it has some symptoms similar to major depression, it might feel like you’re skirting just under the line of a depression diagnosis. You may feel:
- low energy
Some people might consider this mild depression (rather than severe). Your depressed mood is present for at least 2 years, and lasts most of the time, for most of the day.
With PDD, you might experience feelings of depression more often than you don’t. You may feel sad a lot but just can’t seem to feel better.
It’s fairly common for people with depression to struggle with sleep. You may find yourself sleeping too much, or feeling tired most of the day.
You may also develop insomnia, where you have trouble falling or staying asleep.
Changes in appetite
You might not have much of an appetite, or don’t feel like eating and notice you’re losing weight. Or instead, you might find yourself overeating and gaining weight.
With low self-esteem, you may struggle with confidence and believing what you’re capable of. You could also have critical or negative thoughts about yourself, or try to overcompensate.
Trouble concentrating or making decisions
You may find yourself bogged down with indecision — agonizing over every decision you have to make. You could also have a hard time concentrating, like on a work project or book you’re reading.
When you feel hopeless, you can start to think things are never going to get better. It might be difficult to problem-solve or focus on anything positive in your life.
Only a healthcare professional can diagnose PDD, and sometimes other conditions will need to be ruled out first.
Some conditions look similar to (or overlap with) PDD.
Major depressive disorder (MDD)
In major depressive disorder, your symptoms may be more severe than PDD, but for shorter amounts of time — at least 2 weeks.
- experience deep feelings of worry, sadness, or hopelessness
- sleep or eat too little or too much
- lack interest in things you used to enjoy
- have thoughts of self-harm
Previously called manic depression, bipolar disorder is characterized by mood episodes that involve intense emotions, sleep issues, and racing thoughts.
Bipolar disorder is known for its highs — mania or hypomania — but you may also have depressive episodes in bipolar I disorder, and will experience depression in bipolar II.
Symptoms can include:
- trouble concentrating
- feeling hopeless
- feeling sad
You might cycle through these high and low episodes, or you can even have them at the same time.
Also known as cyclothymia, this is a type of bipolar disorder that’s sometimes seen as milder — but you can still experience the ups and downs in mood.
In cyclothymic disorder, you’ll experience mood changes for at least 2 years, including symptoms of depression.
Personality disorders have different symptom patterns than depression or bipolar disorder. They’re almost always diagnosed in adulthood and tend to be lifelong conditions.
If you have a personality disorder, you might have a harder time responding appropriately to difficult experiences, such as losing a job. A personality disorder can impact how you relate to others, which can also impact relationships.
Examples of personality disorders include:
- borderline personality disorder (BPD)
- narcissistic personality disorder (NPD)
- obsessive-compulsive personality disorder (OCPD)
Seasonal affective disorder
Although the more up-to-date name is major depressive disorder (MDD) with seasonal pattern, you probably know this as seasonal depression or seasonal affective disorder (SAD).
It can be easy to confuse seasonal depression with PDD because both involve depression symptoms. But if you experience seasonal depression, your symptoms will tend to pop up during specific times of year.
If you think you might be dealing with PDD, there are some things you can do.
To receive a PDD diagnosis, your doctor should rule out any physical reasons for your depression, since some medical conditions like thyroid disorders or low vitamin D can mimic symptoms of depression. So they might start with a physical exam and lab work.
If a physical reason has been ruled out, your doctor will probably ask you questions about your mental health, thoughts, and feelings.
Along with feelings of depression or irritability, you also need to have two or more of these other symptoms:
- appetite changes or overeating
- insomnia or other trouble sleeping
- having little energy or feeling extra tired
- feeling bad about yourself
- difficulty concentrating or making decisions
- feeling hopeless
More than having these symptoms, they also need to affect a big part of your life to match a PDD diagnosis. It’s also possible to meet the criteria for a PDD diagnosis and a major depressive diagnosis at the same time.
Everyone’s treatment plan will vary depending on their unique situation. But research continues to show that a combination of medication and therapy tends to be the
It’s important to feel comfortable with a therapist you choose and agree with their approaches to therapy. Asking for recommendations from friends or your doctor is a good place to start, but it’s possible you might need to try out a few before you find one you like.
It can feel draining to live with persistent depressive disorder. And if you’re not sure what your symptoms add up to, it can be frustrating trying to get the right diagnosis.
If you decide to seek professional support, a good mental health professional can help you work through your emotions and help you come up with a treatment plan that meets your needs.
You can also learn more about treatment options for PDD here.