Are we a generation that is riddled with high-functioning depression; is depression endemic? I pose this question to start with, as it helps us interrogate what high-functioning depression is and investigate the impact it has on our 21st-century generation.

We live in a fast-paced, capitalist world; everyone is in a rat race, chasing the next best thing, and striving. Resultantly, stress and burnout are rife, yet normalised, it's a part of everyday life. We seldom pause and check in with ourselves, or our loved ones. There's a warped notion that if one is getting up each day, keeps a job and earns a salary, they're fine.

What we do not understand, is that some people are struggling internally and living with high-functioning depression, which is debilitating in many ways. Sadly, it often takes a person having a complete mental breakdown and psychic collapse for them, and the people around them, to have an appreciation of how work-related stress can lead to serious mental health problems - acute or chronic.

In my role as a therapist, I have encountered many people who come to therapy with chronic and debilitating mental health problems; the most common one is high-functioning depression. What is bothersome, is that some of these people are not even cognisant of their suffering from depression.

What is high-functioning depression?

High-functioning depression, also known as dysthymia, is a form of depression where the person experiences all the symptoms of depression, but they are typically milder. The symptoms tend to be chronic, low grade and don't necessarily impair day-to-day functioning. As a result, people with high-functioning depression can carry on with their life as usual, and present as if all is well externally. At times, the sufferer may not even recognise that they have depression, albeit high-functioning, and so this is also easily missed by family, friends and health professionals.

People with high-functioning depression tend to struggle internally and, in many situations, present quite differently outwardly. For example, if they are aware of the low mood or what is often described as “being constantly in a funk”, they may mask their symptoms or become highly performative to disguise the depression. Therefore, it is easy for symptoms to be excused as one’s personality, or as dismissed as one being “moody”.

What are the symptoms of high-functioning depression?

Like frank depression, people with high-functioning depression experience:

• chronic low mood
• difficulties concentrating
• brain fogginess
• hopelessness and pessimism
• sleep disturbances - lack of sleep, broken sleep, or sleeping too much
• low energy levels and lethargy
• low self-esteem and self-regard
• poor appetite or increased appetite
• mood swings (anger, guilt, frustration, sadness) and tearfulness
• apathy - lack of interest and motivation
• general sense of overwhelm and acopia
• low libido

Risk of comorbidities

People with high-functioning depression are at a much higher risk of using narcotic drugs and alcohol as a form of self-medicating, to numb and/or elevate the low mood. This can create a vicious cycle, detrimental to a person’s mental health since alcohol is a depressant and narcotics are stimulants (exacerbating symptoms).

This is common and problematic in corporate environments, where there is a culture of drinking after work and social events where there is access to alcohol and narcotics. It’s not unusual for people who have depression to end up developing alcohol and substance misuse, which feeds into the depression, creating a vicious cycle.

Toxic work environments and high-functioning depression

Many companies are beginning to develop systems to promote mental well-being in the work environment, and there is a drive towards normalising mental health while reducing the stigma around mental illness. Employee Assistance Programmes (EAPs) are also drawn in to provide short-term therapy and support to employees who may be struggling with their mental health.

However, I believe that the main objective is often to get the employees back into work as quickly as possible and minimise loss. The reality of these high-pressured environments where performance is constantly monitored, is that employees are at a much higher risk of developing and living with high-functioning depression.

The work pressures lead to chronic stress, which easily turns to burnout. This can provoke secondary mental health problems, such as anxiety and depression, which can become chronic and low-grade high-functioning depression. Individuals in these environments are less likely to pay attention to their mental health, as their focus is on their work.

If they are less productive, they risk being engineered out, and being put on Performance Improvement Plans (PIP). Bumper bonuses and commissions also reinforce the culture of pushing one beyond capacity, risking their mental health. These environments tend to be highly competitive, and poor performance is associated with incompetence, which creates additional issues around one’s self-esteem and self-image. There is very little empathy for each other and it can be cutthroat.

The toxic cultures in these environments result in some people being pushed to their limits mentally; they continue working while experiencing depressive symptoms. Not attending to these symptoms is what turns into high-functioning depression, where a person is functioning but struggles internally. The stigma around mental health also acts as a barrier for these individuals to access help. Taking time off for mental health can be seen as a sign of weakness or failure.

Suicide and high-functioning depression

Social media and the digital world have given us access to news from different parts of the world. It's not unusual to read about people who lost their loved ones to suicide, where the individual's struggles went unnoticed by those around them. Many stories that continue to shock the world are those of celebrities and entertainers reported to have died by suicide: Robin Williams, John McAfee, Alexander McQueen, Stephen “tWitch” Boss, and Kurt Cobain, to mention but a few.

How is it possible that these people, who seem to be coping well with life in the public eye, entertaining others, end their lives? I believe this indicates that they may be struggling internally, and experiencing high-functioning depression, seemingly coping on the outside. Living with this contradiction between the internal and external world can be a real struggle as one lives in duality. Ending one’s life ends up being the solution, albeit a painful one for those left behind.

Many studies have confirmed a correlation between depression and suicide. The World Health Organization (WHO) estimates that 90% of all suicide victims have some kind of mental health condition, depression being primary. People with depression are more likely to end their lives by suicide than any other illness. This is not to exclude anxiety, which often co-exists with depression.

Self-care tips

Identifying symptoms of high-functioning depression is key. If you suspect that you have high-function depression, there are some ways to manage your mental health:

Could l be experiencing high-functioning depression?

People who are experiencing high-functioning depression are not always cognisant of it. In many cases, it takes one small thing to tip them over the edge, and for them to notice how poor their mental health is. When this happens, suicidal ideation emerges; due to the untreated depression. If you think you may be experiencing high-functioning depression, it's important to seek help in a timely manner and galvanise additional support around you.

High-functioning depression is normal, but it is not a life sentence. With the right treatment, people with high-functioning depression can recover, and continue living their lives normally, feeling more wholesomely.

If you suspect that your loved one is experiencing high-functioning depression - you notice some of the symptoms identified above - it's important to try to engage them and encourage them to seek professional help. Therapy is key in the treatment of depression - some people end up taking antidepressants, adjunct to therapy. I always remind others that taking antidepressants or going to therapy is not a sign of weakness, quite the opposite, a strength.

It's more painful to watch a loved one struggle or die by suicide without doing anything about it than to reach out and have honest conversations. You may very well be the only person who has reached out.

It's hugely significant that we keep re-evaluating our attitudes towards mental health and be open to our experiences being unique to ourselves and different to others. Instead of being quick to judge other people - changes in behaviour or temperament - let's be open to it being a result of poor mental health. Compassion for each other will always take us a long way.