Recognising and treating high-functioning depression

High-functioning depression: when functioning leads to exhaustion

Many men affected by depression wear a suit and tie. They are always punctual, get their work done and appear confident. Their so-called high-functioning depression fundamentally challenges our understanding of mental illness: it remains invisible because it hides behind performance and conformity – especially in men.

Functional depression describes a condition in which those affected – despite inner exhaustion – cope with their everyday lives, keep appointments and fulfil their social roles. But appearances are deceptive: behind the façade lies deep dejection, loss of interest and lasting psychological strain.

What is high-functioning depression?

Highly functional depression is one of the atypical forms of depression. People with highly functional depression are often professionally successful, socially active and appear emotionally stable. But behind this apparent balance lies a constant feeling of being overwhelmed. Many sufferers report physical symptoms, inner emptiness, irritability, increased need for sleep and a pronounced perfectionism.

These symptoms usually develop gradually, are accompanied by a constant need for self-optimisation and are difficult for those around them to recognise. Men in particular often experience their exhaustion as personal failure, not as a mental illness.

What are the symptoms of high-functioning depression?

• A depressed mood that lasts for at least two weeks

• Problems concentrating and a lack of motivation

• Loss of interest and a tendency to withdraw socially

• Sleep problems despite a strong need for sleep

• Constant tiredness despite sufficient sleep

• Irritability and a feeling of inner emptiness

These depressive symptoms not only affect emotional well-being, but also social contacts and physical well-being.

Why are men particularly affected?

Many men do not experience emotional stress as ‘ill’, but as weakness. The social pressure to always be productive, calm and in control leads them to suppress depressive symptoms, and instead focus on physical complaints – back pain, gastrointestinal problems or sleep disorders are medically clarified without considering the psychological origin.

Many men do not show typical symptoms such as crying or social withdrawal, but express their high-functioning depression through overwork, irritability, cynicism or emotional distance. This often leads to a late diagnosis.

Atypical depression and dysthymia: the chronically underestimated forms

Atypical depression is characterised by the fact that positive events can temporarily lift the mood. Sufferers show increased reactions to rejection, increased appetite, a strong need for sleep and long-lasting exhaustion. These symptoms make diagnosis more difficult, especially in men.

Dysthymia, also known as persistent depressive disorder, usually lasts for at least two years. It appears less dramatic than a depressive episode, but has a lasting negative impact on the sufferer's quality of life. Many patients with high-functioning depression experience a combination of both conditions.

How is high-functioning depression diagnosed?

It is challenging to diagnose high-functioning depression. Because those affected ‘function’, there is often no reason to seek psychological clarification. A diagnosis is only made when there is severe listlessness, chronic moodiness or recurring physical symptoms.

It is also important to record atypical symptoms. Classification is carried out within the framework of established classification systems for mental illnesses such as the ICD-10 or DSM-5.

What treatment options are there?

People suffering from highly functional depression benefit from early, professional support. The following have proven particularly effective:

• cognitive behavioural therapy

• depth psychology-based psychotherapy

• systemic therapy

• psychiatric medication support if necessary

It is important that the therapy also takes gender-specific aspects into account. The aim is to strengthen emotional expressiveness, self-compassion and self-management.

When should you seek help?

If you feel that your everyday life is becoming increasingly difficult, that your zest for life is waning or that you feel drained and empty inside despite being productive, it is advisable to seek professional help. You don't have to wait until you can't take it anymore. Even people who are supposedly ‘functioning’ can suffer from depression – and get support.

Conclusion: high-functioning does not mean healthy

Because it hides behind coping with everyday life and social adaptation, the highly functional depression in men often goes unrecognised until it is too late. However, it is a serious mental illness that responds well to treatment when it is recognised early.

Do you have questions or are you looking for therapeutic support? The Praxis für Psychologie Berlin is here to help you in confidence.

FAQ: Frequently asked questions about highly functional depression

What is high-functioning depression?

A form of depression in which those affected appear to cope with their everyday lives without any problems, although they suffer from inner emptiness, exhaustion and other depressive symptoms.

How does high-functioning depression manifest itself?

Through tiredness, concentration problems, loss of interest, perfectionism, irritability and the feeling of being drained on the inside.

How does a high-functioning depression present itself?

Often by ‘functioning outwardly’, while a depressive symptomatology develops internally. Many sufferers appear calm on the outside, but suffer internally.

What does a high-functioning depression feel like?

Like a constant inner pressure, with an inability to feel joy or lightness.

High-functioning or classic depression: what's the difference?

Classic depression is often accompanied by clearly visible symptoms such as a lack of motivation and social withdrawal. In contrast, high-functioning depression often goes unnoticed for a long time.

How is high-functioning depression diagnosed?

By psychological or psychiatric professionals, taking into account atypical symptoms and life context.

How is high-functioning depression treated?

With psychotherapy, behavioural therapy, or medication if necessary. Lifestyle changes can also help.

What are the dangers of a high-functioning depression?

Chronification, social withdrawal, increased risk of suicide, undetected suffering for many years.

How can you recognise a smiling depression?

Similar to a high-functioning depression: those affected appear happy on the outside, but are deeply depressed on the inside.

What triggers depression?

It varies from person to person: genetic predisposition, stressful life events, hormonal changes, chronic stress or traumatic experiences.

Do you lack motivation, sleep a lot and withdraw from social situations when you're depressed?

That can be the case, especially with the classic forms. High-functioning depression often takes a more subtle form.

Burnout and depression: two terms for the same condition?

No. Burnout is not a separate diagnosis, but it can develop into depression. Both conditions share symptoms such as exhaustion.

Depression in men – same same but different?

Yes. Men often show different symptoms than women. They tend to react with irritability, cynicism or overwork.

How do I deal with a depressed man?

With understanding, open communication, patience and advice on possible professional help.

Can dysthymia be treated?

Yes, with psychotherapy, medication if necessary, and psychoeducational measures.

How can dysthymia or high-functioning depression be recognised?

By prolonged low mood, exhaustion, reduced zest for life despite everyday functionality.

Depressed mood and winter depression: what helps?

Light therapy, exercise, daily structure, talk therapy.

Diabetes and depression – how are the two related?

Chronic illnesses increase the risk of depression. Conversely, depression can make it more difficult to manage diabetes.

Does socialisation cause women to suffer from depression more often than men?

Socialisation, role expectations and hormonal influences play a role. Men often express depressive symptoms differently.

Is it really the case that women suffer from depression so much more often than men?

Statistically speaking, yes. In practice, however, depression in men often goes unrecognised.

What role does a lack of social contacts play?

This can be both a cause and a consequence of depression. Establishing new contacts can help to stabilise the situation.