Many people with high-functioning depression don’t notice their symptoms. Because they cope with their professional life and everyday life supposedly normally, while suffering internally. Which symptoms can be a warning sign and which therapy options are available.
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Brief overview: high-functioning depression
Definition: High-functioning depression is considered a little-researched form of atypical depression. As a rule, outsiders do not notice the disease, since those affected seem to cope with their job and everyday life normally.
Symptoms: Feeling of exhaustion (“I can’t take it anymore”), inner emptiness, increased need for sleep, irritability and urge for perfectionism.
Causes: Usually several triggers come together, including hereditary predisposition, traumatic experiences, high stress levels and fears.
Diagnosis: Difficult to diagnose as there is no standard procedure to date. In addition to anamnesis and physical examination, tests and questionnaires are important in a psychotherapeutic practice.
Treatment: Three pillars of psychotherapy, antidepressant medication and lifestyle change.
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What is high-functioning depression?
A high-functioning depression (high-functioning depression, high-functioning depression) is considered to be a form of atypical depression that has not been researched much to date. Therefore there is still no uniform definition. However, it is characteristic that sufferers hide or deny their complaints from those around them – and mostly from themselves. Compared to classic depression (major depression), those affected seem to be able to master their lives as usual.
Certain comorbidities often occur with atypical depression. These include:
Women are more likely to be affected by high-functioning depression than men. Experts suspect that the number of unreported cases is high. Since they often admit their illness late and seek help, a higher suicide rate can be assumed compared to other forms of depression. It is all the more important to pay attention to warning signs in yourself and in those around you.
High-functioning depression: These symptoms appear
While some symptoms of the high-functioning form also occur in normal depression, other complaints are quite atypical for the mental disorder. For example, patients have less trouble sleeping, do their job, or continue to participate in social activities. In addition, they continue to appear empathetic and sensitive towards their fellow human beings and their problems. That is why it is often difficult for those around them and even those affected to recognize the disease correctly.
Signs of high-functioning depression:
- increased need for sleep
- cravings
- increased alcohol consumption
- exhaustion
- feeling of being overwhelmed
- inner emptiness, sadness
- Despair
- gloomy mood
- Irritability, sensitive to criticism or rejection
- Self-reproach, self-doubt
- Obsessive brooding, thought spirals
- need for perfectionism
- Difficulty switching off and relaxing
It is characteristic of people with high-functioning depression that they often suppress their emotions and thoughts and only allow them to occur when they are alone. If the thought “I can’t do it anymore” is going through your head more and more often, you should also pay attention.
Nevertheless, the complaints mentioned do not have to have a disease value, but can indicate an excessively high stress level and too little rest. However, if symptoms persist or keep recurring, it is advisable to seek medical attention.
What are the causes?
Similar to other depressive disorders, high-functioning depression is based on a complex of causes. In most cases, several risk factors interact.
Possible causes are:
- pronounced and persistent stress
- financial difficulties
- traumatic experiences (even in childhood)
- genetic predisposition in the family
- Imbalance of neurotransmitters, especially serotonin
- physical illnesses
- chronic pain
- Addictive behavior (alcohol, medication)
- fears about the future
In addition, people who lack self-confidence, tend to be perfectionists and often criticize themselves seem to have an increased risk of developing the disease.
Diagnosis of suspected high-functioning depression
So far, high-functioning depression has not been considered a disease in its own right. Since the symptoms are often less visible to the outside than in classic depression, this makes the correct diagnosis more difficult. In addition, those affected often admit to themselves late that they need help and therefore wait a long time before they see a doctor.
As part of the anamnesis, existing psychological and physical complaints are queried, which can give rise to a first suspicion. This is followed by a physical examination to rule out organic causes for the symptoms.
Those affected are then referred to a psychotherapist. The diagnosis is then confirmed with the help of special tests and questionnaires. Here it is also important to differentiate high-functioning depression from other mental disorders that cause similar symptoms. This includes, for example, dysthymia – a chronic depressive mood in which those affected also continue to function in everyday life.
What are the treatment options?
For the treatment of a highly functional form, similar therapeutic approaches are possible as for classic depression. The greatest treatment success usually occurs when those affected accept their illness and accept the help that is offered.
The measures in detail:
Psychotherapy: Cognitive behavioral therapy is often used, but family therapy or self-help groups are also possible. The German Depression Aid provides further information on the latter. In severe cases, admission to a psychosomatic facility or psychiatric clinic may be necessary.
Medicines: Antidepressant drugs such as selective serotonin reuptake inhibitors (SSRIs) and MAOIs may also be prescribed. In the case of the latter, a strict diet without foods containing tyramine should be followed. Because these can lead to dangerous blood pressure crises in combination with MAO inhibitors.
Lifestyle change: Sick people should reduce and eliminate triggers such as excessive stress as much as possible. In some cases, working hours can be reduced, responsibility given or – if financially possible – a household help hired. Learning meditation or relaxation techniques can also be helpful, as can exercise and healthy eating. Addiction counseling can help with alcohol abuse.
If you also suffer from severe tiredness and an increased need for sleep, you should still try less sleep after consulting a doctor. Long sleep can actually increase depression, while sleep deprivation can alleviate symptoms.
Psychotherapy: What forms of therapy are there?
