What You Should Know about High-Functioning Depression

Amanda Leventhal looks like any other college student. She maintains a high grade point average, sings in her campus choir, and hangs out with a group of good friends. It is unlikely anyone would identify her as depressed. When she wrote an essay on her private battle with anxiety and depression, her friends were shocked.

When you think of depression, you may imagine social withdrawal, pulling away from favorite activities, difficulty sleeping, and tears. While these symptoms accurately portray some people with depression, other face of depression appear very different.

Depression may look like Olympic swimmer Allison Schmitt, or actress Kristen Bell. It may look like your co-worker or neighbor, people who seem to have it all together. These faces are typical of what is being called high-functioning depression. And because depression still carries a stigma, these people often keep their pain hidden – sometimes until it is too late.

Carol Landau, Ph.D., is a clinical professor of psychiatry and human behavior and medicine at Brown University. She treats many high-functioning patients who seem just fine on the outside, but are deeply sad on the inside. She explains that these patients are often high achievers, and many are women with a tendency toward perfectionism. According to Dr. Landau:

People often say being “high-functioning” is better than being “low-functioning,” but that’s not really true because the most important thing is for a depressed person to get help – which a high-functioning person is limiting herself from.

Levanthal wrote her essay after years of private struggle. She says:

It was something I had been thinking about for a while. I was up late one night, not sleeping, and decided to put into words everything I had been reflecting on over the years.

Landau explains disclosure is often difficult for women.

We’re still striving to be caregivers, and part of that is not admitting we need help. But it’s a huge problem. Depression is actually the leading cause of disability worldwide, according to the World Health Organization, which takes into account things like days lost from work, not being up to doing daily activities, and [possibly leading to] other illnesses like diabetes. So the minute someone opens up to their friend about it, they’ll find out that their friend will say, “Me too,” or, “My sister feels that way too,” or, “So does my mom,” or, “So does our other best friend.”

Levanthal has some tips for identifying someone who may be struggling with high-functioning depression.

You might have a friend who is cranky all the time, or who people think of as a “bitch,” but inwardly that person is really struggling. Other subtle signs to look for: ironic or morose jokes – if they are out of character – or often seeming out of it.

Landau suggests you ask that person if she is okay, and mention you’ve noticed signs of distress. Be there to listen, and be able to suggest resources like a therapist, or even a meditation app. There are many resources for people seeking relief.