Therapy for High Functioning Depression

What is high functioning depression?

High functioning depression, also known as masked depression, is a form of depression that often affects high achieving people who appear to be well-adjusted, happy and successful with no notable outward signs of depression. They often excel at their jobs, home life and relationships. 

However, many of these seemingly happy individuals struggle with self-care. They may fail to make time to eat, either skipping meals or working through meals without a proper break. They may wake up with dread about the day or spend too much time scrolling on social media even though they don’t derive any real value from it. They may refuse to take a day off from work or may fail to delegate work or household duties to others. They may feel that they are the only ones who can do the job properly. The inability to give up control can become overwhelming and leave the person feeling emotionally numb and lonely. These are all symptoms of a high functioning depression. 

People with this type of masked depression do not feel energized, joyous and present. Instead, they often feel burnt out, irritable and distracted. If you pay attention, it looks like a spark is missing but they continue to juggle life quite well. Yet they may wear a smile to show the world they are just fine. 

Is it difficult to diagnose?

People with masked depression generally do not fit neatly into a box. They don’t quite meet criteria for major depressive disorder.  High functioning depression is complex and can be difficult to diagnose since it’s a depression with many different faces. It can present as irritability, substance abuse, anger issues. Masked depression looks different across different genders, cultures and personalities. 

Most people who struggle with high functioning depression do not always identify with the diagnosis of depression. They might deny feeling depressed. They may think that since they are not in bed all day crying, they are okay. 

What is anhedonia?

Despite functioning quite well, people with this masked depression often experience anhedonia. Anhedonia is characterized by a loss of interest in normally enjoyable activities. They do not generally derive pleasure out of socializing or going out for a nice meal the way they used to. This loss of interest is often accompanied by other symptoms, such as difficulty sleeping, appetite disturbances, reduced motivation, and fatigue. 

The lack of ability to feel pleasure can eventually lead to emotional numbness which is a significant manifestation of anhedonia. People often cope by overworking themselves. They do not allow themselves to feel emotion. Anhedonia is a sneaky symptom. It creeps in insidiously until the person feels nothing.   

Are people with high functioning anxiety aware of their depression?

Individuals with high functioning depression are so concerned with the people in their life who depend on them that they don’t have time to feel depressed. They become fixated with a list of to-dos at work or at home and they don’t stop to take time to process their emotions. 

At work and home the person delivers but can’t derive satisfaction from work or home life. They can be highly controlling, feeling like no one else can step in and do the work for them. They overly identify with their jobs and what they do for others and they are unaware that they lack joy. They may not find joy in food, have low energy, and have sleep problems. 

Unfortunately, many people believe that depression is only diagnosable when a person is not functioning properly. This belief can hinder someone from finding treatment. In contrast, depression can be seen in people who over function. They get up before the alarm goes off because of the angst of the day. They skip meals or work through them. They feel burnt out and doom scroll instead of being present for their family. They may struggle with addiction or workaholism. But they are successful at work and taking care of family obligations. 

Doctors will frequently miss this diagnosis since there may be no notable distress. In addition, most people with masked depression do not want to go to therapy and explore their deeper feelings. This makes diagnosis and treatment especially challenging. 

Can symptoms of high functioning depression overlap with symptoms of anxiety?

High functioning depression overlaps with the symptoms of Generalized Anxiety Disorder and other anxiety disorders. In both masked depression and anxiety people might struggle with poor appetite, physical slowing, loss of motivation, sleep disturbances, irritability,  etc. Anxiety and depression are really just different sides of the same coin, traveling together and disrupting the quality of one’s life. 

What is the treatment for high functioning depression? 

We are hardwired to feel joy and to thrive. It is important for people to take time out of their busy lives and give themselves permission to find peace,  happiness, and comfort. Just because you are able to get all of your obligations done and a bottle of wine or social media scrolling takes the pain or loneliness away, it is important to know that there is room in your life to feel better. Take it seriously because there are treatments available. 

The medications prescribed are often the same for both anxiety and depression. And Cognitive Behavioral Therapy (CBT) often treat both simultaneously. 

• Medication

Dopamine, serotonin,  norepinephrine are the neurotransmitters that help people feel joy. The levels of these neurotransmitters appear  different in the brain of someone who is depressed. Medications such as selective serotonin reuptake inhibitors (SSRIs), antidepressants, anxiolytics, and antipsychotics, can all help balance the brain and improve the moods of people who struggle with depression. 

• Cognitive behavioral therapy (CBT)

Cognitive therapy helps reframe your thought process about having to overachieve. Cognitive reframing is essential in recognizing that if you decide not to go above and beyond your call of duty, you are not a burden to others. 

If you think all you have is what you do, then you might stop engaging in your hobbies. Behavior therapy incorporates lifestyle modifications to help you create more balance in your daily routine. 

• Mindfulness and meditation are essential in helping you clear your mind as you become more aware of the stress in your body. It allows you to breathe and let go and  create room for joy. 

If you are bombarded with life and suffer from emotional numbness or diminished ability to feel joy, contact Dr. Suzanne Feinstein about your symptoms and ask how to address it. 

Dr. Suzanne Feinstein, Director at Advanced Behavioral Health, LLP, is a Columbia University-trained Clinical Psychologist who specializes in the treatment of depression and other mood-related disorders, the full spectrum of anxiety disorders, body focused repetitive behaviors, OCD, and ADHD. She is highly skilled in using cognitive behavioral therapy (CBT) in combination with other evidence-based techniques such as Exposure Therapy and Response Prevention (ERP), cognitive reframing, mindfulness and relaxation training, DBT, ACT. etc. She has had great success helping her clients gain control over their mood, anxieties and impulses.