What Causes High Functioning Depression?
Understanding High Functioning Depression
High Functioning Depression (HFD), though not an official diagnosis in the DSM-5, HFD is a term frequently used in mental health contexts in current culture and in online societies. It describes individuals who experience depressive symptoms but continue to function at high efficacy in their daily lives and many do not identify with the term “depression” do to cultural reasons amongst others. This condition can be particularly insidious as it often goes unnoticed due to the individual's ability to maintain their responsibilities and their inability to expreay involve therapy, possibly medication, and lifestyle changes that modify exercise, diet, and mindfulness practices. Gradually reengaging in activities, even if not immediately pleasurable, can be beneficial in overcoming anhedonia.
The Complexity of Causes
The causes of HFD are likely multifaceted, often intertwining biological, psychological, and social factors. Dr. Judith has used the Bio-Psycho-Social Model. Similar to many medical and mental health conditions, people with HFD may express similar symptoms but have very different etiologies or causes. For example, not everyone with depression will show the same biological markers on imaging. This is why imaging of the brain via MRI, CT Scans is not used in everyday clinical practice. Looking at the whole picture may be helpful in understanding HFD.
Biological Factors: Genetics can play a crucial role in HFD. A family history of depression or other mental health disorders can increase the risk. Neurobiological aspects, such as imbalances in brain chemistry and hormonal fluctuations, are also significant contributors.Some physical diseases may contribute to depression and some states of physiological imbalances such as infection or inflammation can do this as well. Toxins and exogenous factors may worsen depression or increase risk.
Psychological Factors: Personality traits like perfectionism, a tendency towards high self-criticism, or a chronic sense of inadequacy can predispose individuals to HFD. Past trauma, ongoing stress, and unresolved emotional issues can further exacerbate the condition. As a researcher involved in many clinical research studies in PTSD and trained and certified on the CAPS5 assessment, Dr. Judith focuses on past trauma as a key possible predictor in individuals who report HFD.
Social Factors: Environmental stressors, such as a high-pressure work environment, relationship issues, or chronic social stress, may contribute to HFD. Societal expectations and cultural norms around productivity and success may also contribute to its development. The constant pressure to perform and succeed, especially in the face of internal struggles, may lead to the masking of depressive symptoms. Lifestyle Factors such as Poor sleep, lack of physical activity, unhealthy diet, and inadequate stress management may contribute to the onset and persistence of HFD. Societal unrest, war, conflicts, systemic and institutional oppression, and wide disparities in economics also play a role. The post pandemic world is a world of both uncertainty and excess. Many people cope with the enormous amount of uncertainty by consuming in excess and we have seen an increased consumption of maladaptive behaviors (eg increased social media, increased tech use) in combination with declines of healthy and adaptive behaviors (eg. increase in sedentary lifestyles). This likely contributes to the onset of HFD.
Recognizing the Symptoms
While individuals with HFD can maintain their responsibilities, they may exhibit signs that can go unnoticed. These include:
Persistent Fatigue: Despite maintaining a normal routine, individuals may constantly feel tired.
Subtle Emotional Changes: Feelings of sadness or emptiness that don't necessarily impede daily functioning. Feelings of irritability or anger.
Cognitive Challenges: Problems with concentration, decision-making, or memory.
Changes in Sleep and Appetite: Difficulty sleeping or changes in eating habits that are not overtly disruptive but persistently problematic.
Decreased Satisfaction: A general sense of dissatisfaction with life achievements, irrespective of actual success. Muted feelings towards things that used to bring more joy or pleasure.
The Role of Stress and Burnout
Modern lifestyle demands and the prevalence of chronic stress are likely significant contributors to HFD. Prolonged exposure to high-stress environments, without adequate coping mechanisms, may lead to burnout, which typically follows the high functioning period in those who have HFD.
Managing High Functioning Depression
Managing HFD requires a comprehensive approach:
Professional Therapy: Counseling or psychotherapy can be instrumental in addressing the underlying issues.
Medication: In some cases, antidepressants or other medications may be recommended.
Lifestyle Modifications: Incorporating regular exercise, a balanced diet, adequate sleep, and stress management techniques.
Building Support Systems: Strengthening social connections and seeking support from friends, family, or support groups.
Dr. Judith is developing a methodology to potentially address and prevent HFD and it will be largely based on her research and clinical practice findings.
Conclusion and Further Exploration
Understanding the causes, presentations and risk factors of HFD is the first step towards effective management and recovery. For those who resonate with these symptoms or suspect they might be experiencing symptoms of HFD, Dr. Judith provides a thoughtful and insightful resource that may be useful for self reflection and awareness. Her High Functioning Depression Quiz may offer a potential ways to explore these feelings further in a confidential and supportive manner. You can take this insightful quiz at Dr. Judith's High Functioning Depression Quiz for a better understanding of your experiences. Keep in mind that this is in no way a diagnosis and that these tools may be useful when discussing a treatment plan and diagnosis with your licensed provider.
Disclaimer: You may want to consider your individual mental health needs with a licensed medical professional. This page is not medical advice.
Dr. Judith Joseph, a board-certified Psychiatrist and Media Consultant with over 1 million followers on social media, leads the First-of-its-kind study on High-Functioning Depression. While there is a multitude of research on depression and dysthymia, there is very little on depression in the prodromal phase in people who have symptoms of depression but do not meet criteria for a major depressive episode because they are functioning at a high capacity and they do not report or acknowledge being in significant distress. These individuals do not necessarily identify with the emotion “depression” until someone points out that they are exhibiting symptoms of depression and or anhedonia. While High Functioning Depression is a term that has risen recently in the past 5 years in the online discourse and mental health circles, it is not yet recognized amongst medical professionals and is not in the diagnostic manual for psychiatry (DMS-5). Many individuals during and after the Covid-19 pandemic began to present to Dr. Judith’s practice using the term, “High Functioning Depression” and there have been reports of HFD worsening without treatment into fatal forms of mental illnesses. This along with Dr. Judith’s online followers asking for more resources on HFD, led to Dr. Judith and her research team submitting the first of its kind High Functioning Depression study to the IRB in 2023. She is currently enrolling individuals into this study to learn more about the risk factors and unique presentations of individuals who identify as having High Functioning Depression. Dr. Judith holds degrees in biology, chemistry, religion medicine, and business from prestigious institutions such as Duke University and Columbia, and has post-doctoral and research training at Columbia University and NYU. Passionate about inclusive mental health treatments, Dr. Judith heads a dedicated team of 10 women focused on innovative research for various mental health conditions. Her lab pioneers high-functioning conditions research, develops psychometric scales for mood and anxiety, and promotes evidence-based approaches. Her lab has enrolled patients into phase 2-4 clinical research studies aiding in the development of novel treatments for pediatric, adult and geriatric conditions ranging from ADHD to Alzheimer’s dementia. Some of the novel treatments have become FDA approve and now help to treat millions of people worldwide. Her clinical research site, Manhattan Behavioral Medicine has participated in both Pharma and NIH funded research and is one of the few clinical research sites solely owned and solely operated by a black woman Principal Investigator. This is important as it is well known that for many years minority populations and women were largely underrepresented in clinical research. Dr. Judith is dedicated to creating space for diversity and inclusion in this space so that research and evidence-based treatments are representative of all populations. Dr. Judith Joseph is committed to advancing mental health treatment and embracing diversity in her work.