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Better Understanding High Functioning Depression


High-Functioning Depression: Causes, Symptoms, and Care

Depression is a complex disorder prevalent in today’s society. Individuals experiencing depression, across all types, number over 260 million worldwide, according to the World Health Organization. This illness affects 16% of women and 11% of men over their lifetime in Canada. Various clinically recognized forms of depression include major depression, also known as severe depression, and persistent depressive disorder (also called dysthymia). High-functioning depression, a relatively recent term, has garnered increased public interest in recent years, particularly since 2022 following the suicide of a former American beauty queen struggling with high-functioning depression. With Neuroperforma, the largest network of Neurofeedback clinics in Canada, explore what high-functioning depression entails, why it’s challenging to identify, and potential treatment avenues.

What is High-Functioning Depression?

The term “high-functioning depression” describes a less severe form of depression in which individuals can maintain a relatively everyday life. Those experiencing this form of depression appear to function normally in their daily lives. For example, they may retain performance in their professional activities despite inner struggles. Individuals affected by this type of depression are somewhat considered “highly functional” as they can fulfill and maintain their professional, social, and familial responsibilities while still experiencing depressive symptoms privately.

High-functioning depression is neither an officially recognized diagnosis nor a clinically recognized disorder, notably by the Diagnostic and Statistical Manual of Mental Disorders DSM-5, a reference for psychiatric diagnoses in North America, nor by the WHO. Consequently, the medical and scientific communities are divided on this term and concept, with its usage sparking controversies among mental health professionals. Despite this context, an increasing number of psychiatrists are closely examining this type of disorder, as reported by several Canadian press outlets.

  • High-Functioning Depression and Smiling Depression: Closely Related Notions

The term “smiling depression” is akin to high-functioning depression. This condition is considered a “masked dysthymia,” where depressive symptoms are concealed behind a facade of happiness and normalcy.

Individuals with smiling depression hide feelings of sadness, despair, and fatigue, sometimes out of fear of judgment or stigma. Despite internal distress, they maintain a semblance of normalcy in their daily lives, going to work and taking care of their families.

Several reasons may prompt them to conceal their depressive nature, such as fear of burdening loved ones, the desire to avoid appearing weak, or a lack of recognition regarding the severity of their condition.

  • High-Functioning Depression and Dysthymia: What Are the Differences?

Dysthymia is a diagnosed form of depression. The medical community may refer to it as a chronic and persistent mood disorder. Dysthymia and high-functioning depression are two forms of depression distinguished by their intensity and impact on daily functioning.

Dysthymia, also known as persistent depressive disorder, is a chronic type of depression characterized by persistent feelings of sadness, discouragement, and loss of interest in daily activities. These symptoms typically last for at least two years and can significantly affect a person’s quality of life.

In contrast, high-functioning depression, sometimes called “smiling depression,” is characterized by less severe depressive symptoms that allow individuals to maintain a certain level of functioning in their daily lives. They may go to work, take care of their families, and have a social life, but often experience underlying sadness, fatigue, and sometimes a lack of motivation.


Similar to dysthymia, the precise cause of high-functioning depression in an individual remains unknown. To determine probable causes, a physician may undertake a personalized approach by studying underlying factors contributing to its onset. Key factors may include :

  • Biological factors: Genetic predisposition and hormonal influences, such as the menstrual cycle, may play a role in high-functioning depression.
  • Social causes: Excessive lifestyle factors such as social media use, video gaming, spending, or substance consumption may increase the risk.
  • Psychological sources: Many individuals experiencing this condition have undergone traumas in the past, which may contribute to the onset of this type of depression.


Often hidden behind a facade of normalcy, high-functioning depression can be challenging to identify, both for the individual experiencing it and for their surroundings. For some healthcare professionals, the five key signs of this manifestation include :

  • An underlying feeling of emptiness and sadness carefully concealed from others.
  • Completion of professional tasks diligently but without enthusiasm or motivation.
  • Escape into distractions: the individual excessively turns to social media, TV shows, or junk food to escape emotional pain.
  • A facade of happiness: significant efforts are made to appear happy and positive, even when inner sadness prevails.
  • Physical health or personal well-being is neglected only when nobody is watching.

Several specific characteristics also allow for the distinction of high-functioning depression according to physician precision, such as the possibility of experiencing chronic physical symptoms like headaches or stomach aches arising due to the concealment of emotional distress or resorting to self-medication and substance abuse in an attempt to alleviate emotional pain.

Approaches to Treatment

As high-functioning depression is not recognized as a clinical diagnosis, there is no official or specific treatment protocol at present. For dysthymia, however, practical therapeutic approaches exist to manage symptoms and enhance quality of life.

Treatment for persistent depressive disorder may include cognitive-behavioral therapy, helping individuals identify and modify negative thought patterns contributing to their mood. Management to improve dysthymia symptoms may also extend to adopting a healthy lifestyle, including balanced nutrition, regular sleep, and physical activity.

Learning stress management techniques such as meditation or yoga may also be beneficial. In the case of dysthymia, these therapies may be combined with antidepressant medication.

To establish effective management for this specific form of depression, several physicians and mental health specialists are interested in these disorders and advocate for in-depth studies for official recognition.


High-functioning depression is challenging to experience. Some healthcare professionals consider it a precursor to depression. As such, approaches can be devised to support better “highly functional” depressed individuals to prevent the worsening of their condition. At Neuroperforma, we specialize in non-medicated and non-invasive alternatives like Neurofeedback to improve emotional and psychological well-being for individuals experiencing neurodevelopmental disorders, anxiety, ADHD, or depression. Get in touch with the Neuroperforma clinic network to learn more about high-functioning depression and potential therapy prospects.