High functioning depression, also sometimes referred to as dysthymia or “atypical depression”, is a form of depressive disorder. Many people use the term high-functioning depression when what they’re describing is persistent depressive disorder (PDD), previously called dysthymia, so when we talk about symptoms of high-functioning depression, we’re usually talking about symptoms of PDD. It presents with less severe symptoms than major depression. People who suffer from high functioning depression may appear to be relatively happy and well-adjusted on the surface, but they are still struggling with chronic low moods and feelings of emptiness or hopelessness.

This type of depression can be especially difficult to diagnose. This is because many people do not realize that they are struggling with a mental health disorder. Friends and family members may also be reluctant to believe that someone who seems so composed could be dealing with such a serious problem. The characteristics of high functioning depression are not as severe as those of major depression. But they can still be very disruptive to a person’s life. People with high functioning depression may find it difficult to concentrate, stay motivated, or enjoy activities that used to please them. They may also experience problems with sleep and changes in appetite. Because many people have internalized the misconception that depression has to look a certain way, those who experience high functioning depression might not be aware of it.

Causes of High Functioning Depression


Some medications can contribute to feelings of depression. For example, steroids and some blood pressure medications have been linked with mood changes that may lead to low energy, sadness, irritability, or other symptoms associated with high functioning depression.


People who have a first-degree relative, such as a parent or sibling, with major depression are at increased risk for high functioning depression. If you can trace your family tree back several generations and notice that almost everyone struggled with some type of mood disorder throughout their lives, it may be helpful to explore whether there is any genetic component to this pattern.

Life events

 As with major depression, traumatic events such as the loss of a loved one, financial problems, or a high level of stress can trigger high functioning depression in some people

Substance Abuse

People who struggle with substance abuse may be at increased risk for high functioning depression. Drug and alcohol use can alter the way neurotransmitters function in the brain, which may increase feelings of sadness or irritability.

Brain chemistry.

 Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in high functioning depression and its treatment.

Biological differences. 

People with high functioning depression may have physical changes in their brains. The significance of these changes is still uncertain, but they may eventually help pinpoint causes.

Symptoms of High Functioning Depression

You’re Cranky and Moody

We know that depression is often associated with idleness and passivity. It’s like nothing and no one can trigger an emotional response from you. Life seems plain, boring, and uneventful. But you might be surprised to hear that high functioning depression can do the exact oppositeif you’re dealing with this condition, you might notice that you’re cranky all the time. You get irritated at the slightest discomfort and even respond with angry outbursts to minor events such as your partner making a bad joke.

You Feel Tired Even After Proper Rest

One symptom that all forms of depression have in common is exhaustion. When you insist on going about your life like everything’s okay but you’re running low on emotional resources, you will begin to experience frequent episodes of exhaustion. No matter how much you sleep and how healthy you eat, you still get tired more easily than you used to and that’s because the problem isn’t your lifestyle, but the emotional turmoil that’s draining your energy.


This is the most common symptom of high functioning depression and can be accompanied by feelings of emptiness, hopelessness, or worthlessness. Sadness can also take the form of grief, as people with high functioning depression often have a difficult time dealing with loss and may become depressed after losing a loved one or experiencing some other type of major life change.

You Bury Yourself in Work

For people who are dealing with high functioning depression, the office becomes a refuge from negative thoughts and unpleasant emotions. it’s easy to ignore the mess in your personal life when you overwhelm yourself with business meetings and work-related tasks. In time, this unhealthy coping strategy can lead to chronic stress and burnout.

Other symptoms of high functioning depression include:

  • Self-esteem difficulty
  • Feelings of emptiness
  • Low energy or motivation
  • Reduced social activity
  • Lack of or decreased appetite.
  • Poor sleep or insomnia

How to Treat High Functioning Depression

Treatment is similar to that of any other form of depression. But unlike in the case of other forms of depression, progress may be slower given that high functioning depression is ‘subtle’ and doesn’t alter your overall mood that much. The following are treatment methods that can be employed:

Cognitive Behavioral Therapy (CBT)

This type of therapy works to change how a person thinks and acts, which can improve mood symptoms. CBT is often paired with antidepressants or other medications that target mood disorders. This combination is very effective in treating both depressive symptoms and feelings of hopelessness.


Some people do not respond well to traditional types of antidepressant medication such as SSRIs (selective serotonin reuptake inhibitors) and will need to be clinically reviewed and examined following usage of these medication. Monoamine oxidase inhibitors (MAOIs), antipsychotics, tricyclic antidepressants, and atypical antidepressants are choices that work on neurotransmitters in the brain to help reduce depressive symptoms.

Self-Help and Coping Skills

Many people find it helpful to learn new ways of coping with life stresses and difficult emotions, such as practicing mindfulness or breathing exercises daily. There are many resources available that can teach individuals how to develop coping skills for depression. Support groups may also be beneficial in helping patients feel less isolated while they take steps toward recovery from high-functioning depression.

Treatment will depend heavily upon the severity of the person’s disorder, their response to treatment so far, what other mental health concerns are present (such as anxiety), any coexisting medical conditions that need attention, etc. Each individual must seek out care through a provider who has experience in diagnosing and treating high-functioning depression.