Can Someone Have Functional Depression?

Woman with functional depression facing a window holding coffee

Functional depression, sometimes referred to as high-functioning depression or dysthymia, is a term used to describe individuals who experience symptoms of depression but can still maintain their daily responsibilities and routines. Dysthymia is now classified as Persistent Depressive Disorder (PDD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Functional depression can be complicated to diagnose. People with functional depression may not show the severe symptoms typically associated with major depressive disorder, making it harder to recognize that they are struggling. Some of the most common symptoms of functional depression include:

  1. Low mood or persistent sadness
  2. Loss of interest in previously enjoyable activities
  3. Fatigue or low energy
  4. Irritability
  5. Difficulty concentrating or making decisions
  6. Feelings of guilt or worthlessness
  7. Sleep disturbances, such as insomnia or oversleeping
  8. Changes in appetite or weight
  9. Social withdrawal or isolation

Despite experiencing these symptoms, individuals with functional depression may continue to perform well at work, maintain relationships, and engage in social activities. However, this does not mean they are not suffering or need help. Patients with functional depression are some of the most difficult to treat. Much like it is challenging to appreciate physical changes in people you see daily, functional depression slowly chips away at a person’s ability to live a full life. Those around them may not see the destructive consequences. As such, when the condition is finally diagnosed, it has typically progressed into something more serious, approximating a major depressive episode.

“Families of those with functional depression are often blindsided by how long their loved one may have been suffering. Further, because the patient themselves has been able to conduct a relatively normal life, albeit with internal demons, they tend to be more resistant to treatment,” says Ben Brafman, cofounder of SBMHC. “Cases such as these are where the family is the catalyst for change. It can be difficult for a mental health counselor to discuss a condition the patient may not think exists. But when attacked in solidarity with the psychiatric and medical team and the family, we often make significant breakthroughs and prevent the worsening of depressive symptoms.”

Is Functional Depression Treatable?

Yes! Although the symptoms may be less severe than those of major depressive disorder, seeking treatment is important to improve quality of life and prevent worsening of depressive symptoms. Treatment options for functional depression may include:

  1. Talk therapy is a gold-standard, effective treatment for depression. Cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and psychodynamic therapy have been proven helpful for individuals with functional depression. These therapies help people identify and change negative thought patterns, improve communication and relationship skills, and resolve underlying emotional concerns
  2. Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs), can help manage the symptoms of functional depression
  3. Healthy lifestyle changes can help improve symptoms of functional depression. This may include regular exercise, a balanced diet, maintaining a consistent sleep schedule, reducing stress through relaxation techniques (such as mindfulness, meditation, or yoga), and building a solid support network of friends and family
  4. Support groups can provide a space to share experiences, learn from others, and develop coping strategies
  5. Some individuals find relief from their depression symptoms through alternative therapies, such as acupuncture, massage, or herbal supplements, but be sure to speak to a counselor and medical doctor before pursuing any therapeutic or pseudo-therapeutic options on your own

The most effective treatment plan for functional depression often involves a combination of these approaches tailored to the individual’s specific needs and circumstances.

Co-Occurring Disorders

Co-occurring disorders are two or more diseases or conditions that occur simultaneously, and treating multiple conditions requires a specialized therapeutic team like ours at SBMHC. Like any disease, depression can co-occur with various physical and mental health conditions, and co-occurring conditions can worsen depression symptoms and complicate the treatment process. Some common diseases and disorders that co-occur with depression include:

  1. Anxiety disorders
  2. Substance use disorders
  3. Bipolar disorder
  4. Eating disorders
  5. Attention deficit hyperactivity disorder (ADHD)
  6. Post-traumatic stress disorder (PTSD)
  7. Obsessive-compulsive disorder (OCD)
  8. Chronic pain conditions
  9. Cardiovascular diseases and diabetes
  10. Cancer
  11. Neurological disorders

Collaborative care involving mental health professionals, primary care physicians, and specialists can help create a comprehensive treatment plan that addresses both depression and any co-occurring conditions.

Differential Diagnosis

High-functioning depression can be mistaken for several other conditions or situations due to its subtler symptoms than a major depressive disorder:

  1. High-functioning depression can be mistaken for everyday sadness or stress, as people might not recognize their symptoms’ persistent nature and depth
  2. Some individuals might interpret the symptoms of high-functioning depression as a part of their personality, such as being introverted, pessimistic, or moody
  3. High-functioning depression can be misinterpreted as burnout, especially when people are under chronic stress at work or in their personal lives. Burnout may share some symptoms with depression, such as fatigue, irritability, and reduced motivation
  4. Functional depression often involves symptoms of fatigue and low energy, which can be mistaken for chronic fatigue syndrome or other disorders
  5. Difficulty concentrating and making decisions are common symptoms of high-functioning depression, which can sometimes be mistaken for ADHD or other attention-related disorders
  6. It may share some symptoms with Generalized Anxiety Disorder (GAD), like irritability, fatigue, and sleep disturbances, which can lead to misdiagnosis

A proper evaluation can help differentiate between high-functioning depression and other conditions, leading to appropriate treatment and improved well-being.

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