Depression does not only feel like a heavy sadness. In many cases, high-functioning people with depression appear just like everyone else. They are still productive workers, helpful friends, caring parents, but inside of them is a brewing maelstrom of discontent.
Judith Joseph, a New York University psychiatrist and author of the upcoming book “High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy,” said there are many high-functioning patients she treats, particularly women and minorities, who “can’t afford to slow down” even when they are depressed.
Before these symptoms develop into a major depressive disorder, people might be exhibiting concerning “hidden signs” of depression that could get overlooked, Joseph said.
“In health care, in order to code for something, and in order to treat someone or even to prescribe therapy or medication, you have to lose functioning. You have to check that box or else you don’t meet diagnostic criteria,” she said. “So there are all these people out there who have these symptoms who are pushing through pain.”
The first step to changing how you feel is to name what you are going through.
“If you want to continue doing the things that you love and being with the people that you love, it’s important to recognize when you’re struggling silently,” Joseph said.
Here are some of the biggest, less-visible signs of depression that you need to be paying attention to:
You overcommit to your job.
For people with high-functioning depression, a job is not just a calling, it is their only purpose that is keeping them going. Tanisha Ranger, a Nevada-based clinical psychologist, said she has experienced this type of functioning depression firsthand.
During this time of her life, “I would get up and I would go to work, and I would be really good at my job, and I would get home and I would get immediately in bed,” she recalled. “There was nothing that I was doing outside of going to work. The only people that I was interacting with were co-workers and clients.”
“Usually you’re… over-committing in one part of your life, like your role, whatever your role is,” Joseph said. She gave the examples of a working mom who doesn’t have time to take care of her basic needs, an athlete who pushes himself to the brink for his team and an entrepreneur who overworks because they do not want to fail.
You no longer feel joy or pleasure in activities you used to enjoy.
Feeling anhedonia, or a lack of feeling and a lack of pleasure in things that once excited you, is a sign that you are at high risk of depression.
There are a plethora of sensations that could be an indicator of anhedonia. Here are questions Joseph posed to prompt reflection:
- After you took a nap, did you feel rested?
- When you ate, did you enjoy your food? Did you savor it, or did you shovel it down?
- When you hung out with a loved one, did you enjoy the interaction? Or were you busy and distracted?
- When you have intimacy with your partner, is it pleasurable for you or do you seek to get it over with?
- When you’re drinking your coffee in the morning, are you just chugging it to get caffeine, or are you enjoying the flavor?
If you find that you are losing enjoyment in many of your everyday activities, that is concerning.
“I think it’s a sneaky symptom,” Joseph said. “People feel like, ‘That’s just me feeling blah,’ but it is an early sign of depression, and it’s one of the symptoms that is correlated with high-function depression.”
You lose all internal motivation.
People often mislabel this symptom as “laziness,” but Ranger said “a lot of people with depression have a lot of haphazardly started and never completed projects, and it’s not because [they are] too lazy to do it. It’s because [they] can’t sustain the motivation.”
You may have the will to complete tasks that keep you employed, for example, but you keep losing the energy and will to take care of yourself.
“I always describe depression as a disease of inertia. You just aren’t moving,” Ranger said. When she experienced functioning depression, Ranger said she lacked self-directed motivation: “I couldn’t be motivated to do something just for me at first, like I’ll let me down in a second.”
You keep sacrificing yourself to people-please others.
People-pleasing behavior is a more subtle sign of hidden depression, but this kind of “masochistic trait” is something that Joseph said clinicians like herself keep track of.
People pleasers “don’t want to let people down,” Joseph said. “They don’t want to lose that role as the person who does it all because that’s where they derive their self-worth from.”
You never feel like you or others are good enough.
Ranger said people with depression can fall into a concerning pattern of thought that boils down to “I’m bad, the world is bad and nothing’s ever going to change.”
So even if you outwardly appear fine, if you are feeling increasingly hopeless, this is a sign to pay attention to.
Ranger said women, and women of color in particular, feel this symptom. “We don’t necessarily feel like ‘I’m depressed.’ We just feel like ‘I’m not good enough, I’m not doing enough, I’m not taking care of myself enough. It’s just not enough,’” Ranger explained. “Instead of feeling like, ‘Oh, I’m depressed,’ we feel like, ‘Oh, I’m a failure.’”
What To Do If You Believe You Have ‘Hidden Depression’
It may not feel like it when you’re in the thick of these hard emotions, but it is possible to change how you feel and think, for the better.
“You deserve more than just functionality. You deserve joy. You deserve to have a life that you enjoy,” Ranger said.
Here is how to get started on your journey to feeling better:
Feel your emotions.
Too often, people feel numbness in this type of functioning depression. To combat this, pay attention to what you are feeling inside.
“Acknowledge and accept your emotions rather than pushing down the pain,” Joseph said. Talking to a loved one, a therapist, or journaling, singing or crying ― a “natural stress reliever,” Joseph said ― can help you learn how to express your emotions better.
Socialize.
When was the last time you had a pleasant conversation with another human being? Talk to your barista, call up your mom, text a friend.
Beyond moving your body every day, Ranger suggests “micro-dosing friendship.” “It only takes a little bit of social connection to improve your mood,” she advised.
Remember your values.
“Many people with high-function depression are chasing goals that are mostly materialistic, like getting an accolade or getting a job or accumulating things,” Joseph said. “But at the end of the day, when you’re on your deathbed, you’re not going to want more things.”
So write down what is important to you so you can find moments in your day to tap into your values. Joseph, as an example, makes a point to learn something new about Black history because it helps her feel good about her community.
Find moments of joy every day.
To help lessen anhedonia, Joseph said she will help patients identify “as many points of joy in a day as possible.” This can look like finding time to savor your lunch away from your desk or calling a loved one instead of doom-scrolling on TikTok, for example.
Reach out to a mental health professional.
Of course, depending on the severity of your symptoms, more help may be needed. Just because you’re able to keep up with your life and your obligations doesn’t mean you don’t deserve care. Consider working with a therapist to explore other options.
Whatever you do, do not ignore these symptoms, because these feelings will not go away.
“Eventually something will happen. Stress will eat at your body,” Joseph warned. You will either have a physical breakdown that manifests as some form of physical condition, like an autoimmune disease, or you will eventually mentally break down.”