High-Functioning Depression: How To Recognize It in Yourself

When people talk about high-functioning depression, they’re often describing a form of chronic, low-grade depression called dysthymia (also known as persistent depressive disorder). It’s the kind that doesn’t always look like the depression you see in movies — no dramatic breakdowns or days spent in bed — but rather a quiet, heavy fog that lingers for years. You might get up, go to work, meet friends, and still feel like you’re running on empty underneath it all.

Common symptoms of dysthymia include fatigue, low self-esteem, and poor concentration. Unlike seasonal affective disorder (SAD) — which tends to come and go with the winter months — high-functioning depression sticks around year-round, often blending into daily life so seamlessly that even you might not realize how much it’s affecting you.

What makes it “high-functioning” isn’t that it’s any easier to live with — it’s that you’re still functioning through it. You’re keeping up appearances, ticking off your to-do list, and holding conversations while quietly fighting an ongoing battle that no one else can see.

What is high-functioning depression?

Depression doesn’t always look like falling apart. For some, it shows up as a quiet sense of sadness, hopelessness, or exhaustion that sits just beneath the surface — even while they’re holding everything together. You might still show up to work, maintain relationships, and meet daily responsibilities, all while feeling emotionally drained inside.

This experience is often called high-functioning depression. It’s not a formal diagnosis, but a way to describe people who live with the symptoms of depression while maintaining a seemingly stable, “normal” life on the outside.

An essay on the National Alliance of Mental Illness website helps illustrate just what a person’s experience with the condition looks and feels like. In the first-hand account, the author is having a big day in their career, where during the day, they were all smiles and joy, and later that evening, they were on the floor, consumed by ruminating thoughts.

According to the National Institute of Mental Health, 2.5% of adults will experience dysthymia in their lifetime.

Is high-functioning depression real?

Yes — high-functioning depression is very real. Depression doesn’t have one “look,” and it’s defined by how you feel and what you’re experiencing internally, not by how well you appear to be managing on the outside.

Clinical depression vs. high-functioning depression

Clinical depression is a diagnosis, while high-functioning depression can be used to describe someone who may have depression, but is still able to function in a way that allows them to meet the demands of their daily life.

Chronic high-functioning depression

High-functioning depression can absolutely be chronic. Like other forms of depression, it may ebb and flow with life’s stressors — showing up more intensely during challenging times — or linger steadily, even when everything around you seems fine.

High-functioning depression symptoms

High-functioning depression can be hard to spot — even in yourself. The signs are often subtle and easy to brush off as “just being tired” or “a bit off.” But these symptoms can quietly chip away at your energy, confidence, and sense of joy over time.

Common symptoms include:

• Persistent low mood: A dull, lingering sadness or emptiness that doesn’t fully go away, even on good days.
• Fatigue or low energy: You keep up with your responsibilities, but everything feels like it takes more effort than it should.
• Loss of interest or pleasure: Things that used to bring you joy — hobbies, social plans, even small wins — now feel flat or meaningless.
• Sleep changes: Trouble falling or staying asleep, or sleeping too much but never feeling rested.
• Low self-esteem: A constant inner critic that makes you feel “not good enough,” no matter how well you’re doing.
• Difficulty concentrating: Your mind feels foggy or scattered, making it harder to focus or make decisions.
• Irritability or restlessness: You might feel easily frustrated or tense, even over small things.
• Guilt or self-blame: A tendency to replay past mistakes or feel guilty for not being “happier.”
• Social withdrawal: You still show up for people — but maybe less often, or without feeling fully present.

What does high-functioning depression look like?

Whether you call the condition high-functioning depression, dysthymia, or persistent depressive disorder, its impact on your life is probably undeniable.

From the outside, someone with high-functioning depression might seem perfectly fine — they show up for work, keep their home in order, and maintain relationships like nothing’s wrong. But inside, they’re often running on empty, weighed down by sadness, fatigue, or a quiet sense of hopelessness.

Psychiatric Nurse Practitioner Melissa Brown describes it like a duck gliding across a pond: calm and composed above the water, but beneath the surface, paddling furiously just to stay afloat.

Do I have high-functioning depression?

The only way to know for sure is to talk with a mental health professional. Many people with high-functioning depression don’t realize they’re struggling because they don’t fit the stereotype of what depression “should” look like. But if you’ve noticed a persistent low mood, loss of interest in things you used to enjoy, feelings of hopelessness, low motivation, or trouble focusing, it may be more than just stress or burnout.

If any of this sounds familiar, consider reaching out for help. A professional can listen, offer clarity, and guide you toward a treatment plan that helps you feel like yourself again.

Is there a high-functioning depression test?

No, there’s no single test that can diagnose high-functioning depression, but Brown suggests paying close attention to your patterns — especially during downtime. She explains that the biggest clue often lies in what you do when you don’t have to be “on.”

When you finally get a break, do you have the energy to enjoy hobbies or connect with friends? Or do you immediately crash, “bed rot,” and struggle to do anything until it’s time to perform again? Brown says that constant depletion during off-hours can be a key sign that high-functioning depression might be at play.

Can you be high-functioning and depressed?

Yes — you can absolutely be high-functioning and depressed. Depression doesn’t always stop you from getting out of bed or showing up for work. For some people, it looks like keeping everything together on the outside while quietly struggling on the inside. You might still meet deadlines, make dinner, and smile in conversation — but underneath, you feel numb, exhausted, or detached from the life you’re living.

High-functioning depression often hides behind productivity and perfectionism, which can make it harder to recognize — and even harder to reach out for help. But no matter how “together” you look, your feelings are valid, and support is available.

Causes of high-functioning depression

There isn’t one clear cause of high-functioning depression, but Brown explains that “It often ties back to how someone was raised. Many people grow up believing they have to keep everything together — that no matter how they feel inside, they’re expected to perform, achieve, and appear fine.”

Brown says that this mindset can lead to “perfectionist tendencies and unrealistic self-expectations,” where your worth feels tied to how much you accomplish. Over time, that pressure to constantly ‘do well’ — even when you’re struggling — can mask the signs of depression beneath a polished surface.

Treating high-functioning depression

Even if you’re managing day to day, living with high-functioning depression can feel like moving through life in grayscale — everything technically works, but nothing feels quite right. The good news? It’s treatable.

But since there is not a single cause or trigger for high-functioning depression, zeroing in on what works best for you will come down to trying different things and seeing what works.

With the right support and strategies, it is possible to lift that weight and rediscover a sense of balance. Here’s what treatment can look like.

Therapy for high-functioning depression

Brown recommends regularly seeing a therapist for those struggling with high-functioning depression.

Medicine can be helpful, but without talking through the root causes of what you are experiencing with a professional like a therapist, the problems will not go away. Brown says that medicines can definitely put you on a foundation from which you can improve, but they will not change things like how you respond to stress or your mindset.

Therapy in tandem with the right medications has been shown to improve symptoms of depression and help people feel better about themselves and their lives.

CBT exercises for high-functioning depression

Cognitive Behavioral Therapy (CBT) is a form of talk therapy that helps you recognize and challenge unhelpful thought patterns and behaviors. For people with high-functioning depression, CBT works much like it does for clinical depression — by targeting the root of negative thinking and helping you reframe it in a more balanced, realistic way. You can work with a therapist trained in CBT, but some of its exercises can also be practiced on your own between sessions.

One simple place to start is with a thought journal. Jot down negative or automatic thoughts as they come up, then use a technique called cognitive restructuring to identify distorted thinking patterns — things like catastrophizing, all-or-nothing thinking, or filtering out the positives. Once you recognize these patterns, you can practice reframing them, crafting new responses that reflect both how you feel and what you know to be true.

Brown also recommends Activity Scheduling. Many people with depression lose interest in things that once brought them happiness, and Brown encourages her patients to intentionally reintroduce those activities — even in small doses. Setting aside time for something that once felt joyful can slowly help rebuild a sense of connection, purpose, and pleasure.

Best medication for high-functioning depression

When it comes to medication, Brown says antidepressants can be a helpful option for people managing depression. She points out that there are far more choices available than most people realize — and that not every medication works the same for everyone. Some of the more commonly prescribed antidepressants can come with not-so-pleasant side effects, so Brown emphasizes the importance of working closely with a healthcare professional to find the right fit for your body and your needs.

Antidepressants for high-functioning depression

Brown often prescribes medications like Trintellix and Auvelity for people living with high-functioning depression. She’s found that these options may come with fewer side effects, noticeable improvements in focus and cognition, and in some cases, a faster onset of relief compared to other antidepressants.

If you think antidepressants might be right for you, Brown stresses the importance of being open and honest with your provider about what you’re experiencing and what you hope to get out of treatment. That transparency helps your clinician find a medication that’s the best fit for you — not just your symptoms.

Managing daily life and coping with high-functioning depression

Living with high-functioning depression can feel like you’re constantly pushing through — meeting responsibilities while quietly running on fumes. It’s important not to minimize or dismiss what you’re feeling. These symptoms aren’t something you can just “shake off,” and reaching out for support is a sign of strength, not failure. Therapy, medication, and lifestyle shifts can all make a real difference.

Here are a few ways to help manage day-to-day life with high-functioning depression:

• Reach out for professional support: Talking to a therapist or mental health provider can help you untangle your thoughts, learn coping tools, and explore treatment options.
• Prioritize rest and recovery: You might be high-functioning, but you still need downtime. Allow yourself to rest without guilt — your body and mind need it.
• Create small, achievable goals: Instead of focusing on everything at once, break tasks into smaller steps. Completing one thing at a time can help you feel more grounded and capable.
• Journaling with intention: Writing down your thoughts and feelings — without judgment — can help you make sense of what’s going on beneath the surface and spot patterns that might be weighing you down.
• Stay connected: Isolation can make depression worse. Check in with a trusted friend or loved one, even if it’s just a quick text or coffee catch-up.
• Add structure to your day: Routines can help stabilize mood and energy levels, even if it’s as simple as waking up and eating at consistent times.
• Incorporate movement: Gentle exercise — a walk, stretching, or yoga — can help release built-up tension and boost mood, even in small doses.
• Be kind to yourself: High expectations and perfectionism often feed high-functioning depression. Practice self-compassion and remind yourself that doing your best is enough.

Managing depression while still showing up in life takes strength — but you don’t have to do it alone. Support and recovery are absolutely possible.

Our top-recommended books on high-functioning depression

If you’re a fellow bookworm, there are some amazing books out there that unpack what high-functioning depression really looks like — reminding you that you’re not alone and offering practical tools to help you navigate it day by day.

• High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy, by Dr. Judith Joseph — This book shines a light on what high-functioning depression really feels like — with five practical tools to help you stop just surviving, start healing, and reconnect with genuine joy again.
• Why Smart, Creative and Highly Sensitive People Hurt: A Toolkit for Thriving in a Chaotic World by Eric Maisel — A lifeline for anyone whose mind never seems to switch off — offering practical, compassionate tools to help smart, sensitive, or overthinking people understand their pain, manage their emotions, and find real meaning in the chaos.
• High Functioning Depression: How to Break Functional Freeze and Find Happiness Again, by Michael Collis — Written for busy overachievers who seem to have it all together, this book helps you recognize the hidden signs of high-functioning depression — and gives you practical, science-backed tools to break free from “functional freeze” and start feeling genuinely happy again.
• Why Has Nobody Told Me This Before? by Dr. Julie Smith — This comforting, no-nonsense guide breaks down practical tools for managing low mood, motivation, and burnout — perfect for anyone with high-functioning depression who wants real strategies to feel better, one small step at a time.
• Perfectly Hidden Depression: How to Break Free from the Perfectionism That Masks Your Depression, by Dr. Margaret Robinson — This compassionate read helps you uncover the perfectionism that often hides high-functioning depression — offering gentle, practical tools to release self-criticism, face buried emotions, and finally feel safe being imperfectly human.
• How to Come Alive Again: A guide to killing your monsters by Beth McColl — This brutally honest and laugh-out-loud guide helps you navigate the messy reality of being “fine” on the outside but falling apart inside — offering warmth, humor, and practical advice for anyone quietly battling high-functioning depression.
• Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions by Johann Hari — This eye-opening read challenges everything you thought you knew about depression, helping people with high-functioning depression understand the deeper causes behind their feelings — and discover real, human ways to heal beyond medication alone.

Is there a high-functioning depression cure?

There’s no quick “cure” for high-functioning depression — but there are ways to make life feel lighter and more manageable. A good first step is reaching out to a mental health professional and being honest about what’s really going on beneath the surface. You can also start small at home by trying CBT techniques, like challenging negative thoughts or patterns that keep you stuck.

Often, because high-functioning depression has milder symptoms, many people will opt out of asking for help from loved ones or seeking care from professionals. There is also a likelihood that you may feel it is less noteworthy to mention because you have felt this way for as long as you can remember. But just because your symptoms are mild doesn’t mean you don’t deserve help.

Taking that first step can feel daunting, but high-functioning depression rarely disappears on its own. Your mental health matters — no matter how capable you seem — and getting support can help you feel not just okay on the outside, but genuinely better on the inside too.

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Nora Rosenfeld is an editorial intern at Rescripted, studying Journalism and Global Health at Northwestern University. She is passionate about women’s and mental health and plans to pursue health and science writing.