HomeBlogPatientIs It Possible to Have High-Functioning Depression? Is It Possible to Have High-Functioning Depression? June 13, 2017Patient Is It Possible to Have High-Functioning Depression? It took decades of effort, but with the 2013 release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the mental health community finally recognized chronic depression as a separate and distinct condition, not a subset of major depression. According to Dr. James McCullough, a professor of psychology and psychiatry at Virginia Commonwealth University, that was a major step forward for the clinicians and researchers who long believed that dysthymia—the formal name for chronic, persistent depression—was a very different disorder. While major, episodic depression is far more prevalent (about 7 percent of the U.S. population), McCullough said there are approximately 14 million dysthymics in the U.S., a prevalence of 2-3 percent, costing the economy some $40 billion. Dysthymia Diagnosis “Dysthymics are frequently misdiagnosed, and thorough diagnosis is the only way I know to really tell what you’ve got,” said McCullough. “When I get a depressive, my first task is, have I got a chronic here or an acute episodic? If I’ve got a chronic, I’ve got a much more difficult case.” Duration of the depression is one of the clinical hallmarks of chronic depression. Adults who have been depressed continuously for two years or more (one year or more for children or adolescents), are considered to be chronic. By working backward in time through questioning, the duration of symptoms can be assessed. For acute, episodic, major depression, just two weeks of continuous depression is required for the diagnosis. Interviewing a patient can also uncover another distinguishing element of dysthymics: early maltreatment in the family, abuse or emotional deprivation. McCullough said 9 out of 10 dysthymics describe such disruptions in the early developmental years, which is not always true with major depression. “There is a whole lot of research demonstrating that early developmental maltreatment and abuse is related to adolescent and adult depression,” McCullough noted. “It’s kind of a no-brainer—you beat around kids, and they pay the price.” Signs and symptoms Even though the symptoms of dysthymia are typically milder than with acute depression, its price can be steep and long-lasting. McCullough has treated 2,200 dysthymic patients over the course of his 45-year career, and has seen recognizable patterns emerge. “Major depression you’ve got a major shut-down in the system. Dysthymics still go to work, they stay married, but they’re no fun to be around,” he said. “The hallmark of chronic depression is hopelessness. ‘I’ll always be this way; I’ll always feel this way.’ Nothing is ever OK, it’s not sharp edges, it’s rounded. It’s a pessimistic view, and the damnable thing about dysthymia is that it’s a lifetime disorder unless it’s effectively treated. Episodic, major depression is not.” When asked about the concept called “high-functioning depression,” McCullough flatly stated that there is no such thing, and that the term is a misleading misnomer. “It’s a bear” In McCullough’s opinion, acute depression is fairly simple to treat with cognitive behavioral therapy (CBT). “Dysthymia, on the other hand, is not very responsive to medication or psychotherapy,” he observed. He has developed a treatment modality specifically designed to address the early developmental issues that plague dysthymics. It’s called the cognitive behavioral analysis system of psychotherapy, or CBASP. He said it is the only treatment that has been shown to be effective with chronic depressives. “It’s an interpersonal model of psychotherapy. I don’t go after the way you’re thinking, as with CBT,” he said. “It’s not quite that simple with the chronics.” CBASP involves close personal consultation with the therapist, who helps the patient to modify behavior and develop needed problem-solving and interpersonal skills. “There is a lifestyle issue involved with chronic depression, and if you don’t change the way you live, you’re going to stay depressed.” Dr. McCullough added that there is also a role for medication in treating dysthymia. “All of the chronics I see, I usually try to find a medication that makes them feel a little better. But hell, it’s a crapshoot, it’s trial and error.” When told about the GeneSight® pharmacogenomic test to help bypass that antidepressant trial and error approach, he enthused, “That’s great!” His advice What should someone do who suspects they may suffer from chronic depression but has never been diagnosed? “Tell them to go on Google and look up dysthymia—look up the symptoms, and also look at the length of time they’ve been feeling this way,” McCullough recommended. If an individual feels he or she may meet the clinical criteria, it may be worthwhile to begin with Dr. McCullough’s writings, and seek a practitioner proficient in CBASP. Our articles are for informational purposes only and are reviewed by our Medical Information team, which includes PharmDs, MDs, and PhDs. Do not make any changes to your current medications or dosing without consulting your healthcare provider. The GeneSight test must be ordered by and used only in consultation with a healthcare provider who can prescribe medications. As with all genetic tests, the GeneSight test results have limitations and do not constitute medical advice. The test results are designed to be just one part of a larger, complete patient assessment, which would include proper diagnosis and consideration of your medical history, other medications you may be taking, your family history, and other factors. If you are a healthcare provider and interested in learning more about the GeneSight test, please contact us at 855.891.9415. If you are a patient, please talk with your doctor to see if the GeneSight test may be helpful. Patient Which Mental Health Provider Should I Consider? A Symptom-Based Guide The support of a good healthcare provider can make all the difference when you’re struggling with your mental health. But how do you connect to one in a sea of ... 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Patient Which Mental Health Provider Should I Consider? A Symptom-Based Guide The support of a good healthcare provider can make all the difference when you’re struggling with your mental health. But how do you connect to one in a sea of ... Read more
Patient One explanation for why we experience Side Effects? Understanding Your Genetic Response to Antidepressants Antidepressants often play an essential role in helping patients with their mental health conditions. But as many patients can attest, it’s frustrating when... Read more
Patient Barriers at Every Turn: How Systemic and Social Factors Block Men from Mental Health Care Taking the important step of seeking care for mental health isn’t always an easy decision. Uncertainty about the need for care, social stigmas associated wi... Read more
Healthcare Provider Overcoming Side Effect Concerns: Leveraging Pharmacogenomic Insights to Inform Depression and Anxiety Medication Selection Whitnee Brown, a lifelong resident now practicing in Birmingham, Alabama has nearly an entire alphabet following her name, abbreviations for degrees and certifi... Read more
Patient Concerns about Mental Health Medication Side Effects Remain a Barrier to Getting Help for Those Diagnosed with Depression and Anxiety Lisa Roberts has raised a family, reached an impressively high level in her career, and was an anchor for her mother and other family members. When, within ... Read more
Patient Common Antidepressant Side Effects Taking an antidepressant can be an effective way to help treat a mental health condition like depression or anxiety. However, these medications can also cre... Read more
Patient MTHFR Mutations: Clinical Implications and Management Strategies MTHFR mutations—changes in the methylenetetrahydrofolate reductase (MTHFR) gene—have gained increased attention in the medical community due to their potent... Read more
Patient Can an App Help Me Manage My Anxiety? Health and wellness smartphone apps have become so common that if you can name a health goal, desire or condition, you can probably find an app for it. N... Read more
Patient Black Trailblazers of Psychiatry and Mental Health: A Legacy of Healing and Advocacy As we celebrate Black History Month, we want to recognize a few individuals who have made extraordinary contributions to the field of psychiatry and mental heal... Read more
Patient Mindful Moments: Tips for Anxiety If a well-meaning friend or family member has ever told you to “just breathe” when you’re feeling worked up or stressed out, you’d be forgiven if you felt l... Read more