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Low-Grade or High-Functioning Depression

Low-Grade or High-Functioning Depression

This material has been reviewed for accuracy by: Renee Albers, PhD

Say you’re living the American Dream. You have a well-paying job, a devoted partner, successful children, and a sense of purpose. You have everything you ever imagined you’d need to feel happy.

So, why can’t you shake this feeling that the other shoe is about to drop? That the world is about to fall off its axis? That you can’t feel good about all that you have, and you may never experience true happiness again?

Because you are a high-functioning member of society, you push those “self-indulgent thoughts” aside. You know that many people would dream to have just a smidgeon of what you are taking for granted. It’s time to get a grip, to stop complaining, even if it is only to yourself. It’s time to pull yourself up by your bootstraps and love your life.

Then, you listen to Michelle Obama’s new podcast and hear her say something that resonates:

“I’m waking up in the middle of the night, cause I’m worrying about something, or there’s a heaviness … There have been periods … where I just, have felt too low … I know that I am dealing with some form of low-grade depression.”

Maybe the name she gives her condition – low-grade depression – is the name for the pain and discomfort that has been plaguing you.

Is High-Functioning Depression Real?

Button with GeneSight logo and text learn more about the GeneSight testWhen high-functioning people suffer depressive symptoms, they may think they are not clinically depressed.

“Indeed, the catch-22 of high-functioning depression is that sufferers often believe that since they can push through their sadness while barely missing a step, it would be indulgent to seek help. But that’s like believing one’s own happy-on-the-surface social media status updates,” writes therapist Sherry Amatenstein on Psycom.

“While the stigma against seeking mental health treatment is lessening, there remain some dangerous myths. Such as that if depression isn’t severe and persistent – involving frequent bouts of uncontrollable weeping, emotional paralysis, and suicidal thoughts – then there isn’t a real problem and one should just tolerate pain with stiff-lipped silence,” Amatenstein writes.

Vice.com reports that “brain scans of people with persistent high-functioning depression also show that regions associated with inward thinking or rumination are hyperactive. These regions, one of which is called the Default Mode Network, could be the basis of negative thoughts about oneself. And studies have shown that certain pharmaceutical drugs, meditation, and psychotherapy all help to tame these overactive networks.”

Symptoms of High-Functioning Depression

Individuals who feel they have low-grad or high-functioning depression that persists for a long period of time may have dysthymia, chronic depression, or Persistent Depressive Disorder (PDD). The Mayo Clinic reports that PDD has similar, yet milder symptoms to Major Depressive Disorder (MDD).

Black man holding paper with smiley face printed on standing in front of orange background signaling high functioning depression

“If you have persistent depressive disorder, you may find it hard to be upbeat even on happy occasions – you may be described as having a gloomy personality, constantly complaining or incapable of having fun,” writes the Mayo Clinic. “You may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. These feelings last for years and may significantly interfere with your relationships, school, work and daily activities.”

Other symptoms of high-functioning depression may include sleeping too much or too little, poor or overstimulated appetite, inability to make decisions, feelings of guilt, and irritability.

The Mayo Clinic writes that those suffering from high-functioning depression typically experience symptoms for years and rarely go for more than two months without symptoms.

Ways to Recognize High-Functioning Depression

In the Mighty, psychotherapist Annie Wright, LMFT, points out that even if someone with dysthymia generally can handle all the “logistical adulting stuff of their life,” inwardly, “this same person may be gripped with a challenging set of symptoms invisible to those of us who love and know them.”

Some of the signs and symptoms of low-grade depression that Wright shared include:

  1. Lack of joy. When simple pleasures that used to make you happy no longer bring you joy, high-functioning depression may be present.
  2. Thinking critically of yourself and others. It can sound like a chronic, never-ending critique of yourself and others around you.
  3. Decreased energy. If you don’t feel like you have enough energy to make it through the day, this may be a sign of low-grade depression.
  4. “Small things feel like huge things.” It can feel like you cannot control irrational anger over small inconveniences or disappointments. Likewise, you find yourself feeling overwhelmed by an event that wouldn’t have been a big deal to you in the past.
  5. Guilt and worry. This is an unrelenting feeling of guilt and worry over your past and future.
  6. Coping strategies become the norm. “If you find yourself needing extensive zone-out time after work and on the weekends, turning towards your coping mechanisms more often than not — such as substances or behaviors like using alcohol, drugs, excessive gaming, constant Netflix, etc. — all in an effort to escape your life, this could speak to underlying depression,” writes Wright.
  7. Unable to relax/unwind. Some may keep themselves busy to avoid uncomfortable thoughts and feelings.

How to Discuss High-Functioning Depression with a Healthcare Professional

Don’t let the “high-functioning” part of “high-functioning depression” mislead you. Depression – in any of its forms – is a condition that can and should be treated.

“If you think you may have dysthymia, it’s essential to seek help. Seeing a mental health professional is the first step to recovery,” according to the National Alliance on Mental Illness (NAMI).

It is important to clarify with your physician that you believe you’re suffering from low-grade depression and present reasons why.

“Most people with dysthymia are undertreated,” according the Harvard Health Newsletter. “They may only complain about physical symptoms or fail to complain at all because the disorder has become so much a part of them that they believe that is simply how life is. In older people, dysthymia may be disguised as dementia, apathy, or irritability.”

Healthcare providers may do a brief screening questionnaire and/or refer you to a mental health professional such as a psychiatrist or psychologist.

Treating High-Functioning Depression

Finding effective treatment for any type of depression can be complex. What works for each individual patient is impacted by their life experience, their temperament, and their genetics. However, in most cases, high-functioning depression may be treated effectively with a combination of psychotherapy and medications.

Numerous studies have shown that combined treatment with psychotherapy and medication was found to be notably superior to either treatment used alone, Dr. David Mintz, MD, writes in Psychiatric Times.

“Combined treatment produces not only faster and greater short-term benefits but greater long-term benefits as well,” he states.

If a healthcare provider is considering medication as part of the treatment for high-functioning depression, then the GeneSight test may help. If you are interested in the GeneSight test, discuss whether you might be a good candidate with your doctor. If your provider decides to order the test for you, they will receive your results and can review them with you during an appointment.

High-Functioning Depression Deserves Treatment

On the surface, high-functioning depression may seem like it’s easier to deal with than major depression but it is not, according to the Vice.com article.

“Depression is a very heterogeneous condition,” Michelle Craske, a professor of psychology and psychiatry at UCLA told Vice. “It takes a lot of different forms in terms of its severity and in terms of what it looks like in the actual symptoms. We should not dismiss the mild forms because it’s still a struggle and there’s still a value to getting treatment.”

If you’d like to learn more about high-functioning depression and treatment, turn to the following links:



Map showing GeneSight healthcare providers

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.