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Psychiatry & Medication

High Functioning Depression

 May 14, 2020

By  Natalie Kirilova

Medicinal Mushrooms

What is High functioning depression?

High functioning depression is considered to be the same as dysthymia, which is a type of depression that is diagnosed in 1.5% of adults in the U.S. annually. It is a low-level depression where one is able to perform most of their daily tasks and carry on with life “normally” but experience mild depressive symptoms which may escalate to more severe depressive symptoms.

Dysthymia is most common among high achievers who appear to be doing well and able to function “normally” in their everyday lives. 

Many don’t get treated because they may not even understand that they are suffering from dysthymia. They most often consider it just a personality pattern or circumstantial. During the visits to a doctor, they usually do not mention any of the symptoms, which makes it impossible to promptly diagnose this type of depression. 

What are the symptoms of high functioning depression?

There are various possible symptoms of dysthymia including:

  • low appetite or overeating;
  • difficulty sleeping or excessive sleep;
  • tiredness or fatigue;
  • low self-esteem;
  • The need or desire to be constantly busy to escape negative thoughts;
  • a conscious tendency for failure.

How is it different from major depressive disorder (MDD)?

MDD has more severe symptoms than dysthymia including anhedonia, lethargy, or agitation.

What do experts say?

Dr. Barton Goldsmith, a psychotherapist in Westlake Village, California says  “For people fighting with dysthymia, any moments of boredom or confusion usually result in self-blame and feelings of distress, until the next activity that requires critical thinking arises. This kind of depression just sort of pops up, like an annoying computer message, and your psyche has the same reaction.”

What are the causes of high functioning depression?

There is a lack of evidence that this type of depression is caused by biological factors. The possible causes include genetic predisposition or childhood episodes of trauma, stress, isolation from others, and other negative life circumstances.

Stress at a young age or physical trauma can affect the onset of dysthymia. In the elderly, this type of depression may be linked to physical disability alongside cognitive dysfunction or certain ongoing illnesses. It is hard to identify the cause or trigger of dysthymia, as the majority of patients have co-occurring conditions, such as anxiety disorders, substance abuse, cyclothymia, and others.

If not treated, this low-level depression has the risk of developing more severe depressive symptoms and causing other mental and physical problems.

What are the possible treatments for high functioning depression?

High functioning depression can be treated with medications and/or therapy as well as other alternative treatments.

Medication for high functioning depression

The most prescribed medications to treat depression symptoms are selective serotonin reuptake inhibitors (SSRIs), dual-action antidepressants (Effexor), and certain tricyclic antidepressants (Tofranil). The first-line medications are SSRIs, as they have less potential to cause side effects and are usually well-tolerated.

The therapeutic effect of medications can be felt on average in 6-8 weeks. The SSRIs most commonly used are Prozac and Zoloft.

  • Antidepressants against placebo were studied for efficacy in MDD and dysthymia treatment using meta-analysis. 17 out of 194 studies have been focused on dysthymia. The review shows that patients who received antidepressant therapy reported significant improvements for dysthymia.
  • Tricyclic antidepressants were studied for efficacy in remission of dysthymia. 64 subjects completed 16 to 20 weeks of continuation therapy on tricyclic medications. 46 remained in full remission during the continuation treatment.
  • Venlafaxine was studied for efficacy in dysthymia treatment. 17 subjects received Venlafaxine for one week. The results have demonstrated that 13 subjects responded to the treatment. They reported significant changes in symptomatology and functioning.

There are different types of medications available. Speak to a psychiatrist to understand the best treatment plan for you. 

Therapy for high functioning depression

Psychotherapy may be used alone or in conjunction with medications to treat dysthymia. A doctor or a therapist may prescribe cognitive-behavioral therapy as well as psychodynamic therapy, and interpersonal therapy.

  • Cognitive-behavioral therapy was used in subjects with dysthymia. 49 out of 97 subjects were enrolled in therapy for 12 weeks. The remaining 48 subjects took Sertraline. The reduction of symptoms has been observed in both groups. The results have also demonstrated that cognitive-behavioral therapy was the same effective alone rather than in conjunction with Sertraline or placebo.
  • Individual psychodynamic therapy alongside Family therapy was studied for efficacy in children with depression disorders including dysthymia. 72 subjects were enrolled in one of the therapies. Depression scores have been reduced in both groups. 74% of subjects who did Psychodynamic therapy reported with no depressive symptoms at the completion of the study. 75% – with Family therapy. At a 6-month follow up, 100% of subjects who received Psychodynamic therapy did not qualify a clinically depressed.
  • Interpersonal therapy alongside Moclobemide was studied for efficacy in subjects with dysthymia. 35 subjects received the treatment and were evaluated 12, 24, 48 weeks after the clinical trials. All subjects reported significant improvements in depression scores using the Global Assessment of Functioning, and Quality of Life and Satisfaction Questionnaire.

There are different types of therapy available. Speak to a therapist to understand the best treatment plan for you. 

Alternative treatments to high functioning depression 

There is a variety of other treatment modalities, including:

  • Support groups have been also linked to efficacy in patients with dysthymia. 
  • Yoga 
  • Tai Chi 
  • Meditations
  • EMDR
  • Light Therapy

Take the depression self assessment test to see what level of depression you may have and find recommended treatments. 

Disclaimer: This website does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on our Site. If you think you may have a medical emergency, immediately call your doctor or dial 911


Natalie is a writer with a focus in medical research with over 10 years of experience

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