“High-functioning” Depression is Still Depression

This article discusses depression and suicide. If you or someone you know is at risk of suicide please call the US National Suicide Prevention Lifeline at 1-800-273-8255, text HOME to 741741, or go to SpeakingOfSuicide.com/resources for additional resources.

Depression is a serious mental health condition that requires attention and medical care. “Left untreated, depression can be devastating for those who have it and their families,” warns the National Alliance on Mental Illness (NAMI). “About 21 million US adults—8.4 percent of the population—had at least one major depressive episode in 2020.”

It’s normal to feel down occasionally but if you’re sad most of the time and it has a negative impact on your life, you may have clinical depression—a condition that can be treated with medication, psychotherapy, and lifestyle changes.

There are different types of depression. One is major depressive disorder or MDD. You may have this type if you feel depressed most of the time for most days of the week. Symptoms include loss of interest or pleasure in your activities, weight loss or gain, trouble sleeping or feeling sleepy during the day, feeling restless and agitated, being tired and without energy, feeling worthless or guilty, and suicidal ideation. 

Another variety is persistent depressive disorder (PDD), frequently referred to as “high-functioning” depression. Someone struggling with PDD may experience many of the symptoms of MDD, but often less severely and less frequently. This allows the person to appear to function almost normally, going to work or school, performing well, keeping up with responsibilities at home, and engaging in most social activities.

The phrase “high-functioning” depression highlights “a really important point that people can be suffering with mental illness and still appear outwardly to be able to function or not appear mentally ill to an outside observer,” Rebecca Brendel, president-elect of the American Psychiatric Association told the Washington Post.

But the term could exacerbate shame and misunderstanding about mental health and depression, Brendel added. “Saying that somebody is high-functioning even though they have a mental illness in and of itself raises the stigma associated with mental illness.”

A tragic recent case is Cheslie Kryst who died in January after jumping from a high-rise apartment building in Manhattan. According to her mother April Simpkins, the 30-year-old television correspondent, model, and former Miss USA “was dealing with high-functioning depression which she hid from everyone—including me, her closest confidant—until very shortly before her death.”

According to the Mayo Clinic, PDD symptoms typically don’t disappear “for more than two months at a time. In addition, major depression episodes may occur before or during persistent depressive disorder — this is sometimes called double depression.”

If you persistently experience sadness, emptiness, hopelessness, or suicidal thoughts, seek help. Persistent symptoms of depression are correlated with an elevated risk of substance misuse and suicide.

Don’t Lose Hope!

Although depressive disorders can have a devastating impact, they often respond to treatment. “The key is to get a specific evaluation and treatment plan,” recommends NAMI. After a careful assessment, patient-centered treatment plans may include any of the following:

  • Psychotherapy, including cognitive behavioral therapy, family-focused therapy, and interpersonal therapy.
  • Medications, including antidepressants, mood stabilizers and antipsychotic medications.
  • Exercise can help with prevention and mild-to-moderate symptoms.
  • Brain stimulation therapies can be tried if psychotherapy and/or medication are not effective. These include electroconvulsive therapy (ECT) for depressive disorder with psychosis or repetitive transcranial magnetic stimulation (rTMS) for severe depression.
  • Light therapy, which uses a lightbox to expose a person to full-spectrum light in an effort to regulate the hormone melatonin.
  • Alternative approaches including acupuncture, meditation, faith, and nutrition can be part of a comprehensive treatment plan.

Co-occurring mental health and substance use disorders should be addressed concurrently in a comprehensive treatment program addressing all needs of such patients. “Dual diagnosis” is a term used to describe the presence of addiction and other co-occurring mental health conditions such as depression and post-traumatic stress disorder.

Colorado Recovery offers multiple comprehensive treatment options for depression, including residential options, intensive outpatient programming (IOP), and transitional living. Clinical depression in any form requires treatment even if the person with the disorder is believed to be “high-functioning.” If you or a loved one is experiencing persistent sadness, feelings of hopelessness, or has had suicidal thoughts, contact your doctor or call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Keeping Connected in Mental Health Therapy During COVID

Peggy Caspari, MA, LPC, RN, Colorado Recovery Executive Director

After suffering through two years of COVID-19, the mental health of many Americans is in a bad place. According to the just-released Mental Health Index: US Worker Edition, cases of post-traumatic stress disorder (PTSD), depression, and addiction are soaring amid the current Omicron surge of the pandemic.

An alarming one in four American workers screened positive for post-traumatic stress disorder (PTSD)—that’s a 54 percent increase in just the past three months and 136 higher than levels before the pandemic. Depression is also surging—up 87 percent since the fall and 63 percent higher than before COVID.

“We expect mental health declines around the holidays; however, nothing of this sheer magnitude,” said Mathew Mund, the CEO of Total Brain, one of the partners publishing the Index. “We see a very troublesome surge in mental health concerns at a time when Omicron begins to grip the nation; workplace vaccine mandates are put in place, and the holiday season is in full swing. Employers must be prepared to address trauma in the workplace.”

Colorado Recovery has been addressing this kind of stress for clients and their staff throughout the pandemic. “There’s just a lot going on in the world. The fears around the pandemic, anxiety, the inability to travel—it’s affecting everyone, our clients and our staff,” said Peggy Caspari, MA, LPC, RN, Colorado Recovery’s executive director. “People worry about how sick they might get and about the possibility of giving COVID to their children. These are complicated scenarios and different individuals react differently to them.” Caspari said. “There’s a lot of anxiety and unfortunately anxiety is contagious. It can easily be transmitted to co-workers and clients.”

To counter any stress they may experience, Colorado Recovery staff practice being calm. It has been said, “If you remain calm in the midst of great chaos, it is the surest guarantee that it will eventually subside.”

At Colorado Recovery, “we practice calm in our lives so we can counteract anxiety,” said Caspari. “That way we will get through this together and we will help each other. We avoid catastrophizing and remain calm internally.“ Individuals who catastrophize become anxious as they overestimate the likelihood of a poor outcome. 

Not projecting their own anxiety is especially important for therapists working with people who have a mental illness. “We the helpers have to meet our clients with calmness and convey the message ‘we will get through this together’ instead of spreading toxic anxiety which is not helpful.” 

With a bit of luck and solid mitigation measures, Colorado Recovery was able to continue serving clients while preventing COVID cases on its campus—until December. After two clients tested positive, they had to isolate themselves in their rooms. It was a tough challenge given that Colorado Recovery’s treatment approach emphasizes social connections which are at the core of its Warner model

Fortunately, staff and clients were able to rise to the occasion. “It was interesting to witness the creativity brought on by this challenge,” remembered Caspari. In order to counteract the forced isolation, “they played board games on Zoom. They did art projects with our art therapist on Zoom. They did their group therapy sessions remotely. The vocational therapist did game nights with them online.”

This situation lasted ten days before they were cleared to rejoin in-person activities. But the team at Colorado Recovery was adamant to mitigate the isolation and provide connections with therapists and peers to minimize emotional stress all around. 

“The groups were determined to keep going and they were very creative in order to achieve that. They were just amazing,” Caspari said. “It was a little bit of a roadblock but they worked through it.”

The treatment program at Colorado Recovery aims to empower adults with mental illness, and those who support them, with an unrelenting optimism for recovery, purposeful involvement in the community, and an enhanced sense of meaning in life.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.