bottaro: high-functioning depression needs more recognition and attention

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there are people who wake up every morning with symptoms of depression, only to crawl out of bed and handle all the demanding duties of their day. it's time we recognize and support them.

by angelica bottaro

published mar 19, 2025

5 minute read

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5 minute read

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there are people who wake up every morning with symptoms of depression, only to crawl out of bed and handle all the demanding duties of their day. it's time we recognize and support them.

people often practice masking when living with high-functioning depression. masking is the term used to describe hiding symptoms so that those around you don’t notice. getty images

according to the diagnostic and statistical manual of mental illnesses, high-functioning depression isn’t real—or at least it’s not a clinical diagnosis. but there are people who wake up every morning with symptoms of depression, only to crawl out of bed and handle all the demanding duties of their day.

these high-functioning individuals will argue that it’s very real, and just because they continue to perform in their jobs, take care of their families, or accomplish any degree of tasks, it doesn’t mean they’re not experiencing the significant lows that come along with having a depressive disorder.

that’s why we need to talk about high-functioning depression and give it the recognition it deserves as another type of the debilitating mental health issue that people contend with.

so, let’s get into it. what exactly is high-functioning depression? it’s pretty simple. people live with depression symptoms, including fatigue, anhedonia (lack of interest or joy in life), poor concentration, sleep disturbances, feelings of excessive guilt or low self-worth, hopelessness, and even thoughts of suicide, but instead of withdrawing and showing signs of the disorder, they go out into the world and continue to live their daily lives.

they wake up in the morning feeling all the hallmark emotions of the debilitating mental disorder that often drives the inability to participate in life, and yet, they do it anyway.

because they’re still functioning while experiencing symptoms of depression, does it matter? they’re still living their lives. they’re still paying their bills on time and getting their work done. they’re still looking after their kids and showing up to school events with smiles on their faces. it’s not hurting anyone (else).

of course, it matters. when someone feels as though they have to fake their way through life, it only makes matters worse.

i suffered through high-functioning depression following a car accident. i’d cry in my car before going into work. i’d wake up in the morning wishing i hadn’t. i’d spend the time i wasn’t “on” rotting in my bed, hoping for absolution, for the darkness to stop, even though i had no faith that it would come.

putting the mask on

people often practice masking when living with high-functioning depression. masking is the term used to describe hiding symptoms so that those around you don’t notice. it reminds me of the comedy and tragedy masks that show one smiling ear to ear with joy while the other cries out in pain. these two masks mark the outward and inward experience of people living with high-functioning depression.

they wake up in the morning, set out their clothes, and put on the comedy mask before heading out the door—no one’s the wiser. not colleagues, friends, or even those closest to them could tell that comedy is not what is happening beneath the surface.

when they get home, they can remove the mask and replace it with something a little more authentic—tragedy. they can sink back into the hole they climbed out of that morning when the tragedy mask is on, ready to feel all their depression symptoms at once after suppressing them for hours on end.

this is a dangerous approach because suppression doesn’t eliminate these symptoms. it only gives them time to fester, and when the day is over, and the blinds are drawn, those symptoms become amplified until it’s time to cover them up again the next day.

theories around high-functioning depression and its place in mental health

many mental health professionals don’t recognize high-functioning depression as its own hell-born entity because they believe it’s something else entirely: persistent depressive disorder (pdd). pdd is a form of depression that doesn’t have symptoms as severe and lasts for two years or longer, by definition.

but what exactly is mild depression? the same symptoms, such as sadness, emptiness, fatigue, low self-worth, cognitive changes, avoidance, and sleep problems are all present. so, how exactly can you feel mildly hopeless? are there actual degrees to it? i’m sure some will disagree, but in my mind, feeling hopeless is feeling hopeless.

which brings me to my next point: pdd is something that people have to contend with in their daily lives, but can high-functioning depression be folded into this diagnosis? no. why? because high-functioning depression stands on its own two feet. people who experience severe depressive symptoms, including suicidal ideation, may still get up and be a functioning member of society.

trying to pin it down into a milder form discredits the suffering of people living with high-functioning depression. it amplifies a stigma that someone doing well can’t possibly feel this bad or experience such debilitating symptoms.

just because someone shows up in life doesn’t mean that their symptoms aren’t severe. it just means they’ve learned how to cope with them in ways that don’t draw attention. a person can be suicidal and still get a promotion at work. a person can feel severe emptiness and still hit up a happy hour on their way home from work. it isn’t about the severity of high-functioning depression, and because of that, it requires its own recognition.

this could be out of necessity in the sense that a person knows if they don’t go to work, they can’t pay their bills, and then where would they be? or perhaps due to personality traits and characteristics, such as feeling as though you have to be perfect all the time and cannot slip, even for a moment, under the weight of it all. their upbringing, whether there was severe pressure to succeed or the stifling of emotions in the home, could also play a role. people are different, and the way they cope with depression varies significantly, regardless of its severity.

however, these are just theories because high-functioning depression has yet to receive the investigation it deserves.

giving people a chance to seek help

since mental disorders are often only addressed if people can’t function in their day-to-day lives, those living with high-functioning depression often fail to reach out for help.

for one, they would have to take off the comedy mask and tell someone what they’re actually going through, which would erase everything they’ve learned about coping with these symptoms.

secondly, it’s hard to tell someone you’ve been thinking about ending your life when you’re consistently making plans for the future or continuing to vie for a promotion. they instinctively have a hard time believing what you’re saying is true.

so, do we have to talk about high-functioning depression? yes, we do. we have to give it the recognition it deserves as a mental health disorder.

until people characterize high-functioning depression as its own disorder with complexities and symptoms—that make a person’s mind feel like a prison—those who have it will continue to struggle alone.

angelica bottaro

angelica bottaro is the lead editor at healthing.ca, and has been content writing for over a decade, specializing in all things health. her goal as a health journalist is to bring awareness and information to people that they can use as an additional tool toward their own optimal health.