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The hidden burden: high functioning depression


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Extreme mood swings, lethargic responses, the urge to stay in bed day after day – all personality changes associated with having a clinical depression disorder.

These easy-to-spot symptoms have always been the tell-tale signs, but what happens when there aren’t any visible changes? When those symptoms just aren’t there, like an illness that only hurts on the inside? High functioning depression is exactly that.

According to the Mental Health Foundation, there were over 8.2 million reported cases of depression in 2013 alone. Lack of awareness has meant little to no research on high functioning depression, meaning those who suffer must be remaining silent.

The incapacitating effects of mental health disorders have a major impact on everyday life, yet some sufferers appear to get through each day with little notice from others in terms of their declining mental health. The signs are thought to be clear, but sometimes the distinct decline in motivation and drop in success associated with the disorder just do not happen outwardly.

Trainee mental health nurse Isobel O’Brien has worked alongside patients who suffer from depression. She says: “Those diagnosed with high functioning depression do appear mentally well at first.

“They are sociable, and do not appear to be suffering from depression of any kind when around others. The reality of the situation is that on the inside, the individual can be in a constant and severe low mood.”

Although sufferers and non-sufferers of depression may think this sounds better than externally showing signals, it often means avoiding getting help due to the lack of motivation from others. Often termed as being ‘low grade’ in comparison to those who outwardly suffer, it may be hard for families to get to grips with the fact that declining mental health isn’t so easy to spot in a loved one.

“I can understand why it may seem as though having high functioning depression would be easier as it appears that individuals with the disorder aren’t struggling,” Isobel admits. “When, in fact, they are experiencing a decline, and to a significant degree.

"Depression can affect every person differently so it is important not to undermine the symptoms that are present, even if it’s in a person who usually appears mentally well.”

It must be noted that many people appear to live healthy, successful lives yet can be suffering inwardly; those with high-functioning depression are more prone to severe anxious episodes that may last days or weeks, yet often do not seek help. Feelings of absolute hopelessness, insomnia and general low mood can easily prevent people from living their life to the absolute fullest, despite their outward functionality.

“Depression in general is more than just experiencing temporary feelings of sadness. It is a serious condition affecting the mind and body,” Isobel explains. “It can have significant impacts on various aspects of everyday life such as sleeping, eating, relationships and work. Individuals with any form of depression usually lack in motivation and have a low self-esteem.”

According to the Harvard Medical School publications, low-grade depression lasts an average of five years without treatment, making it highly important that help and treatment is sought. Society’s vision of mental health disorders is visible misery and despair, but this is simply not the case for everybody. Many people with high functioning depression keep their struggle under wraps, despite the massive emotional strain it causes.

Everybody is at risk of mental health issues – like a cold for the brain, it can leave you feeling like you never want to get out of bed. Slapping a smile on your face and simply getting on with life may not seem possible to some sufferers, but the scary thing about high-functioning cases is that this is the norm. Terrifyingly, the Mental Health Foundation states that one in four of UK residents will suffer from a mental health issue in any given year.

The most important thing about high-functioning depression may just be raising awareness of the issue, so that those suffering realise there are treatments available. From bosses talking to their employees about mental health, to schools letting students know that there is help available to those struggling in silence – awareness could be key to helping those with high functioning depression open up and get help.

The importance of awareness was raised as even Isobel admitted that it’s often difficult to question someone on their mental health when it’s not clear they’re struggling in the first place.

“From another person’s perspective, it may be difficult to tell if a person is suffering with high functioning depression as when individuals with the disorder are in social situations, they tend not to display any symptoms and as mentioned before, appear mentally well," she says.

“Awareness is important as it encourages those having problems to step forward and admit they may need professional help.”

Although you may think you’ve never heard of a case, high-functioning depression is spoken about everyday – the mother you see on the news who said she had ‘no idea’ her suicidal son felt that way, or the co-worker that finally breaks down as the pressure to continue their success pushes them over the edge. Mental health is becoming more prominent in everyday society, but we must not forget those who attempt to ignore their own struggles.

“If an individual visits their GP presenting with symptoms of depression they will be offered treatment, even if they are high functioning,” Isobel explains. “In most cases, a course of counselling or talking therapy will be offered and this can sometimes be combined with prescribed medication.”

For those who feel a major shift in mood and other signs of a mental health issue, fight back by opening up and seeking treatment. Our society must not forget to help the over-achievers in the ever on-going battle against mental ill-health.

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