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"But You Don't Look Sad"; When You Wear Your Mental Illness Well

“High functioning depression is the ultimate oxymoron. You function well, but you’re not well.” — Unknown

High-functioning depression, also known as persistent depressive disorder (PDD), is a type of depression characterized by persistent low mood, feelings of hopelessness or worthlessness, and often combined with a lack of interest in activities that were once enjoyable. However, people with high-functioning depression may not show obvious signs of depression. They can often maintain a successful external appearance in their daily lives.

When I began talking about my own mental health journey several years ago, I cannot tell you the number of people who said to me, 'but you don't look sad', I even had someone say, 'are you sure it's depression, you are working, you have a family, what do you have to be depressed about?'.

Do you think you may have high-functioning depression, but other people's comments make you feel that perhaps you don't? or have you been made to feel as if you are making a mountain out of a molehill?

Individuals with high-functioning depression may have developed coping mechanisms that allow them to function effectively in their personal and professional lives, despite feeling persistently down or having an underlying sadness. They may appear to be successful, high-achieving, and seemingly "happy" on the outside, while internally, they may struggle with feelings of emptiness, anxiety, and sadness. They have learned to 'mask' symptoms and often to compartmentalize them away from daily chores that must be done.

Symptoms of high-functioning depression may also include:

  • Disrupted appetite — Either eating too much or too little.

  • Problems with sleep — sleeping too little or too much

  • Low energy- low energy levels and extreme fatigue.

  • Poor self-image — experience low self-esteem. feeling worthless, experiencing guilt

  • Cognitive Difficulties— struggle with concentration and focus.

  • Hopelessness-Believe there is little hope for change.

  • Feeling alone whilst in the company of others

To be diagnosed with High-functioning depression (or the technical term of PDD), two of the above symptoms must be present for two years or more.

People with high-functioning depression may also experience co-occurring conditions like anxiety, substance abuse, or eating disorders. High-functioning depression is not easily diagnosed because it tends not to manifest like other forms of depression. A person with high-functioning depression may be able to function at a high level in their daily lives. However, they may still experience persistent sadness or a lack of fulfilment.

Treatment for high-functioning depression often involves a combination of medication and therapy. Cognitive-behavioural therapy (CBT) and other talk therapies can help individuals identify and change negative thought patterns and behaviours. Antidepressant medication may also be prescribed to alleviate symptoms of depression.

It's important to note that high-functioning depression can still significantly impact a person's quality of life and should be taken seriously. People with high-functioning depression may often experience intrusive negative thoughts that can progress onto self-harm or suicidal ideation, or suicidal attempts. Therefore, people with the above symptoms must seek help and support from appropriate mental health professionals and speak to their GP.

Eventually, you may feel on top of the world when you subsequently get the help and support you need. Once the positive vibes kick in, you may believe you are ok, and 'over' the depression.

However, 80% of individuals who experience a depressive episode will experience at least one more depressive episode in their lives. One study published in the Journal of Affective Disorders in 2011 analyzed data from 42 different studies and found that the recurrence rate of major depressive disorder was around 50% after one episode and increased to around 80% after two episodes. Another study published in the American Journal of Psychiatry in 2006 found that the recurrence rate for major depressive disorder was about 40–60% after one episode and increased to around 70–90% after two episodes.

I say the above statistics not to upset you, but to bring home the oft reality of depressive illnesses. However, as our understanding of depression improves, so do our strategies to reduce the number and severity of relapses. Positive Psychology (alongside my long-term medication) was and remains my saviour. I still get bad days, but they are much less than previously, and the depth of sadness is significantly less. I would always be here because of my children, but I am here today, thriving because of positive psychology.

A Brief Introduction to Positive Psychology

Increasingly people are turning to the science of Positive Psychology. Positive Psychology focuses on when individuals are at their best and seeks to improve that best. While positive psychology can be deceiving and lead people to believe that this field only focuses on the positive, professionals recognize that negative emotions, failure, problems and other unpleasantries are normal in everyday life. However, interventions designed by Positive Psychology Coaches / Psychologists do not restore individuals to normal functioning but increase happiness and well-being when the individual is ok. This is often described as moving someone from +1 to +3 (Robert Biswas-Diener).

As a Positive Psychology Practitioner, my job is not to replace mental health and medical professionals. Still, it is a vital 'add-on' for when individuals are 'ok' or when they are ready to make positive changes to their lives.

Positive Psychology focuses on a wide range of areas related to well-being and happiness, including positive emotions, character strengths, resilience, hope, mindfulness, positive relationships and meaning and purpose. A core facet of positive psychology is the requirement of a growth mindset and acknowledging that with effort, people can gain greater control over their lives and their levels of life satisfaction and happiness.

On a personal level, the skills taught in Positive Psychology helped me through grief, job burnout and especially my own high-functioning depression. And as is so often the case when someone experiences a profound and life-changing tactic, they want to share this with others, hence my enrolment on various courses to help me to help others who have found struggles with happiness and thriving.

If you have experience with high-functioning depression and would like to learn more about what I do and how I could help you, please book a free 30-minute session on my website.

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