5 Signs You May Be Suffering from High-Functioning Depression
I was shocked when my therapist told me my symptoms were in line with major depressive disorder.
Me? I was literally known for my smile. I was constantly told my smile could light up a room—that when I laughed, people’s worries were gone. People knew me to be enthusiastic, warm, cheerful, and kind. I didn’t match the stereotype of a depressed person.
And yet, even though I didn’t want to hear it, what my therapist said resonated deeply inside of me. The truth was that I was an extremely high-functioning depressed person. Because I’d lived with depression for most of my life, I had come to believe that “this was just the way I was, and this was just the way I would always be.” I had pretty much given up hope of feeling any different on the inside, and so I’d learned to just tough it out and “fake it ‘til I make it.”
But would I ever “make it?” And what would “making it” look and feel like? How would I know when I’d “made it?”
I thought I was just there for a “tune-up” and would be out of therapy within a few weeks. I didn’t know how badly I needed someone to see through the smile, laughter, and warmth I offered to others, to actually recognize that my inside didn’t match my outside.
I was terrified, even furious, at someone seeing through my facade…and yet it was exactly what I needed to heal. In fact, it was this deeply transformational experience that led to my decision to become a therapist. Today, I work with a lot of high-functioning people, many of whose loved ones would never guess that behind the scenes they are struggling with debilitating depression, anxiety, or other mental health concerns.
Here are some signs you could also be suffering from high-functioning depression:
1. You Smile—A Lot
Maybe you really are like Buddy the Elf, and smiling is genuinely your favorite. But notice what’s happening inside when you smile: is it coming from a genuine inward delight, or does it compulsively come to your face as a result of the expectations of others? Perhaps as a mask for what actually feels intensely painful on the inside? Maybe as an expression of what you wish you were feeling?
There are many reasons we smile or laugh, including:
Authentic Joy
Masking Pain or Awkwardness
Avoiding Being Seen
Social Expectations
When you really check in with yourself, what are your motivations for smiling or laughing throughout the day? If you find that your motivation isn’t true happiness as much as you’d like it to be, you’re not alone. Others have even coined the term “smiling depression” to refer to this type of depression, which may occur more often in cultures that tend to prioritize outward appearance, success, and image or that stigmatize mental illness, as well as in women, who often receive the message that they are expected to smile and be pleasant no matter what they may actually be feeling.
With my therapist, as I began to slow down and learn to identify my feelings and the thoughts connected with them in real time, I learned that I often used smiling as a way to mask when I was in pain. It was a huge revelation and moment of progress for me the first moment I caught myself and said, “I just said something incredibly difficult—and I smiled. Why did I smile?” My therapist responded, “Because you’re in pain.” As we unpacked that profound moment, I was able to make huge progress in my own healing journey.
2. You Work—A Lot
While some people spend long hours at work because they truly enjoy it and believe they are living out their life’s calling and passion, others may use work to avoid or mask depression.
When we suffer from high-functioning depression, we may do anything to “avoid ourselves”—including throwing ourselves into work. We may even be really good at telling ourselves it’s because we’re so passionate about what we do, but deep down we may have a nagging feeling that there’s something else going on.
Some of the highest achievers at work may be the most vulnerable. The achievements might be from desperately trying to find some kind of meaning or significance in life, or to feel something.
Still others may not necessarily be known as “high achievers,” but they may overfunction for others at work. They may not always spend long hours in the office, but:
They’re the person who always anticipates their boss’s needs.
They’re the person everyone can always depend on when a last-minute fire needs to be put out.
They’re the one who will always pick up the slack for that member of the team who didn’t pull their weight on the project.
Overfunctioning can quietly mask depression. You might be so in tune with others’ needs and with what needs to get done precisely because you can’t bear to tune in to your own unmet needs. You’re afraid that if you actually “feel what you’re really feeling,” you might drown. So you use work as a distraction.
3. You Can’t Be Alone
While depression is more often associated with being alone than being out with people, high-functioning depression behaves differently. It’s not that it feels good to be around people; if you really take a moment to tune in to yourself, you often feel quite lonely. But, like work, it’s a distraction.
You can occupy yourself with what other people are saying. You can get completely lost in their worlds so you don’t have to inhabit your own. You can fill your schedule with activities that look fun on the outside, so you look “fine,” so no one worries about you.
And maybe, one day, you can finally convince yourself that you’re having fun. That you’re not desperately lonely. That you don’t feel alone in a big room of people. That you don’t feel like you have to put on a mask and conform to the expectations of everyone in the room to be accepted.
But deep down, the depression is gnawing at you. You’re afraid to be alone. What will happen if you’re finally alone with your thoughts and feelings? The thought is terrifying, so it’s best to not risk it.
4. You Deflect or Invalidate Yourself
“But it’s fine.” “But that’s life, you know?”
When someone does get curious about your inner world, you deflect. When they say, “Wow, that sounds really painful,” or “I’m so sorry you’re going through that,” or “I’m so sorry that happened to you,” you brush it off with a comment like the ones above. Or the classic “But I have so much to be grateful for,” or “But other people have it so much worse than me.”
Why do you do this? Why do you deflect intimacy, understanding, and compassion when it’s exactly what you need?
We do what we know. Odds are, this was modeled for you. You may have been told by someone growing up, “You shouldn’t complain; kids in (some other country) have it so much worse than you” or “Buck up, buttercup.” You internalized that voice, and so you disconnected from your own pain. There’s a part of you that’s off in the corner somewhere, sobbing, isolated, desperate for comfort. But that part of you can’t come to the surface and be comforted because you internalized that invalidating voice.
This internalized voice is a defense against the external invalidation or lack of comfort that inevitably came. It was so painful to not receive comfort and nurturing that you convinced yourself you didn’t need it.
You don’t know how to receive comfort or to comfort yourself; it’s not a language you speak (yet).
5. Your Emotions Change Rapidly
Do you typically come across as emotionally calm and stable, but all of a sudden have an explosion that seems to come out of nowhere? There can be many causes for these kinds of outbursts, but in general, what therapists call “emotional lability” is a good mental health indicator. If you have high emotional lability, which means you can go from extremely happy to extremely sad very quickly, or contented to enraged, you could be suffering from high-functioning depression.
That part of you that got “exiled” suddenly comes out screaming. That part of you that never received the comfort or nurture they needed. Most of the time, you can put on a calm face and keep them locked away somewhere out of conscious awareness. But when you have a particularly stressful day, and the stressors just keep piling up, all of a sudden you explode in rage or grief.
Then you shame yourself for not keeping that part of you sufficiently locked away, for letting it get “out of control,” and you determine to keep it better locked away next time. But unfortunately, this pretty much guarantees that your next outburst will be even more dramatic.
The cycle keeps getting more and more out of control until you acknowledge, love, and integrate that exiled part of you.
If You Recognize Yourself in This List …
What are the right next steps?
Find a therapist who is depth-focused. Who won’t just give you practical tools (your coping strategies are already pretty darn sophisticated) but who will get curious about your inner world. That’s what you really need. What you’re craving. Even though you run from it at every opportunity.
Most people with high-functioning depression look so good on the outside that very few people around them get genuinely curious about their inner worlds. In fact, they’ve often surrounded themselves with people similar to their family of origin—people who in general will not get curious about their inner worlds and instead will take the surface as reality, as truth.
So the type of therapist who will be the best fit will likely feel very uncomfortable to be around at first. You are not used to being seen into. It feels dangerous. Exposing. Too vulnerable. But that core of you that feels like a pit of emptiness needs to be filled with ooey gooey warm honey. The way that happens is to allow yourself to be seen by a safe, curious, loving person.
What About Medication?
Some people are adamantly against medication. I was that way for a long time.
When I finally tried antidepressants after being in a year of weekly therapy, I compared what I’d been doing to undergoing surgery without any anesthetic. Therapy hurts. Deeply. This pain is necessary in order to get to healing and comfort. Antidepressants are like an anesthetic for the deep emotional heart and brain surgery you’re going through.
I view antidepressants not as a cure, but as a facilitator to your healing. They help level you out so you actually feel able to do the work you need to do. Otherwise, depression will often have you either running frantically around overstimulated to try to escape your healing, or in “turtle mode” huddled in the bed.
There are alternatives. Hug a loved one. Pet the dog. Go for a hike. Exercise. Take herbal/natural remedies. Go out in the sun. These are ways to raise oxytocin, dopamine, and serotonin. However—the tricky thing about depression is that you often don’t feel motivated to do these things. It’s difficult to set up systems and routines that make these habits automatic and desirable.
So I won’t tell you whether to take medication or not. Some people have had terrible side effects from the wrong dosage or wrong medication for them. I will just say that, for many people, medication makes the process of therapy, and establishing desirable lifestyle habits, more doable.
You Deserve to Be Seen
If you've read this far and found yourself nodding along, that recognition matters. It might feel comforting and uncomfortable at the same time. After all, part of you has worked very hard for a very long time to make sure no one, including yourself, would ever notice.
But here's what I want you to hear: the energy it takes to maintain that smile, to stay busy, to keep that exiled part of you locked away is exhausting. You've been carrying something heavy for so long that it just feels like your normal. It doesn't have to be.
High-functioning depression is real, and it is treatable. The very strengths that have helped you survive it—your self-awareness, your empathy, your resilience—are the same strengths that will help you heal from it. They just need to be redirected inward, toward yourself, for once.
You have spent so much of your life making sure everyone else is okay. What would it feel like to finally let someone do that for you?
