Over the course of the pandemic, a study ran by the Institute of Mental Health revealed that a staggering 8.7% of local respondents met the criteria for clinical depression. Depression, in and of itself, is a term that holds considerable weight when raised up to anyone—especially when it concerns a loved one. After all, it is now considered to be a serious medical condition—taking a heavy toll on an individual’s mental health as well as their propensity to function normally, even impacting their ability to eat, sleep and participate in social activities.
Whilst the topic of mental health is increasingly normalised as an important issue, the causes of its manifestation can hardly be strictly defined; some deal with it as a side effect of a long-term illness, some might suffer from it as a product of grief, whilst others might have it for no particular reason at all. But as more and more conversations happen around the subject of depression, another term has been increasingly circled around; that of “high-functioning” depression. Where the individual suffering from it does not seem to be suffering at all and can perform their day-to-day activities seemingly without a qualm. Often, when it is revealed that these individuals actually require treatment, it may even come as a shock to their family and friends. It almost seems invisible to the people around them, or even themselves—the critical factor as to why it may be considered fearsome to many.
But medical experts do not tout it as an official diagnosis—and perhaps rightfully so. According to Dr Johnson Fam, a Senior Consultant in the Department of Psychiatry at Singapore General Hospital (SGH), it’s actually “misleading” to be using this term, due to what it implies for individuals who are ultimately, still suffering with a very real and dangerous medical condition. Curious as to the nuances of what “high-functioning depression” actually refers to and why it manifests differently for these individuals, we asked Dr Fam to weigh in with his medical expertise, below.
What is “high-functioning” depression?
“High-functioning” depression is actually not an official psychiatric diagnosis. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not recognise it as a clinical disorder. Some articles erroneously use the term “high-functioning depression” interchangeably with persistent depressive disorder (PDD)—this should also be discouraged. PDD is a recognised psychiatric disorder and its symptoms may cause significant functional impairment. The term “high-functioning” depression may mislead one to think that depressive symptoms are trivial in individuals who function at a supposedly high level. “Functional depression” (FD) may be a more appropriate term to describe individuals with depressive symptoms but can still perform day-to-day functions.
What are the common symptoms of functional depression (FD) and how does it differ from major depressive disorder (MDD) or persistent depressive disorder (PDD)?
Symptoms of functional depression may include a general depressed mood, low self-esteem, feelings of hopelessness, sleep and appetite changes, and fatigue. A person with FD typically has fewer, briefer and less severe symptoms as compared to someone with MDD or PDD.
Why is functional depression so difficult to spot in others?
Individuals with FD may appear fine in social settings and their performance at work may not be affected. Thus, it may not be as easy to identify unless you know the person well.
Why is it so hard for individuals who suffer from functional depression to seek help?
Some individuals who suffer from FD might think that what they’re experiencing is part and parcel of life, whilst others may think that it is not a problem as long as they are able to function as per normal on a day-to-day basis.
Certain statistics show that depressive episodes might affect women more. From your experience, does functional depression manifest differently for women?
Depression may be more frequently reported in women due to their genetic predisposition, or greater degrees of hormonal fluctuation. Stress from certain social and cultural expectations is also a possible cause. But women also tend to express their emotions more readily and hence may be more open towards seeking help.
How should one go about treating functional depression?
There is a risk that FD may develop into a clinical depressive disorder. Hence FD symptoms should not be ignored and persons suffering from it should ultimately seek help and talk to a mental health professional if the symptoms persist or worsen. Having a good work-life balance, healthy diet, regular exercise, adequate sleep and avoiding the abuse of alcohol or drugs are all important ways to also aid in keeping depressive symptoms at bay.