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What does 'high-functioning depression' actually mean?

A psychologist explains where the term came from, and why the use of it can be dangerous.

PORTLAND, Maine — We all face a number of feelings through our lifetimes, but some feelings of sadness can stick around for a while. If you're still going to work, socializing, and taking care of your family is that considered 'high-functioning depression?'

Dr. Colleen Cira is a Licensed Clinical Psychologist and founder of the Cira Center For Behavioral Health. She says ultimately, 'high-functioning depression' isn't a real thing. 

"High-functioning depression refers to someone who struggles with depressive symptoms (sadness, tearfulness, apathy, guilt, etc.), but who continues to function quite well in their everyday life by going to work, maintaining social commitments, fulfilling responsibilities, etc.," explains Dr. Cira. "The problem with this term is that it is fundamentally inaccurate."

"According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), one of the main criteria of Major Depressive Disorder is that the symptoms cause 'clinically significant distress or impairment in social, occupational, or other important areas of functioning,'" Cira says. 

What that means - essentially - is that someone can have symptoms of depression, but if they can still function in social activities or work or life in general they do not meet the criteria for Major Depressive Disorder. That doesn't take away from your feelings of sadness or grieving, but it does not qualify you for that disorder. 

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"As someone who not only treats Major Depression but has also suffered from it as well, Major Depressive Disorder is not something that you can simply decide to be over, even if you are incredibly well-versed in it and have an abundance of coping skills and resources at your disposal," explains Dr. Cira. 

Which brings us back to the term, 'high-functioning depression,' and why it's so commonly used. Dr. Cira has a few theories on that, "In Western culture, we are intolerant to feelings other than happiness.  Most of us walk around with this idea that we should be happy all of the time and if we aren’t something is wrong with us, but this simply isn’t true."

"The human experience is complicated and research is clear that our emotional journey over the course of our life is quite complicated as well. No feeling, including happiness, is a constant state, and contentment or peace is mostly about accepting that fact," Cira says. 

Using the term 'high-functioning depression' can not only be problematic, Dr. Cira explains, but also potentially discouraging for people who fall into a gray area on the depression spectrum.

"It can be enormously upsetting for people who have actual, diagnosable, clinical depression because it leads people to believe (and continues to perpetuate) the antiquated idea that depression is a choice. That with a pull-yourself-up-by-your-bootstraps attitude, you can simply 'snap out of it.'  All of which couldn’t be more inaccurate," Dr. Cira explains. "Major Depressive Disorder is a serious, potentially life-threatening condition that is underpinned by very real and serious changes in one’s brain and body chemistry.  This is not true of sadness, which we all experience from time to time and couldn’t be more normal."

To learn more about Dr. Colleen Cira and her Cira Center for Behavioral Health, click here