Sadness is a typical, universal emotion experienced during loss or major life changes. But there is a difference between sadness and depression. While we all experience sadness at some point, depression is an illness. It is a condition that exists without triggers and continues to the extent that it hampers daily functioning.
Depression is more than occasional sadness, and not everyone will suffer from it during their lifetime. It involves periods of hopelessness, lethargy, emptiness, helplessness, irritability, and difficulty in focus and concentration.
Although it is a treatable condition, it is the second leading cause of death across the globe, increasing the burden of illness in the bio-psycho-social realms of society. And that’s not all. It has multivariate faces with a manifestation in more than ten types, depending on the context, onset and severity of the illness.
Nevertheless, the primary symptoms of depression are:
- Changed patterns of sleep
- Reduced or increased appetite
- Lack of feeling of joy and interest in activities that were previously enjoyed
- Lack of energy and lethargy
- Low mood
However, when we speak about high functioning individuals, depression is manifested and overt. A high functioning individual performs more than what is expected of them. Unfortunately, because such people don’t appear to be sad or distressed, it is often missed and the prevalence remains less known.
Most individuals have a mix of skills and abilities, they may be high-functioning in certain areas and not in others. It is also important to understand that ‘high functioning’ is understood in the pathological context.
High functioning depression is clinically referred to as persistent depressive disorder or PDD. As opposed to major depression, where the symptoms make it difficult for the person to remain functional at a daily level, in PDD, the person has persistent but milder symptoms that allow them to remain functional.
To understand the nature of high functioning individuals, we spoke to mental health expert Havovi Hyderabadwalla, a Clinical Psychologist and co-founder of Mind Mandala. She tells us, “One of the biggest issues that high functioning people face is that people don’t believe them, because on the outside, they look like they have everything together. However, just the way people would be supportive of individuals struggling to keep it together and lend their support, high functioning individuals need the same.”
High functioning individuals have a high drive to achieve and they usually use this to do things and tasks which makes them look healthy and in no need for help.
Janki Mehta, psychotherapist and co-founder of Mind Mandala, adds, “High functioning individuals can often be diagnosed with depression because they will have a high need to do work–when this need is not fulfilled, they tend to go into a self-blame zone, and that often results in depression. Having peers who can hold space while they have these ups and downs becomes important. At the same time, telling them to seek help to work through their emotions is required. Emotions are in layers, and often peers will see the first layer or two, and assume that that is all, but therapy may help address the deeper layers.”
While high functioning depression may not leave you devastated and hopeless, it can deteriorate the quality of your life, dampen your enthusiasm for work and also affect school, family, and even social activities. There are certain signs that we may look for, to identify depression in our peers who are high functioning by action and nature:
- People with high functioning depression constantly set higher goals for themselves without appreciation of their achievements. It is difficult for them to accept compliments because they feel they can be better than what they are.
- High functioning individuals with depression are usually low on physical energy but have adequate mental energy that is constructively diverted to work.
- It is difficult for them to deny work, especially when given by people in positions of authority. They are also typically seen as Type A Personalities (workaholic, competitive, self-critical).
- They fear obligation and guilt.
- Depression and anxiety may coexist in the individual.
- Irritability is a lesser-known symptom of depression, and individuals may be seen displaying these emotions on loved ones with no apparent reason. The feeling of guilt lingers.
- Relationships may drain the individual who feels the compulsion to keep contributing or enriching the relationship, even in instances when not required.
- Individuals with high functioning depression either sleep too much or too little.
- They can surface their depression with skills.
- Reduced social interactions and meetings outside work settings. They may prefer isolation, and this may often translate into distance in relationships with peers and kin.
- Co-occurring medical conditions, like diabetes or cancer, cause stress and strain that can lead to depression, which also lowers their immunity, increasing their vulnerability to acquire other diseases or health problems.
- Family history is an important marker for vulnerability to depression. Individuals with a family history of depression are at a higher risk.
- Alcohol or drug dependence, eating disorders or engagement in excessive video game playing may be seen, and this may exacerbate symptoms of depression, anxiety and sleep problems.
- Affluent, educated people are surprisingly, more likely to have high functioning depression. It is a paradox of high functioning depression that it often affects people who are educated and have important jobs.
Please remember that someone who may identify with one or two of the above signs and symptoms may not have high functioning depression. It is important to note the context, cluster, and duration of their symptoms.
Nevertheless, having identified depression, it must not be ignored or delayed.
As far as self-care goes, Hyderabadwalla suggests that they should take the down-time they need, whether it’s watching television or reading. Rest, exercise and nutritious food is important. Therapy should be at the top of their list of self-care.
Mehta emphasises the need for adequate sleep, finding ways to replenish their energy on mind and body, creative outlets and channelising their energy into something they love, rather than work. She also talks about the importance of family time and getting comfortable with the mundane aspects of life.
Earlier intervention (and treatment) helps to manage symptoms and allows the individual to return to healthier functioning. It also reduces their chances of relapse. Mental health professionals such as psychiatrists, clinical psychologists, and psychotherapists (or sometimes, counsellors) are equipped to understand and manage depression. Usually, a combination treatment of medication and therapy works best for treating depression.
(Edited by Shruti Singhal)