Sadness is a typical, universal emotion that is expected in situations of loss, change, or difficult life experiences/situations. One must understand the difference between sadness and depression. Where sadness is an emotion that we all experience at some point of time, depression is not an emotion, it is an illness. Depression is a condition that exists without triggers and continues to be there for a period of time, to an extent that it hampers daily functioning. Depression is more than occasional sadness and not everyone will suffer from depression during their lifetime. Depression involves periods of hopelessness, lethargy, emptiness, helplessness, irritability, and problems focusing and concentrating. Depression needs treatment and it is a treatable condition. Depression is the second leading cause of death across the globe, increasing the burden of illness in the bio-psycho-social realms of society. Depression has multivariate faces with a manifestation in more than 10 types depending upon the context, onset and severity of the illness. Nevertheless, the primary symptoms of depression remain to be seen as-
- 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, the depression is manifested and overtly seen quite differently and not that obviously. High functioning individual, as understand colloquially, refers to someone who is performing above what would be expected of them. It is usually used in a context of development. Thus, the term is actually a comparative term and rather subjective (or based on someone’s opinion). It may be simplistically used to have an “all or none” connotation – which would entail the person either being high-functioning or not. Most individuals have a mix of skills and abilities and may be high-functioning in certain areas and not in others. It is also important to understand that sometimes, high functioning is understood in the pathological context where the individual is referred to as a high functioning disordered personality and such an individual is one who is able to conceal his/her dysfunctional behaviour in certain public settings and maintain a positive public or professional profile while exposing their negative traits to family members or close ones.
Though no clear statistics are available to demarcate the prevalence of depression among high functioning individuals, the situation tends to prevail. What is characteristically seen in high functioning individuals with depression is that the inhibited energy and desire for activity/action is directed in an effort to succeed with goals. The drive to accomplish often sustains action and moves high-functioning individuals towards getting things done which make it appear to be a relatively constructive diversion of energy. High-functioning depression is similar to low-level depression and can last around five years in adults or one to two years in children and teens, according to the Harvard School of Public Health. And while it may not leave you devastated and hopeless, high-functioning depression can deteriorate the quality of life, dampen the 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 individuals who are high functioning by action and nature-
- Setting higher goals and feelings of dissatisfaction: People with high functioning depression constantly set higher goals for themselves without the 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 the position 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, but it’s seen and individuals may be seen displacing these emotions on loved ones and near ones with no apparent reason. The feeling of guilt lingers.
- Feeling drained to maintain relationships may drain out the individual who feels the compulsion to keep contributing more to add value or enrich eh relationship, even in instances when not required.
- Individuals with high functioning depression either sleep too much or too little.
- Depression isn’t a recognizable condition in high functioning individuals as they are able to surface their depression with skills.
- Reduced social interactions and meetings outside work settings. They may be isolative, and this may often translate into a distance in relationships with peers and kinship.
- Co-occurring medical conditions, like diabetes or cancer, cause stress and strain that can lead to depression. Depression also lowers the immunity, increasing the vulnerability to acquire other diseases or health problems.
- Family history is an important marker for vulnerability to depression. Individuals with history of family members suffering from depression are at a higher risk of developing depression
- 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, further hindering people’s abilities to cope.
- Affluent, educated people are, surprisingly, more likely to have high functioning depression. It is said that it is a paradox of high functioning depression is that these are very often people who are educated and have important jobs.
Keeping the above points in mind, it is necessary to note that not every individual who may have these symptoms is an individual with high functioning depression. It is important to note the context and duration of symptoms. Nevertheless, having identified depression, it must not be let go off, ignored or delayed with intervention. Earlier intervention (and treatment) helps to better manage symptoms and allows the individual to return to healthier functioning sooner. Early intervention also reduced the chances of relapse (the illness recurring) for the individual. Mental health professionals such as psychiatrists, clinical psychologists, and psychotherapists (or sometimes, counsellors) are equipped to understand and manage depression. They must be reached out to for help. Usually, a combination treatment of medication and therapy works the best for treating depression. High functioning tendencies of individuals may be managed through therapy.
About the Author:
Pragya Lodha is the Assistant Editor of the Indian Journal of Mental Health and works as a Research Assistant at De Sousa Foundation, Mumbai with over 20 publications in National and International publications in journals and books. Pragya has been working in the field of mental health, engaging in various on the ground and online projects. She also serves as the Associate Programme Developer at The MINDS Foundation, Gujarat. Presently, she is also the India Coordinator and Leader for an Indian-European Project called “Advocacy for Mental Health: Create Leaders to Innovate and Break Stigma”. She is also a Trained Volunteer at Samaritans Mumbai for 2 years with a background in Clinical Psychology and Psychotherapy. Pragya aspires to see mental health as a comfortably spoken about and addressed domain in India, in the coming time.