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What Is High-Functioning Depression?

Depression affects millions of people, disrupting day-to-day to life. But some people who appear highly productive outwardly often suffer in silence and alone. Dr. Ed Jackson, Regional Medical Director of Outpatient Psychiatry for BayCare Behavioral Health, helps explain the condition, signs and symptoms.
What Is High-Functioning Depression?
Featured Speaker:
Edwin Jackson, MD
Ed Jackson, MD is board-certified in general psychiatry and has over twenty years of experience treating children, adults and addition-related disorders. He earned his medical degree from the University of Tennessee and completed his residency at the University of South Florida. Dr. Jackson is the Regional Medical Director of Outpatient Psychiatry at BayCare and the Associate Program Director for BayCare’s psychiatry residency program.

Learn more about Dr. Ed Jackson

 Prakash Chandran (Host): Depression is a mood disorder that many of us are aware of. And it's commonly associated with sadness and sometimes inability to function normally on a day-to-day basis. But did you know that there is a form of depression where an individual is still suffering, but can function at a normal to high level? This is called high functioning depression, and more than likely we all know someone who's gone through it before.

Welcome to BayCare HealthChat. I'm Prakash Chandran. And in this episode, we're going to be talking about high functioning depression. Joining us today is Dr. Edwin Jackson, a Psychiatry Specialist at BayCare Health System.

Dr. Jackson, thank you so much for joining us today. Truly appreciate your time. Let's get started with the basics. What exactly is high-functioning depression?

Edwin Jackson, MD (Guest): Well, thank you for having me. High functioning depression is just like it sounds, it's somebody who suffers from a clinical depression, but on the outside they look like they're high functioning. We see a lot of professionals, doctors, attorneys, businessmen, whose life appears to be going great. They are working well. They have great relationships, yet on the inside, they have a type of depression that's just as clinical, or maybe even worse than something you would see on the outside, because they're the kind of people that doesn't get help. And you know, sometimes the first indicator that somebody has high-functioning depression can be maybe a suicide attempt or even completion.

Host: Yeah, that's really tough to hear. And I imagine that they're high-functioning almost because they have to be. Usually these individuals are in high stress jobs. They are supporting people and they feel like they just need to get things done, that they don't make time for themselves until it's sometimes too late. Is that correct?

Dr. Jackson: That is correct. And the fact that they're high functioning in their other life means that they're high functioning and they have the high ability to mask it, to present to society what we think they should be presenting. They're achieved well in life and they're not about to show a weakness, or what they consider a weakness.

Host: Dr. Jackson, can you tell us a little bit more about who this affects?

Dr. Jackson: Well it's across the socioeconomic classes. We stereotype it as somebody who may be a professional, but it could be anyone. Could be somebody who just has the ability to, and let's use the term, give a poker face. They can present what they think society is looking for. They can almost, like an actor they can present as if everything's okay. So socio-economic, but we think of it sometimes as people who are professional, but it basically it's just like a depression, any depression it reaches all walks of life.

Host: Now you talked about that potential suicide attempt or completion as an indication that someone might have been going through high-functioning depression, but are there any other signs that people can look out for?

Dr. Jackson: Well, if somebody is under a lot of stress or there's a little bit of changes, one of the first indicators for depression in general, is sleep disturbance. The first thing to go is usually sleep. A person complaining of not having trouble sleeping or a spouse knows that somebody is waking up earlier or having trouble sleeping or tossing and turning. Sleep is usually the first to go. Also maybe relying on maladaptive coping mechanisms, alcohol, increase in alcohol intake can be a sign of underlying depression. And of course, it makes it worse. Alcohol is a depressant, so it's a vicious cycle. Any changes in the normal relationships or, you know, maybe irritability not to the point where the person, you know, is combative or argumentative, but just maybe short, you know, somebody who's under a lot of stress and you see a change in their demeanor, personality, habits. You know, it's a potential that there's a high-functioning depression going on.

Host: So that leads me into my next question. How is high-functioning depression officially diagnosed?

Dr. Jackson: Usually by a clinician. And it's usually someone that seeks it out or a family member refers them to treatment. Occasionally, it might be a referral from say if it were a professional, maybe the job performance did start to suffer, but as I said, that's usually one of the last things that there may be a referral to, you know, the EAP program, employee assistance program.

And once they've got somebody in their office, they're talking about it, they may just spill all the marbles and just say, yes, this is what's going on inside. You know, I've been, trying to do my best, but sometimes I think I, just can't keep up.

Host: Yeah. So let's talk about the different treatments. If someone is identified as having high-functioning depression, what options do they have?

Dr. Jackson: Well, there's several options, or even a combination, psychotherapy, medication or both. I usually like to start with psychotherapy. Medications if it's severe or you have worries, and sometimes we go straight to medications with therapy, but psychotherapy is always I think the best treatment. We rely on medications, but medications alone usually are not the cure. The longer I do psychiatry, the more I realize that there are other aspects. Yes, it's a tool, but it's not the cure most of the time. It's a tool to the cure.

Host: And I know you said that medication alone is not a cure, but when medication is used, what can people expect to be given?

Dr. Jackson: Well, typically we use antidepressants. Antidepressants, like serotonin re-uptake inhibitors. Serotonin is a neurotransmitter, a chemical in the brain. And we think that a lack of it or decrease amount of it in the brain can cause anxiety and depression. The main stay of pharmacological treatment are antidepressants raise the serotonin level. There are some other antidepressants that work through a different neurotransmitter called dopamine. And sometimes we use them or sometimes we use both because they do work differently. If we don't get quite the response that we want from a one type of medication, then we can sometimes substitute or you use both of them together.

They are safe medications. I think Prozac was one of the first that came out. Maybe I should use the generic fluoxetine was the first that came out and that came out in the eighties. So, we know the long-term effects. We know they're safe and we use them frequently.

Host: I know that they're safe, but are there any side effects that people should be aware of? Like long-term or short?

Dr. Jackson: There's no permanent long-term side effects, but there is a side effect that can be quite bothersome to some people especially the medications that work through serotonin. Some people can complain of a decrease in their sex drive. When the medicines first came out, this was puzzling to doctors. They thought, well, you know, this is probably because of your depression and once you start to feel better and the medicine start to work the sex drive will come back. But we have realized over time that, the serotonin re-uptake inhibitors, the medications like fluoxetine, paroxetine, trade names of like Prozac, Zoloft, Paxil, they can decrease the sex drive and sometimes make sexual function difficult. If that is a problem or a problem where to the point where it's bothersome to the relationship or the person; then we do have the other antidepressants that work through the dopamine. Sometimes we'll use those in lieu of, or we'll use both for a while and try and wean off the serotonin re-uptake inhibitors.

Host: Okay, understood. And are there any co-occurring problems that are associated with high functioning depression that people should be aware of?

Dr. Jackson: Maladaptive behaviors. One of the biggest that I see is developing alcohol abuse and alcohol dependence. Alcohol looks like it's your friend it can de-stress you. Maybe help with anxiety, make you feel better in the short run, but in the long run it becomes co-occurring problem or eventually, maybe even worse than the depression to begin with. Another co-occurring problem that we often see is anxiety. Anxiety and depression. Some people think are very much similar but depends on the person on how they manifest it, whether they manifest it as depression or anxiety. A lot of times the treatment is the same though. We use the serotonin re-uptake inhibitors.

Host: And just taking a step back, if I as an individual feel like I might be suffering from high functioning depression, where might I get help?

Dr. Jackson: Well, I would encourage you first to seek out a mental health provider. If you don't know any, you can ask your primary care doctor and they can refer you. It doesn't necessarily have to be a psychiatrist first. It can be, but it doesn't have to be. If you go see a psychiatrist and they think that well, this is a mild high-functioning depression, we don't need any medications at this time. We can refer you to therapy. Or if you're unsure, it doesn't hurt to go anyways. You know, therapy doesn't have to be something that you do when you have a problem. Consider it as growth. A lot of people, professionals will typically be in psychotherapy to help them grow.

Not that there's anything wrong with them now, they're not necessarily having a depression, but almost as a life coach. So if in doubt, I encourage you to seek out a therapist.

Host: Yeah. You know, you would think that after all of this time, especially kind of being in the midst of a pandemic, that getting therapy or having a therapist, wouldn't be something that's taboo. But sometimes I feel like it still is. It feels like more people should have kind of an objective opinion outside of their, you know, core family or circle of friends that they can talk through things with. Wouldn't you agree?

Dr. Jackson: I agree. Maybe it's some embarrassment too. Whether it's, how taboo is it now? Well, it may notbe as taboo as you think. People may think, oh society doesn't really accept that as much as it should or it will be an embarrassment. And some of that might even be in your own head.

You'll be surprised how accepting people are. It may be your own perception on things. Actually I think it's accepted quite a bit. And I think some of the people who you think would not be accepting of it might be surprising. You might be surprised on how they may say well, I think that was a good idea for you to go see a therapist. I had a problem a couple of years ago and I did the same thing, and they, something that you never would have known.

Host: I'm so glad you said that. Because I do think that many of us, even myself included, we have a lot of self-talk. I remember I was talking with my college roommates the other day. We're a little older now, we have children and you know life just comes at us and it gets harder and harder. And I think that in having some transparent conversations, I'm realizing that a lot of them are getting help and they feel supported and it has been largely the thing that has gotten them through all of life's challenges, especially recently.

So I'm really glad again that you brought that up because oftentimes it is just self-talk, it might be in our head. And it's important for us to realize that and do something about it.

Dr. Jackson: You know, and in psychiatry residency, after you finished medical school, you go through a residency program a four year where you work as a junior doctor. And typically the psychiatry residents are encouraged and in some programs, maybe it's mandatory to get themselves into psychoanalysis and psychotherapy, not necessarily because they're having a problem or, the work is too difficult, but they consider it growth. Doctor first heal thyself. You first have to know yourself to help others. So, considered it as growth that it's almost a manual for life.

Host: I love it. Final question, if I have a friend or a loved one that is going through what I consider high functioning depression, what's the best way that I can help them in a positive way?

Dr. Jackson: Well, sometimes just being there for them. If you do mention something about possibly talking to a therapist, you may use some of the techniques that I just talked about. Maybe bring up something in your own life or how it is not taboo, how it's growth and that it might be helpful.

Yes, you're doing fine now, but what about taking it to the next level, you know, really, you know, getting control over your mind and your emotions whether through meditation or therapy. So it's all in how you present it.

Maybe not even use the term help. Maybe use the terms therapy for growth.

Host: Right. Therapy for growth. You keep coming back to that. And I really like that. It's a way to set a foundation for growth and continual growth. The last question that I always like to ask is given all of your experience as a psychiatry specialist, what is one thing that you know to be true that you'd like to leave our listeners with?

Dr. Jackson: Life is a journey. It's hard. But with the difficult aspects of life we learn, we become, we grow. Without some type of struggle, there really isn't any growth and it's all part of life. And there's a meaning to it, even though you may not see it now. In the long run, there's a meaning to it.

Host: Wonderful place to end. Thank you so much for your time today, Dr. Jackson.

Dr. Jackson: My pleasure. Thank you.

Host: And that wraps up this episode of BayCare HealthChat. You can head to our website at for more information, and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share it on your social media and be sure to check out all other interesting podcasts in our library. My name is Prakash Chandran. Thanks again for listening and we'll talk next time.