High functioning depression | Depressive, but (highly) functional?

The D^D Judith Joseph works in Manhattan, the economic heart of New York. Among his patients, many are very successful professionally… while presenting depressive symptoms. These patients identify their discomfort with a specific condition: high-functioning depression (high-functioning depression).

You don’t know this term? It’s normal. This condition is not recognized by the World Health Organization nor by the DSM-5, the American manual which lists the main diagnostic categories of mental disorders. On the other hand, on the Internet, the concept has been gaining ground for five years. The suicide of former Miss USA Cheslie Kryst, who according to those close to her suffered from “high-functioning depression”, helped to popularize the term in 2022.

The D^D Judith Joseph, a psychiatrist, is very interested in this. She is recruiting patients to conduct a study on the subject – the first to address it, according to her. Very active on social networks, “Dr. Judith” also produces TikTok videos to publicize the signs that she attributes to high-functioning depression. One of his videos garnered 5 million views. We see him drinking coffee in the morning instead of breakfast, eating in front of his computer, scrolling through social media posts in bed…

British psychologist Julie Smith, called “the psychologist with 20 million likes », She also published a video on TikTok, also viewed millions of times. The “five main signs” of high-functioning depression, according to her? Feeling an inner emptiness, but not showing it; work hard, but without enthusiasm; numbing yourself with social media, TV series or junk food; work hard to appear happy; and neglect each other, but only out of sight.

Not the criteria

According to the D^D Judith Joseph, these patients have depressive symptoms, but they do not meet the criteria for major depressive episode, a disorder recognized in the DSM-5. “The major depressive episode must disrupt functioning, or cause significant distress,” explains the D^D Joseph. However, she says, many of these people function very well (“they exceed expectations”) and do not necessarily report distress. “They don’t take the time to feel things,” she illustrates.

According to some experts, this “high-functioning depression” is a simple derivative of persistent depressive disorder (or dysthymia), a mild but persistent form of depression. In the eyes of the D^D Joseph, high-functioning depression is more of a precursor to major depressive disorder.

When a patient presents symptoms, the psychiatrist focuses on prevention by exploring with him the underlying factors, whether biological (such as heredity or the menstrual cycle), social (“too many social networks, too much video games, too much shopping, too many substances”) or psychological (many patients have suffered trauma). “The problem with Western health care is that we wait until the person is no longer able to function or is in distress to do something,” she laments.

Psychiatrist at the Montreal Mental Health University Institute, Dr.^r Georges Pinard confirms that it is possible for depressed people to remain functional, to different degrees. “On the other hand, for these people, it comes at the cost of great effort, and it has repercussions in all spheres of life,” says Dr.^r Pinard, medical head of the Anxiety and Mood Disorders Department.

The D^r Pinard had not heard of the term “high functioning depression”, which, remember, has not been the subject of any published study. He easily explains his popularity on social networks: the pace of life is stressful, he recalls, and we face a lot of demands and insecurity. “It is certain that, in a context like this, we are likely to recognize ourselves in some of these symptoms,” he says.

According to him, this is the negative point in all this: worrying people where there is not necessarily reason to be concerned.

The DSM-5 has often been criticized for overly medicalizing certain situations that can be experienced by most people at different times in their lives, and that is exactly what we are doing by creating this category of disorders.

The D^r Georges Pinard, psychiatrist at the University Institute of Mental Health of Montreal

The D^r Pinard nevertheless believes that it is not useless to continue to find new things and try to categorize them. He finds the term high functioning depression “interesting”, and does not exclude that it will one day be studied, and therefore more credible. His popularity on social networks also has the advantage of drawing people’s attention to a more serious problem, he says: the major depressive episode.

The D^D Judith Joseph, for her part, is hopeful that this condition will one day be recognized as a precursor to depression. She draws parallels with imposter syndrome, a phenomenon that is not in the DSM, but which has been studied and talked about. “It takes a lot of studies for things to end up in the DSM-5, it takes a lot of time. That’s why I think social media is so powerful,” she concludes.

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