High functioning depression looks like someone that is able to handle work, school and family obligations on the outside successfully, while also secretly battling chronic fatigue, emptiness, and persistent sadness on the inside.
Clinically this high functioning depression also often aligns with PDD or Persistent Depressive Disorder, which is also known as dysthymia, where low grade depressive symptoms last for 2 years or more.
When a person has high functioning depression, what people see on the outside is the outer mask, in which the person is reliable and shows up to work on time, meets deadlines and cares for others.
Success, in which the person achieves goals, maintains a home, or participates in social events.
Perfectionism, in which the person pushes extra hard to keep up appearances and hides internal struggles.
And passing as being "Fine", where the person appears calm or composed to coworkers and friends while also being internally overwhelmed.
What people don't see in a person with high functioning depression is that the person runs on autopilot, is exhausted, experiences anhedonia, harsh self criticism and irritability.
A person with high functioning depression often feels completely disconnected or numb, as if watching their life from far away.
The person with high functioning depression also feels a deep, heavy fatigue that sleep doesn't fix and loses genuine pleasure or joy in hobbies and activities that they used to love and they constantly judge themselves, feels worthless, or even feels guilty for not being happy8.
People with high functioning depression also have a shorter fuse or feel easily worn out by minor demands from other people.
Because people with high functioning depression also keep all their plates spinning, friends, family and even the person themselves with high functioning depression often write off the symptoms as regular stress, burnout, or just how their personality is.
Although, carrying this heavy burden without relief also takes a major toll.
The deepest form of depression is severe major depression that is accompanied by suicidal ideation, self harm, or even psychotic features, where your daily functioning also becomes completely debilitating.
Severe major depression is the worst stage of depression.
And while clinical depression is often viewed through levels of severity, which include (mild, moderate and severe) or progressive worsening phases rather than fixed "stages" of depression, the most dangerous and intense point of depression is marked by extreme functional impairment and crisis.
The key signs of severe depression include complete debilitation, severe emotional numbness or agony and crisis symptoms.
Complete debilitation in severe depression are where basic daily tasks, like showering, getting out of bed, eating or even working feel physically and even mentally impossible.
Severe emotional numbness or agony in severe depression involve intense feelings of worthlessness, crushing guilt and profound hopelessness taking over.
And crisis symptoms of severe depression involve emergence of thoughts of death, suicide, self harm, or in rare cases, psychotic features such as catatonia or delusions.
The common signs of severe depression are physical pain, severe isolation, extreme hopelessness, total loss of function and suicidal thoughts.
Suicidal thoughts include believing there is no escape from the agony, or that loved ones would be better off without you.
Total loss of function includes being unable to get out of bed, eat, bathe or do basic daily tasks.
Extreme hopelessness includes feeling completely empty, numb or convinced that life will never get better.
Severe isolation includes pulling away from all friends, family and support systems.
And physical pain includes experiencing any unexplained aches, severe fatigue, or extreme sleep and weight changes.