When we think of depression, we might imagine a person clutching a box of tissues and completely unable to make it out the front door. But that stereotype is fundamentally untrue. Depression can manifest in many different ways, including what some people refer to as “high-functioning” depression.
Experts say high-functioning depression often isn’t noticeable to most people. If you live with it, you know how true this is. Most days, you plaster a smile on your face, excel at work and even maintain successful relationships. This, however, doesn’t mean that you aren’t struggling with the debilitating symptoms of depression each and every day.
Sound familiar? Here are a handful of things that people with high-functioning depression can understand better than anyone, according to experts and other people who have been there.
1. Everyday routines feel exhausting.
Kati Morton, a licensed marriage and family therapist and author of Are U Ok?, said only those with high-functioning depression know just how hard it is to get ready for the day or complete basic tasks.
“People who aren’t depressed cannot understand how much energy it can take for us to get up, shower and get out the door,” Morton said. “Many people with high-functioning depression report that they feel exhausted by the time they even make it into work or to that event they said they would go to.”
Reya Kost, the clinic director at Haven Hills Recovery, a trauma-informed recovery center for women in San Diego, California, said it’s difficult for people to comprehend how someone “with a good job, great family and lots of friends could be unhappy.”
“When struggling with depression and maintaining a fully scheduled life, life is hard, exhausting, and rarely does it feel fulfilling,” Kost said.
2. Seeking help feels like a monumental task.
Many people dealing with high-functioning depression have a desire to feel better and be more engaged and connected in their lives, according to Kost. However, mustering up the energy to seek help can be extremely difficult when you’ve been pretending all day ― despite a constantly low mood and little motivation to complete tasks.
“Sometimes the suggestion to ‘get help’ can feel patronizing,” she said. “Chances are the person suffering has thought of seeking help, they just haven’t figured out how to get it done yet.”
3. How you feel on the inside doesn’t match up with how you act.
Karla Campos, who runs a digital marketing agency in Tampa, Florida, and lives with high-functioning depression, said people always talk about how “cool, calm and confident” she acts. But appearances can be deceiving.
“When depression hits, all I want to do is be alone, curl up in a ball and sleep,” she said. “I can’t, however, so I play my part. It feels like I’m acting.”
“In order to look confident I ask myself, ‘What would Karla do on a normal day?’ Karla would say hi to people, she’d feel present, she’d be excited about life,” she added. “But on days that I’m depressed, I don’t want to say hi to Mr. Jones or anyone. It’s not because Mr. Jones or anyone did anything wrong; I want to be alone because everything is draining and exhausting.”
4. You’re the harshest critic of everyone, including yourself.
When you struggle with high-functioning depression, your ruthless inner critic condemns yourself, others and the world at large, said Valeria Skopich, a psychologist at a military hospital in Bila Tserkva, Ukraine.
“You think that you are a loser, your boss is an idiot, your partner is the most annoying person who ever lived, and life is simply unbearable,” she said. “There are negative thoughts spinning in your head that you just can’t turn off.”
Skopich said this type of negative thinking also includes self-doubt.
“You can constantly doubt whether you are on the right path in your career, whether you are in the right relationship, what you are doing with your life and even if you can cope with being an adult,” she said.
5. People don’t understand how you could ‘be depressed.’
“Many of my high-functioning depressed clients argue that the toughest thing about their condition is that it is not apparent to others,” said John Duffy, a Chicago-based psychologist.
For example, Duffy said he has counseled a college student who felt hopeless and depressed most of the time despite achieving straight As, appearing put-together and accomplishing everything on her daily to-do list.
“‘You can’t be depressed,’” he said people told her. ”‘Look at how well you’re doing.’”
6. Self-care feels completely impossible.
“Several of my clients have showed up to my office looking like a bus just ran over them,” said Azizi Marshall, founder and CEO of the Center for Creative Arts Therapy, a group psychotherapy practice and training center in Chicago. “They have kept it all together in their daily lives ― interacting with colleagues, focusing on their job, keeping their spouses happy ― and when they come to their session with me, they finally have a place to let go.”
Self-care does is rarely a priority for these patients. “They do not feel their own self-worth or value due to their depression,” he said.
Myisha T. Hill, a mental health advocate and entrepreneur in Thousand Oaks, California, agreed.
“It feels like a burden so you stop doing simple things like putting on lipstick,” Hill said. “Caring for yourself feels like a chore. You lack energy to do simple things like eat healthy, go for a walk or even do your laundry.”
7. You feel zero sense of accomplishment.
Sure, you may be able to knock out your to-do list while living with high-functioning depression. But that doesn’t mean you necessarily feel good or accomplished when it’s done.
“Throughout the day, you transition in and out of tasks, feeling distressed by how emotionally disconnected you are. You wait for the feeling to kick in ― some interest, excitement, anything,” said Greg Kushnick, a licensed psychologist in New York. “You settle for a mild sense of engagement when a task successfully distracts you from your negative thoughts.”
Carrie Krawiec, a licensed marriage and family therapist in Troy, Michigan, agreed, adding that people with depression often do not feel joy, even from activities that once brought them joy.
“They resent their depression for robbing them of joy and it creates anger and negativity to do a once beloved task and feel nothing or worse miserable,” she said.
8. Making ― and sticking with ― plans can be difficult.
“One thing that’s frustrating that people don’t understand is the depressed person’s tendency to make plans then cancel [or] flake,” said Kathryn Vercillo, a writer in San Francisco.
As a person with high-functioning depression, Vercillo said she will often truly feel excited about plans she makes with others. “Then the day comes around and if it’s a good day, I go and have a good time. But just as likely it’s not a good day, and I have trouble forcing myself to go, at which point I cancel, make an excuse, or when I was younger, embarrassingly, just don’t show up,” she said.
This habit may frustrate others, but Vercillo said the situation is much harder on her than people realize.
“We feel terrible when we can’t make ourselves go to something we’ve agreed to but we just can’t get ourselves there,” she said. “We feel guilty, beat ourselves up and ruminate about it and this spins us further into the depression.”
9. Relationships are more challenging than anyone realizes.
Morgan Eisenstot, an account associate at a public relations agency in Austin, Texas, said personal relationships become difficult to maintain when living with high-functioning depression.
“I never want to bog down my friends or family, but at the same time those people push me to find out if I’m OK,” she said, adding that this just leads to her apologizing profusely to everyone she knows. “Those living without depression don’t understand that this is a gut reaction. It’s me making sure that those around me know that I don’t want to bring them into my pit.”
High-functioning depression can also cause feelings of shame, which makes people want to withdraw from others, according to Allison Zamani, an associate marriage and family therapist at the Center for Mindful Psychotherapy in San Francisco.
“Having to share this with another person makes the person feel like an outsider or judged,” Zamani said, adding that it can trigger a feeling of shame when the person you’re with tries to comfort you.
10. Social media can make it easier to hide your depression.
Social media can mask difficult times. This can be true for anyone: Photo captions never share the whole picture of what’s really going on in someone’s life. But this can be especially true for people with high-functioning depression, according to Shana Bearden, a creative director in Knoxville, Tennessee, who lives with the condition.
Bearden shared the following example of a photo caption she posted in the past compared to the reality of what was really going through her mind:
Caption: Hello Monday! I am looking forward to jumping into work this week after a relaxing weekend of popcorn and Netflix binging.
Reality: Last week was a total disaster. If I don’t land two new clients this week, am I totally F#$%ED?! I spent the whole weekend laying on the sofa feeling sorry for myself, watching TV and eating food that required the least amount of work to make. Today is a new day! Gotta fake #highvibes so I don’t repel potential clients!
11. ‘High-functioning’ doesn’t mean there isn’t a risk for self-harm.
Someone may be at risk even they’re able to mask their condition.
“We can hold down a job and perform very well while still suicidally depressed and fighting each day to stay alive,” said Catherine Callan, a health care advocate with ICareHealthCare in Santa Barbara, California, who lives with high-functioning depression.
If you know someone living with depression who mentions they’re struggling or maybe they’re just not showing up in ways that they used to, it’s worth checking in with them. And if you know they’re at risk, always ask about self-harm ― even if it’s awkward.
“Ask us directly if we are considering suicide,” Callan said. “It can be essential to our survival.”
“Living With” is a guide to navigating conditions that affect your mind and body. Each month, HuffPost Life will tackle very real issues people live with by offering different stories, advice and ways to connect with others who understand what it’s like. In February, we’re covering depression. Got an experience you’d like to share? Email firstname.lastname@example.org.
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.