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To an outside observer, you seem fine. You’re meeting your obligations, and hanging out with family and friends … but on the inside, you feel sad and down most days. And you’ve felt this way for a long time. Could you be depressed? Even if you’re functioning so well?

It’s possible. If this describes you, you could have what’s colloquially called “functional depression” or “high-functioning depression.” The technical term is persistent depressive disorder (previously known as dysthymia). This condition is a form of depression that’s often mild but lasts for at least two years.

Symptoms of functional depression

As alluded to above, the primary symptom of functional depression is a dark mood on most days that lasts for two years or more. Although the day-to-day severity is typically mild, there may be one or more periods of major depression at some point. 

It’s important to note that in younger people, like kids and teenagers, a depressed mood can look more like irritability. And it only has to last for at least one year in those younger populations to be considered a sign of functional depression.

Aside from the main symptom, other possible symptoms of persistent depressive disorder include:

  • Feelings of hopelessness.
  • Low energy/fatigue.
  • Poor self-esteem.
  • Appetite disruptions (either a poor appetite or overeating).
  • Trouble sleeping (insomnia) or sleeping too much (hypersomnia).
  • Trouble concentrating or making decisions.

To be diagnosed with persistent depressive disorder, someone must have the main symptom of a persistent low mood plus at least two of the other symptoms listed above.

Who can develop functional depression?

Anyone can develop this condition, from children to adults. Persistent depressive disorder that arises in someone younger than 21 years old is considered early onset. Data from a 2007 survey (the National Comorbidity Survey Replication Survey) suggests that approximately 2.5% of people experience functional depression at some point in their lives. The disorder is more common in women than men. In addition, those who have other mental health issues, who have been through trauma, or who have relatives who are depressed may be at increased risk. 

At-home treatments for functional depression

You should tell your doctor or other mental health provider if you feel that you may be depressed. But if your symptoms are very mild and are not disrupting your daily life, there are some things you can do at home that may help boost your mood. These include:

  • Getting adequate sleep (seven to nine hours for most adults).
  • Exercising.
  • Eating a healthy, well-balanced diet.
  • Scheduling time to do activities you enjoy.
  • Spending time outdoors.
  • Talking about your feelings with a friend or family member.

When to seek help for functional depression

If you feel distressed by your symptoms or find that they are disrupting your daily life (even if you appear functional to someone else), it’s time to seek professional help. Your healthcare provider will likely ask questions about your mood and history. They may also give you an exam and run some lab tests to be sure that there’s not another explanation for your low mood. If you and your provider decide that treatment is needed, you’ll most likely begin with talk therapy (also called psychotherapy) and/or an antidepressant medication.

The most common type of talk therapy is cognitive behavioral therapy (CBT), in which a therapist will help you retrain your brain to have healthier thought patterns. Another option is psychodynamic therapy, which involves analyzing your past to gain insights into — and address — your present mental state. Aside from one-on-one CBT or psychodynamic therapy, you may also benefit from group therapy sessions or support groups.

In terms of medication, the most common ones used for functional depression are: 

  • Selective serotonin reuptake inhibitors (SSRIs).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs).
  • Atypical antidepressants like bupropion and mirtazapine.

SSRIs and SNRIs work by blocking the recycling of mood-related molecules back into neurons. In contrast, atypical antidepressants work through various other mechanisms (they’re called “atypical” because they don’t fit neatly into the other common antidepressant drug classes). 

If you find yourself becoming less and less functional, and other treatments aren’t working, alternative treatments may help. A medication called esketamine is one option. This FDA-approved drug is delivered as a nasal spray and is intended to be used alongside oral antidepressants. Another option is a medication-free technique called transcranial magnetic stimulation, or TMS. In this noninvasive method, pulses of magnetic energy are delivered to areas of the brain that may be underactive in people with depression.

Active Path Mental Health can help with hard-to-treat functional depression

At Active Path Mental Health, we specialize in treatment-resistant depression. We offer psychotherapy, as well as esketamine and TMS.

Contact our team today for more information or to schedule an initial appointment.

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