Depression comes in many shapes and forms, as we discuss later – and one of those forms is PDD, or persistent depressive disorder, also known as chronic depression. It used to have another old name you might recognize: dysthymia. In essence, this is a depressive disorder that goes on for more than two years and doesn’t necessarily carry the severity of a major or “severe” depression.
Persistent depressive disorder is something you often learn to live with. While we’ve spoken of and heard a lot about major depression, wherein a person is suffering from a disorder that renders them incapable of functioning on a normal level due to their depressive thoughts and symptoms, many people are suffering from a “high-functioning depression”.
This is where they’re on the spectrum for a depressive disorder but still go on with their day job, making ends meet while functioning on an entirely normal level. Their symptoms are there, but they keep the consequences and mental struggle hidden away.
So, at that point, we have to ask ourselves: is that still a depression?
The short answer is: yes, it is.
Being Depressed and Depression
First, to clear up: yes, there can be a difference between feeling depressed and being in a depressive disorder.
Depressive symptoms aren’t typical to the normal human brain. Depending on our personality, genetics, environment, and the context of the situation, we may experience depressive symptoms in cases of mourning and after dealing with rejection or a breakup of some sort.
A few common symptoms include the following:
- Feeling hopelessness
- Self-loathing or self-doubt
- Lack of motivation
- Difficulty focusing/concentrating
- Low enthusiasm for everything
- And more.
Being depressed isn’t automatically equated with mental illness. It can be normal. However, a “normal” depressive phase ends at some point, typically within weeks or months of the triggering event. It’s when the symptoms go on for longer, don’t have a particular trigger, or seem to get progressively worse that we delve into the realm of disorders and mental illness – because at that point, something is actually wrong.
With that in mind, possessing mild but real depressive symptoms for a period spanning several years is most definitely a depressive disorder, even when the symptoms aren’t as severe as a major depressive disorder.
High-Functioning Depression is Still Depression
We shouldn’t consider someone with high-functioning chronic depression to be far less ill and in need of help and support than someone with another iteration of the disease. In some cases, PDD can manifest in such a way that people experience mild depressive symptoms on a long-term basis over decades, so much so that it becomes an interpreted part of their personality. These people are seen as too negative, sensitive or emotional – and the fact that they’re experiencing depressive symptoms on a regular basis isn’t caught onto, or simply ignored.
It’s not that people aren’t perceptive enough to see this type of condition where it exists – it’s that most people suffering from high-functioning depression don’t want to admit they’re depressed, usually for several very understandable reasons.
Most people who realize their depression try and hide it, for the simple reason that being labeled mentally ill is neither desirable nor helpful to anyone’s career or dreams. If you’re having problems at work and decide to see a therapist only to get diagnosed with a major depressive disorder, chances are you’ll do your best to hide it from anyone who isn’t close enough not to talk about it.
While you can do your job, and support your family whilst being depressed, there’s no guarantee that you’d be able to keep that kind of behavior up without slowly piling onto your depression with other issues, due to a lack of attention. Then again, it’s easily understandable why people with high-functioning depression agree to put themselves through immense amounts of stress while doing their best to hide their issues.
It’s only when things get bad that a lot of people agree to openly seek treatment – because they must. The issue here is glaring – sometimes, people don’t seek treatment not because they’re wholly confident that nothing’s wrong with them, but because they’re legitimately afraid of endangering their livelihood or lifestyle by admitting their diagnosis.
The stigma against mental illness is partially at fault here, as is the difficulty of getting adequate treatment. In many cases, being someone with symptoms of a high-functioning depression is a matter of necessity. Most people can’t afford the time or money to sit down and deal with their mental illness, and they certainly can’t afford others knowing about it, so they have to pretend it doesn’t exist. That’s where things get worse.
From High-Functioning to Debilitating
Depression can render you unable to function at all in several ways. For one, the stress can reach levels of such severity that you experience what is called a mental breakdown. You seize to be rational or functional – you just react. And often, the reaction can be explosive.
In other cases, depression can develop a host of other issues, including a deep-seated anxiety and subsequent panic attacks, or highly negative coping mechanisms like drinking heavily, or destructive/risky behavior.
Finally, heavy depression can lead to an increased risk of suicide. This is the worst-case scenario, where hopelessness leads to a case where a person sees no alternative – but thankfully, it’s not the norm.
A persistent depressive disorder doesn’t have to get worse. It doesn’t have to turn into severe depression or come to suicidal tendencies. It doesn’t have to develop comorbidities like addiction and anxiety. But, it doesn’t get better all on its own, either. When a depression becomes chronic without an actual “trigger” or cause, there’s something deeper within that’s continuously fueling it – a cyclical thought pattern that feeds the depression and causes it to remain a part of a person’s life.
And that’s exactly where treatments like therapy come in handy because they can help someone unravel and mitigate their depression in ways they may not have been able to do alone all these years.
Depressive Symptoms on a Spectrum
Depressive disorders exist on a depressive spectrum, where short reactive depressive episodes make up one end of the spectrum, while the road to the other end is paved with more complex and varying disorders such as manic depression (bipolar), “waxing and waning” persistent depressive disorder, major depression, and more. According to psychiatrists, that’s the first axis – the first level of the spectrum, where the client’s symptoms are best matched to an existing disorder, with footnotes and additional relative descriptions made based on a concrete list of issues and irregularities.
Then, the second layer comes into play: how a person is dealing with the depression. Some people succumb to it through maladaptive coping mechanisms. They turn to drink, or another destructive habit. They mask their disorder with their behavior. Others have the capacity to ignore it and function despite their depression. Others yet do everything they can do deal with it, including lifestyle modification.
The final layer is what else may be affecting a person’s overall mental health, from a physical standpoint. Their personality aside, what existing conditions do they have that could exacerbate their condition? Do they have a thyroid problem? A hormone imbalance? Diabetes, asthma, heart disease or something else? Sometimes, physical symptoms arise because of depression – at other times, they may cause it. And there are times where the two are entirely separate, but build on each other.
The trick to finding out how to help someone with depression is by building the most possibly accurate image of their health, mental and otherwise, through the utilization of these three layers: the psychological, the physical and how a person deals with their situation for further insight into their personality.
What this all does is it helps us – doctors, psychiatrists, families, friends, and everyone in-between – both better understand depression and be able to be more understanding of what it is. Everyone can be depressed, but it’s the severity, the duration and the context that changes from person to person and differentiates a reactive depression from a depressive disorder – and further differentiates all the depressive disorders from one another, often on a case-by-case basis.
Depression is complicated. It’s kinda messy. It’s not always clear whether someone is depressed – although the best way to figure it out is usually just by asking them. There are clearly defined symptoms for depression, but we manage them in different ways.
Some people cope so well they function normally – but struggle with regular, normal tasks far more than the average person. They may have trouble getting out of bed, often lack the motivation to do their work and may have to struggle with even the most mundane of tasks – but they still get things done. That doesn’t make them fine, or mentally healthy – it’s just how they work. And yes, they still need help.
Let’s look at it this way – you can suffer from depression and still be in control of your life, but it comes with a toll. Mounting stress, the constant struggle of dealing with depressive symptoms, the fear and anxiety of having a mental breakdown or being five minutes away from a really bad episode of depression. That’s not anything anyone would want to live with, but many do because they must. And we should do what we can to help them.
Helping a Case of High-Functioning Depression
Depression, high-functioning or otherwise, is best solved through thorough conversation and understanding. It seems a bit simple, but talk therapy – usually cognitive behavioral therapy – is among the most popular and effective ways to tackle depression.
Cognitive behavioral therapy is one among several tools in the arsenal of positive psychology for the explicit purpose of basically making people feel better, in a long-term sense, by giving them a new and more hopeful perspective of their own situation. CBT identifies negative thought processes and helps a depressed client go over why they think the way they think, slowly reversing the cycle by introducing positive thinking into the mix.
All that is affirmed through mental exercises, regular therapy, therapeutic content and the help and support of family and friends.
Of course, it doesn’t always work. And it certainly doesn’t work immediately. Medication is also an option for those who need a different way to cope with depression, usually in the form of SSRIs that help the brain better manage serotonin, the neurotransmitter dedicated to mood and social behavior, as well as a host of other functions.
Then there are alternative treatment methods – from meditation and mindfulness training, which helps people learn to worry less by focusing and concentrating on the present, to physical therapy and exercise to improve a client’s self-image and physical health (and as a result, their mental health). Typically, it’s a combination of several treatments that makes for the best results.
No one can tell you what will work best, because it depends on the case. Some people handle one form of treatment better than another, and in other cases, the best treatment may not be available due to cost and healthcare restraints.
For friends and family members looking for answers, the best thing to do is ask and listen. Don’t berate, don’t interject, don’t interrupt – give your depressed loved one a chance to say everything and anything they need to say, and be open about the way they feel without having you relate to them on something you can’t relate to (unless you can, of course, and have also dealt with similar symptoms for a long time).
Being heard out can already help massively – it’s not exactly a treatment, but knowing there are people out there who care for you and want you to get better for your own sake can be very uplifting.