High Functioning Depression - yet another fancy term?

Though not official or clinical, the term ‘High Functioning’ seems to be gaining popularity in the mental health field.

Is it really a new term though?

Apparently, no!

The term ‘High Functioning’ was first used in the early 1980s in research literature in association with Autism and was popularised by Dr. Lorna Wing - one of the pioneering Psychiatrists in Autism research - who launched the term Asperger’s Syndrome in a scientific paper in Psychological Medicine, in 1981 and is also known to have introduced the concept of Autism Spectrum (Gillberg, 2015).

For a long time, in the field of Mental Health, the term ‘High Functioning’ has remained associated with Autism, giving rise to the infamous term ‘High Functioning Autism’, used as an informal label to describe those on the spectrum who have fewer support needs.

The term ‘High Functioning’, thus, became synonymous with someone who has special support needs but requires minimum support to go about their daily tasks.

As the term remained non-clinical and informal and was often seen as misleading or even offensive, its use was largely replaced by more clinical terms.

Until recently, when the term has found new association with none other than Depression!

What is Depression?

The World Health Organization (WHO) notes Depressive Disorder or Depression as a common and serious mental illness which involves low mood or loss of pleasure or interest in activities for long periods of time.

The American Psychological Association (APA) describes Depression as a negative affective state, ranging from unhappiness and discontent to an extreme feeling of sadness, pessimism, and despondency, that interferes with daily life.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) outlines several symptoms, with at least one of the symptoms being either depressed mood or loss of interest or pleasure, along with five (or more) of the listed symptoms that should be present during the same two-week period and represent a change from previous functioning.

In brief, an individual is diagnosed with Clinical Depression or Major Depressive Disorder (MDD) when a number of symptoms, including low mood, feeling sad and empty and loss of interest in previously enjoyed things and activities, last every day, nearly all day, for at least two weeks and negatively affects how they feel, think and behave, majorly affecting their functioning in daily life.

So, what if an individual has a number of symptoms as listed in the DSM-5-TR, for at least two weeks, including either depressed mood or loss of interest or pleasure, but their functioning in daily life remains largely unaffected?

Well, that’s when High Functioning Depression comes into the picture.

What is High Functioning Depression?

High Functioning Depression (HFD) is described as experiencing depressive symptoms such as fatigue, loss of interest or pleasure, poor concentration, guilt, restlessness, sleep disturbances, and appetite changes without experiencing a lack of functioning or significant distress (Joseph et al., 2025).

It is not a formal clinical diagnosis but has often been used to describe people who experience symptoms of depression but are able to function relatively well in their daily lives, such as going to work, maintaining relationships, and meeting other responsibilities.

Needless to say, the term has been widely used and been popularised in Social Media and public discourse.

But experts, psychologists and psychiatrists alike, have been divided over it.

Some experts support the use of the term, having pointed out that in certain cases, Depression is not something that can be seen or be pinpointed easily. For some people, Depression can lie under the surface, completely undetected by others. Even as the person continues to find it extremely challenging to go about their daily life, to the rest of the world they seem to be doing reasonably well. Much like a floating duck, who appears to be calmly floating on the water but could be furiously paddling underneath, trying to keep up and struggling to stay afloat.

While some others believe that the term comes from a lack of clarity surrounding a formal clinical diagnosis of Persistent Depressive Disorder (PDD), another subtype of depression characterised by a lower intensity of depressive symptoms such as low mood, fatigue, low self-esteem, feelings of hopelessness, and changes in appetite and sleep, that persistently last for at least two years.

Cause for Concern!

Through the discussions revolving around the use of the term High Functioning Depression (HFD), some concerns have come to the forefront.

As Clinical Psychologist Adrianne McCullars puts it, calling someone "high functioning" can make the condition seem less serious, leading to missed diagnoses, delayed treatment, and less support. It may also give rise to harmful ideas about what depression "should" look like, making it more difficult for people with chronic, low-severity symptoms (McCullars, 2025).

Not only the people around but the person themself may misjudge or downplay their own feelings and condition and continue to push themself harder in order to keep going.

In some cases, the dysfunction could just be hidden in other aspects of life. For instance, a person could be performing well or even excelling in their work or studies and other responsibilities but could be struggling to even get out of the bed or their room on weekends.

Highlighting these, Dr. Adrian Ambrose, Associate Professor of Psychiatry at Columbia Vagelos College of Physicians and Surgeons has said, “The longer it goes untreated, the more entrenched the emotional distress can become.” (Ambrose, 2025).

Can High Functioning Depression (HFD) be Identified & Managed?

As High Functioning Depression (HFD) is not a formal clinical diagnosis, there is no set list of symptoms. However, it may be characterised by:

➔ Fatigue

➔ Chronic low mood

➔ Mild depressive symptoms (symptoms of Major Depressive Disorder with low intensity and frequency)

➔ Subtle struggles to keep up with daily tasks

➔ Irritability or anger

It is important to remember that High Functioning Depression (HFD) may not be manifested as dysfunctions or inability to cope with daily tasks. Thus, it becomes important to observe other aspects of daily life other than the key responsibilities such as work, studies and family responsibilities.

Management may include a combination of Talk Therapy and Lifestyle changes like diet, exercises and sleep schedules. It is always advisable to seek professional opinion.

It should also be noted that High Functioning doesn't mean it's harmless. In case someone experiences significant distress about their symptoms (such as hopelessness or worthlessness) or if they feel they are unable to maintain their work or daily activities, it could indicate that they may be progressing to a Major Depressive episode.

Additionally, whenever safety concerns emerge, like thoughts of self-harm or suicidality, it is crucial to seek professional help.

We humans have a tendency to ignore or brush aside things that seem harmless but forget that when harmless things go unchecked, they can very much become far worse.

With that caution, let's try to be more aware of our own emotions and be compassionate towards ourselves and others.

Let's stay healthy, not only physically but emotionally and mentally as well!

~Mrinmoyee Saha | Counselling Psychologist