Depression has many faces, and they’re not always sad. The one who seems to have it all together in front of family and friends, but is actually a wreck behind closed doors or when he or she is alone, is someone whom pop psychology would describe as a high-functioning depressive.
The term “high-functioning depression” is what’s clinically known as dysthymia.
It’s defined by the Diagnostic And Statistical Manual of Mental Disorders 5th Edition (DSM 5) as a mental health disorder characterized by: “Depressed mood for most of the day, for most days than not, as indicated by either subjective account or observation by others, for at least two years,” and includes the presence of two or more of the following symptoms: “Poor appetite or overeating; insomnia or hypersonic; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.”
People dealing with dysthymia do not present themselves like those with major depressive disorder. A person struggling with dysthymia is still able to get up each day and go to work, be in a committed relationship, and post smiling photos on Instagram. They get together with friends, and can manage the day-to-day requirements of life. They do not look depressed.
However, deep inside, the person with dysthymia is engaged in a battle not visible to others—even to those people they love, and who love them. Left untreated, dysthymia can evolve into a full-blown major depressive disorder or other challenging mental health issues.
What are some of the ways that dysthymia can manifest itself?
One, you have difficulty experiencing joy. The things that used to make you happy or look forward to, you now dread and look at as a chore or a burden—a night out with girlfriends, watching your child perform on stage, your Friday night date with a special person, or watching a movie with your colleagues at work. You now avoid these activities because it takes too much effort.
Two, you are beset by constant self-doubt. Am I in the right job? Did I choose the right career? Is this person right for me? Am I right for him or her? You are plagued relentlessly in private by these questions and you can’t seem to get them out of your head.
Three, you have very low energy. You get up in the morning on auto-pilot, but slogging through the day is a Herculean task. You may feel like you hardly have the mental, emotional or physical energy to complete your tasks or handle your life. If you feel like your energy stores are depleted even after you’ve rested or have come from a break, it may be a sign of dysthymia.
Four, small things stress you out. You find yourself overwhelmed by things or events that wouldn’t even have made a dent or mattered in the past. Your friend cancels a lunch date, your child is a few minutes late when you pick her up, there’s a minor traffic incident. When small things make you react like it’s the end of the world, you may be suffering from dysthymia.
Five, there is a generalized sense of sadness that pervades your life. It feels like wherever you are, there is a black cloud hovering. You can’t quite put your finger on why you feel sad.
Six, you are unable to rest or slow down. You have no patience, or are uncomfortable with slowness or keeping still because of the thoughts and feelings that come when you find yourself slowing down. Even if you are physically tired, there is that constant desire to keep going so as to avoid those moments of quiet and stillness.
Tiring and draining
Trying to hold it all together all the time can be tiring and draining on the psyche. Dysthymia isn’t a matter of snapping out of it, or willing your way out of it. The more you push and strive to “will your way out of it” instead of seeking help, the worse you will feel, and the worse your symptoms will get.
Sometimes, in trying to hide, and attempting to treat yourself, other co-morbid disorders may ensue—addiction or eating or substance disorders may begin to appear as you try to stuff all your feelings inside.
The important thing about high-functioning depression or dysthymia is to seek out the help you need. It does not always require medication; more often, psychotherapy or talk therapy is sufficient for a short period of time. When the therapist sees a need to medicate—and often, this is shortterm, as well—he or she will need to refer you to a psychiatrist.
Again—and I’m a firm believer in this—there is no shame in seeking help. There is no shame in sharing your struggles or your story. It is more difficult and dangerous to both your mental health and your physical health in the long-term if you already feel these symptoms and try to treat them yourself.
Help nowadays is often just a text or a phone call away. There are many avenues now for seeking help. Don’t do it alone. There are many others who will understand you, and who will help you.
If you are a family member or a loved one of someone who seems to be manifesting symptoms of dysthymia, please be extra caring and supportive. Offer help, but when it isn’t accepted, don’t feel bad. Keep loving and supporting them even from a distance. Pray for their clarity. One day soon they may come around and share their story.
And when they do, make sure to listen and be there.