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Wellness Wednesday: This is what you need to know about high-functioning depression

The alarming suicide rate has sparked conversations around mental health, specifically depression. Phumzile Mthembu, a clinical psychologist practising at Netcare Akeso in Richards Bay, sheds light on high-functioning depression to help you identify the signs.

High-functioning depression (HFD) is also known as persistent depressive disorder (PDD), and was previously known as dysthymia, explains Phumzile. “This type of depression is a consolidation of chronic major depressive disorder and dysthymic disorder. The symptoms must be present for at least two years for a diagnosis,” she adds.

People with HFD may not realise they’re depressed. “It’s almost invisible and very hard to identify, but very persistent. People with HFD can still go to work or engage in social activities without anyone noticing their distress.”

Depression, high-functiong depression, mental health, suicide, suicide prevention

Glamour: What are the symptoms?

Phumzile Mthembu: The symptoms vary, but these are some that are associated with HFD:

• You feel you’re wasting your time when doing your work or personal activities (e.g. hobbies, gym)

• Feeling misunderstood

• Using unhealthy coping strategies

• Excessive habits to escape reality (e.g. excessive gaming, watching TV, use of social media)

• Being overly critical of yourself and others

• You always convince yourself that you’re OK, even when you feel overwhelmed

• You hardly engage in social activities (e.g. going out with friends, hobbies, holidays, etc.) and only engage when you feel obligated to

• Feelings associated with psychological distress when thinking about work, which might appear as burnout

• Excessive guilt and worry about the past and present

Chronic fatigue

• Feeling you can’t face the world

• Feeling you can’t get out of bed

• A depressed mood for most of the day, indicated as either a subjective account or observation by others

for at least two years

• The presence of two or more of the following while depressed:

• Poor appetite or overeating

• Insomnia or hypersomnia

• Low energy or fatigue

• Low self-esteem

• Poor concentration or difficulty making decisions

• Feelings of hopelessness

G: How is HFD different from any other form of depression?

PM: The only difference from other forms of depression is that it lasts for at least two years with mild yet persistent depressive symptoms. As a consequence, people learn to live with it. People with HFD can be depressed and still be high-functioning and think that they have everything under control because they have an excellent ability to cope. Their outside appearance always appears normal, and others in their surroundings may not even notice that they’re suffering.

G: How can you treat or manage it?

PM: The first step is seeking professional help, an assessment by a trained psychologist and specialist psychiatrist to diagnose and treat your depression correctly. Learning more about the condition may also assist in developing insight and learning healthy coping strategies. Joining support groups may also help strengthen your resilience.

G: Is it possible to go through life not knowing you have HFD?

PM: Yes, it’s highly possible, especially for professional and business people because of the nature of their work. People who’re always busy hardly find time for their emotional and psychological wellbeing. They carry on with their lives and learn to manage and cope with their stress.

G: What can loved ones look out for and how can they best support someone with HFD?

• Over-working or ‘workaholism’

• Excessive sleepiness

• Poor appetite or overeating

• Social withdrawal

• Excessive use of alcohol, drugs or cigarettes

• Mood swings

• Indifference

Suicidal thoughts

• Guilt

Ways to offer support include:

• Learn more about the condition

• Make time for yourself, so you don’t impose your frustrations on a family member with HFD

• Seek professional help to gain understanding of the condition. This could include making use of Netcare Akeso’s mental health facilities or other support groups, such as SADAG

• Improve communication and

validate the person’s feelings

• Focus on what you can do to help.

• Try to deal with unresolved issues.

Image: Unsplash

TOP TIPS for life with HFD

  • Take care of your
  • Psychological wellbeing
  • Opt for a healthy diet and exercise regularly
  • Prevent or address burnout
  • Seek therapy from a registered clinical or counselling psychologist
  • Take breaks with friends or loved ones
  • Make time for relaxation

For info about mental health services and care at Netcare Akeso, visit or email [email protected]. In the event of a psychological crisis, call the Netcare Akeso crisis helpline on 0861 435 787, available 24 hours a day, to talk to an experienced counsellor.

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