It is absolutely possible to be depressed but still functioning and, in fact, it is more common than most people realize. Many individuals experience what is often referred to as “high-functioning depression,” where they are able to go through the motions of daily life while quietly battling emotional pain beneath the surface. They might hold down a steady job, keep up with social obligations, and appear perfectly “fine” to others, all while feeling overwhelmed, numb, or deeply unhappy inside. The disconnect between outward appearance and internal struggle can make this form of depression particularly isolating.
Because the signs are not always obvious, high-functioning depression can go unnoticed by friends, family, and even the person experiencing it. It does not always look like sadness or tears. Sometimes it looks like exhaustion, irritability, or a constant sense of emptiness. In this blog, we will explore what it really means to be functioning while depressed, the potential risks of ignoring the symptoms, and how to seek support when your mental health is struggling behind the scenes.
Anchor Therapy is a counseling center in Hoboken, NJ with mental health therapists specialized in helping children, teens, adults, couples, and families with anxiety, depression, relationship issues, trauma, life transitions, and more. Anchor Therapy is accepting new clients and is now providing in-person sessions and teletherapy sessions to residents of New Jersey, New York, and Florida.
What is high-functioning depression?
High-functioning depression is not an official clinical diagnosis, but it is a term commonly used to describe someone who is experiencing depressive symptoms while still managing to meet daily responsibilities. These individuals may appear successful, put-together, and even cheerful on the outside, yet they are often battling persistent feelings of sadness, emptiness, or low self-worth internally. Because they continue to function- going to work, maintaining relationships, and staying productive- their struggles are frequently overlooked or dismissed by others.
In many cases, high-functioning depression closely resembles Persistent Depressive Disorder (PDD), also known as dysthymia. This condition involves chronic symptoms of depression that are less severe than Major Depressive Disorder (MDD) but last for two years or more. People with PDD may not experience intense emotional lows, but instead endure a constant, dull emotional pain that can sap their energy, motivation, and sense of joy. Over time, it can wear down a person’s sense of purpose and make life feel like a series of obligations rather than something to enjoy.
What are some signs of high-functioning depression?
Constant feelings of sadness, emptiness, or hopelessness (Read our blog “Sadness vs Depression: When To Get Help”)
Low self-esteem or persistent self-criticism (View our blog “Do You Understand Your Self-Esteem?”)
Fatigue or low energy, even after adequate rest
Irritability or increased frustration over small things
Difficulty experiencing joy or pleasure (anhedonia)
Overworking or staying busy to avoid emotional discomfort
Changes in sleep patterns (sleeping too much or too little)
Changes in appetite or weight
Trouble concentrating or making decisions
Feeling emotionally disconnected from others
Perfectionism (Our blog “Is Perfectionism A Coping Skill?” is a must-read)
Fear of failure (View our blog “How Do I Overcome The Fear of Failure?”)
Putting on a “mask” or pretending everything is fine
Rarely asking for help, even when overwhelmed
Feeling like you are “going through the motions” of life
A sense that things are off, but not being sure why
One of the most challenging aspects of high-functioning depression is how easily it hides in plain sight. Because the person is “doing fine” by conventional standards, they may feel guilt or confusion about their emotions. This can lead to silence, denial, or even self-criticism, as they convince themselves that their feelings are not valid or “bad enough” to warrant help. It also means that loved ones might not notice anything is wrong until the person reaches a breaking point.
Understanding high-functioning depression is key to recognizing that depression does not always look like a crisis or collapse. It can look like success, responsibility, and a busy schedule- all masking a deep internal struggle. If you or someone you know feels emotionally off but continues to push through, it is important to take those feelings seriously. Help is not only for those who cannot get out of bed, but it is also for those who do, but feel hollow doing it.
For more information, read our blog “What Is Highly Functional Depression?” to keep learning!
What is smiling depression?
Smiling depression is a term used to describe someone who appears happy, upbeat, or even cheerful on the outside, while secretly experiencing symptoms of depression on the inside. It is not an official medical diagnosis, but it is often associated with MDD in individuals who are masking their emotional pain. These people may continue to function in daily life- going to work, caring for family, socializing- while hiding feelings of sadness, hopelessness, or worthlessness behind a smile.
Unlike more visible forms of depression, smiling depression can be particularly hard to detect. People struggling with it often feel a strong need to maintain the appearance of being “okay” or “in control” either to protect their image, avoid burdening others, or deny the severity of their own emotions. As a result, their inner struggles often go unnoticed, even by close friends or family. This disconnect between how someone feels and how they present themselves can make the experience even more isolating.
What are the signs of smiling depression?
Appearing cheerful, positive, or high-energy in public, but feeling sad or empty in private
Saying “I’m fine” or deflecting when asked about their well-being
Keeping up with daily responsibilities while feeling mentally or emotionally drained
Making jokes or using humor to cover up pain or discomfort
Avoiding deep or emotional conversations
Feeling a persistent sense of hopelessness or worthlessness beneath the surface
Engaging in perfectionism or people-pleasing to maintain a “put-together” image (Our blog “11 Reasons Why You Are A People Pleaser” is a must-read)
Feeling guilty for being depressed, especially when life appears “good” from the outside
Isolating emotionally even when physically around others
Experiencing changes in sleep, appetite, or energy levels
Feeling like they are living a double life- one public and one private
Having thoughts of self-harm or suicide despite seeming happy externally (Feeling suicidal? Help is only a phone call away at the free National Suicide Prevention Lifeline: 800-273-8255)
One of the dangers of smiling depression is that it may prevent individuals from seeking help. They might think their symptoms are not serious enough, or they may feel guilty for being depressed when they have a seemingly “good life.” Because they are able to carry on with their responsibilities, the sense of urgency to address their mental health may be diminished. However, the emotional burden of constantly pretending can become exhausting, and in some cases, may lead to worsening symptoms or crisis points.
Recognizing smiling depression requires looking beyond appearances and paying attention to subtle signs, such as a friend who is always “on” but seems withdrawn underneath, or someone who brushes off deeper conversations. It is a reminder that mental health challenges do not always look like what we expect. Just because someone is smiling does not mean they are not hurting and they may need compassion, understanding, and support just as much as anyone else.
What is a double depression?
Double depression is a term used when someone with PDD, a chronic, low-grade form of depression, experiences a major depressive episode on top of their ongoing symptoms. In other words, a person with a constant background of dysthymia (long-term, mild to moderate depression) temporarily "crashes" into a more intense period of severe depression. This combination can be particularly challenging because the person is already used to living with low mood and fatigue, and the sudden intensification can feel overwhelming and difficult to manage.
PDD often involves symptoms like low energy, poor self-esteem, sleep issues, and a general sense of hopelessness that lasts for at least two years. Many people with PDD adjust to this as their "normal," often not realizing they are living with a form of depression. When a major depressive episode occurs- characterized by more severe symptoms such as deep sadness, loss of interest in activities, changes in appetite, difficulty concentrating, or suicidal thoughts- the contrast can be stark and alarming. This layering of conditions is what defines double depression.
One of the biggest concerns with double depression is that it is frequently underdiagnosed or misdiagnosed. Because the baseline symptoms of PDD can become a way of life, both individuals and healthcare providers might miss the shift into a MDD until the symptoms are severe. Treatment typically involves a combination of psychotherapy and medication, tailored to address both the chronic and acute aspects of depression. Early intervention is key as double depression tends to be more resistant to treatment and associated with a higher risk of recurrence if left unaddressed. Research shows that roughly 3-6% of the population has double depression.
What are the warning signs of a crisis?
Even when someone appears to be functioning- holding down a job, maintaining relationships, and fulfilling daily responsibilities- there can still be underlying emotional turmoil that is easy to overlook. This is often referred to as high-functioning depression where outward appearances mask the depth of a person’s internal struggle. Because these individuals seem "fine" on the surface, warning signs of a deeper crisis can go unnoticed by others and even by the person themselves.
One key warning sign is a noticeable increase in emotional exhaustion or burnout. This can show up as extreme fatigue, disinterest in activities that used to bring joy, or an overwhelming sense of hopelessness despite external success. You might also notice increased irritability, changes in sleep or eating patterns, or withdrawing from social interactions- not necessarily in dramatic ways, but enough to feel “off.” These changes may be subtle, but they are critical cues that something deeper is going on.
Another serious red flag is when someone begins expressing feelings of worthlessness, guilt, or feeling like a burden to others. Crisis does not always look like a breakdown; sometimes, it is the quiet persistence of pain behind a polished exterior. Recognizing these signs early, and encouraging open, non-judgmental conversations, can be a crucial step toward support and recovery.
How do you treat functioning depression?
Treating functioning depression can be challenging because, on the surface, everything might look “normal” while the person is quietly struggling inside. The first and most important step is acknowledging that just getting through the day does not mean you are truly okay. It is vital to accept that your feelings are valid, even if your depression does not look like the classic picture of someone unable to function. This mindset shift can open the door to seeking the help and care you deserve.
Professional support is often the cornerstone of effective treatment. Depression therapists at Anchor Therapy can work with you to identify negative thought patterns and emotional triggers, offering strategies to manage them. Approaches like Cognitive-Behavioral Therapy (CBT) are especially helpful in challenging the unhelpful beliefs that fuel depression. For some, medication prescribed by a psychiatrist can complement therapy by balancing brain chemistry, especially if symptoms are persistent or severe. Early intervention, even when functioning seems possible, can prevent a deeper crisis later on. Our blog “3 Benefits of Working with a Depression Therapist” is a must-read.
Alongside professional help, establishing a balanced daily routine plays a critical role. People with functioning depression often push themselves too hard, ignoring signs of burnout. Creating space in your day for rest, healthy eating, regular sleep, and enjoyable activities; even small ones; can significantly improve your mood and resilience. Check out our blog “How to Create A Daily Routine.” Learning to set boundaries and say no to demands that feel overwhelming helps protect your energy and mental health in the long run. Read our blog “The Truth Behind Why Boundaries Are Important for Maintaining Mental Health.”
It is also essential not to isolate yourself. Sharing your feelings with trusted friends, family, or support groups can lighten the emotional load. Even if you worry about being misunderstood, opening up helps break down the loneliness that often accompanies depression. Supportive relationships provide encouragement, practical help, and reminders that you are not alone in your experience which is a powerful part of healing.
Treating functioning depression is a gradual process that requires patience and self-compassion. It is not about “snapping out of it” or forcing yourself to be happy, but rather learning to care for yourself in a gentle, consistent way. Over time, maintaining therapy, staying connected, and prioritizing self-care can help you move from merely functioning to truly living and thriving despite the challenges depression brings. View our blog “The 8 Forms of Self-Care and How You Can Practice Them.”
Remember, struggling with depression does not mean you are weak or failing, especially when you are still managing to keep things together. If you recognize these signs in yourself or someone you care about, do not hesitate to reach out for support. Healing is possible, and taking that first step toward help can make all the difference in moving from just functioning to truly feeling alive again.
Victoria Scala
is the Social Media Manager, Intake Coordinator, and Community Engagement Director at Anchor Therapy in Hoboken, New Jersey. She is a graduate of the Honors College of Rutgers University-Newark and is currently studying Clinical Mental Health Counseling at the graduate level. In her roles, Victoria is committed to managing the office’s social media/community presence and prioritizing clients' needs.
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