High-functioning depression is a hidden epidemic—a quiet war fought behind smiles, to-do lists, and social media filters
By Abdullah Usman Morai | Sweden
The Cost of Seeming Fine
In the modern world, where appearance often triumphs over authenticity, we celebrate those who seem to have it all together—successful careers, active social lives, and seemingly endless energy. But behind some of these polished façades lies a hidden battle that too often goes unnoticed: high-functioning depression. This form of depression doesn’t necessarily keep people in bed or make them unable to meet deadlines, but it quietly eats away at their self-worth, joy, and mental clarity.
These individuals smile at meetings, meet family obligations, excel in their careers, and cry alone behind closed doors. Because their suffering doesn’t interfere overtly with their ability to function, it’s easily dismissed by others and even by the sufferers themselves. The silence surrounding this condition makes it not only isolating but potentially dangerous.
Understanding High-Functioning Depression
High-functioning depression isn’t a formal diagnosis under the DSM-5, but it is often considered a manifestation of Persistent Depressive Disorder (PDD), also known as dysthymia. Individuals with high-functioning depression typically manage to maintain daily responsibilities but are weighed down by a chronic sense of sadness, emptiness, or dissatisfaction. Unlike major depressive episodes, which can be visibly debilitating, high-functioning depression exists in a shadowy middle ground that makes it particularly hard to recognize.
Read: What Is High-Functioning Depression? Signs and Symptoms
Read: These individuals might describe life as feeling colorless or flat, as if they’re going through the motions. They can laugh at jokes, lead teams, or give presentations, all while battling a relentless internal monologue that whispers they’re not good enough. It is this paradox—appearing successful yet feeling hollow—that defines high-functioning depression.
Real-Life Case Study: Anna’s Story
Anna, a 34-year-old corporate lawyer in London, was the image of success. She had just made partner at her firm, had a loving husband, and two young children. On paper, everything looked ideal. But inside, Anna felt she was merely performing a role. Every morning, she had to convince herself to get out of bed. Small tasks felt monumental, and the joy she once found in work and family seemed to have evaporated.
Despite these feelings, Anna continued to deliver high-quality work, host dinners, and meet every deadline. It wasn’t until she had a panic attack in the parking lot of her office that she finally sought therapy. Her therapist diagnosed her with high-functioning depression—a label that initially baffled her. “How could I be depressed if everything in my life looked perfect?” she asked.
That question is at the core of high-functioning depression’s danger: the disconnect between outer image and inner reality.
The Silent Suffering
Those who live with high-functioning depression are often experts at hiding it. They may feel ashamed of their emotions, believing they have no right to feel this way, especially when their lives appear enviable. This shame can lead to internalized stigma and a reluctance to seek help.
Men, in particular, are vulnerable to this kind of masked suffering due to cultural expectations around stoicism and strength. A study published in The Journal of Affective Disorders found that high-achieving men often underreport symptoms of depression and are less likely to access mental health services.
The term “smiling depression” has also been used to describe this state: the person smiles, engages, and outwardly functions, but inside, they are burdened with despair. Tragically, such individuals are often at higher risk of suicide. Because they possess the energy to make and execute plans, their suicides can come as a shock to friends and family who “never saw it coming.”
Real-Life Example: The Loss of Chris
Chris, a 28-year-old tech entrepreneur in Karachi, Pakistan, was widely admired. He was charismatic, ran a growing startup, and was active on social media, often posting motivational quotes and productivity tips. Yet, underneath the hustle culture, Chris felt increasingly empty. He worked long hours, not out of passion but as a distraction from the sadness that lingered at the edge of every day.
His parents and friends only became aware of the severity of his condition when he died by suicide. The note he left behind described a decade-long struggle with feelings of worthlessness and disconnection. The world mourned the loss of a “bright star,” but it also prompted uncomfortable conversations about mental health in South Asia, where such topics remain heavily stigmatized.
The Cultural and Societal Context
High-functioning depression doesn’t operate in a vacuum; it is shaped and often exacerbated by cultural expectations. In societies that value productivity, resilience, and external achievement, mental health struggles are often downplayed or ignored. Phrases like “get over it,” “be grateful,” or “you have nothing to be sad about” further alienate those suffering quietly.
In South Asian communities, where honor and reputation can be tied to family image, acknowledging emotional distress can be viewed as selfish or weak. This cultural lens leads many to mask their pain, believing that discussing mental health is a luxury or a sign of indulgence.
The corporate world is no better. The “grind culture” glorifies overwork and dismisses burnout as a badge of honor. In such environments, taking a mental health day might be frowned upon, and therapy might be seen as a crutch rather than a tool for wellness.
Impact on Personal and Professional Life
Although individuals with high-functioning depression may keep up appearances, the toll it takes on their personal and professional lives is profound:
- Chronic Fatigue: Even routine tasks can leave them drained. They often feel tired despite sleeping for hours, or suffer from insomnia caused by racing thoughts.
- Cognitive Fog: Concentration becomes difficult. Decision-making feels like climbing a mountain, and memory lapses can impact work performance.
- Emotional Disconnection: They may withdraw from loved ones, feeling unworthy of affection or too exhausted to engage emotionally.
- Perfectionism and Impostor Syndrome: The fear of being “found out” as inadequate can lead to overcompensation and burnout.
- Strained Relationships: Partners, children, and friends might feel pushed away or confused by mood swings and emotional unavailability.
Path to Recovery
- Recognition and Acceptance
The first step toward healing is acknowledging the problem. This often requires breaking through denial and dismantling the belief that one’s struggles are invalid because life seems “good.”
Tip: Regular mental health check-ins with yourself or a therapist can help detect early signs.
- Therapy
Cognitive Behavioral Therapy (CBT) is one of the most effective treatments for high-functioning depression. It helps individuals identify distorted thought patterns, reframe negative beliefs, and develop healthier coping mechanisms.
Case Example: Maria, a schoolteacher in Islamabad, began CBT after feeling numb for years. Therapy helped her link her perfectionist tendencies and chronic self-criticism to unresolved grief and anxiety, giving her tools to build a more compassionate internal narrative.
- Medication
In moderate to severe cases, antidepressants such as SSRIs (Selective Serotonin Reuptake Inhibitors) can help restore chemical imbalances in the brain. These should be prescribed and monitored by a qualified psychiatrist.
It’s important to remember that medication is not a sign of weakness. Just as one would take insulin for diabetes or an inhaler for asthma, medication for depression is a legitimate and often life-saving treatment.
- Lifestyle Changes
- Exercise: Regular physical activity boosts serotonin levels and promotes better sleep.
- Diet: Nutrient-rich foods like omega-3s, leafy greens, and whole grains support brain function.
- Mindfulness and Meditation: Practicing presence through techniques like deep breathing, yoga, or guided meditation can help reduce rumination.
- Sleep Hygiene: Establishing consistent sleep routines can improve emotional regulation.
- Journaling: Writing down feelings can create clarity and emotional release.
- Community and Support
Finding a safe space to express emotions—whether through support groups, friends, or family—can significantly ease the burden. Empathy, not judgment, is key.
Organizations such as The Mind Organization Pakistan, NAMI (National Alliance on Mental Illness) in the U.S., and Samaritans UK offer helplines, counseling, and peer support for those battling hidden depression.
Changing the Narrative
We must move beyond the binary image of what depression “looks like.” It is not always someone crying in bed or visibly withdrawn. It could be your boss, your friend, or the influencer you admire. It could be you.
Rethinking mental health in the context of functionality requires us to redefine strength, not as the absence of struggle, but the courage to confront it.
Workplaces can implement mental wellness policies that include therapy reimbursement, flexible schedules, and non-judgmental spaces for conversation. Schools can introduce emotional literacy curriculums that teach children how to name and navigate their feelings. Media representation must also evolve to portray nuanced and realistic portrayals of mental health struggles.
From Survival to Healing
High-functioning depression is a hidden epidemic—a quiet war fought behind smiles, to-do lists, and social media filters. But visibility can lead to validation. And validation can lead to healing.
We need to collectively unlearn the belief that success is incompatible with suffering. A lawyer, a mother, a tech founder, or a teacher can be both capable and in pain. The mask of high-functioning depression can only be lifted when we replace judgment with empathy and silence with conversation.
If you or someone you know resonates with this description, don’t wait for a breakdown to seek help. Healing doesn’t require you to fall apart first. Even the most polished lives can hold invisible cracks—and it’s never too late to fill them with understanding, treatment, and hope.
Read- Psychology: The Courage to Fail
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Abdullah Soomro, penname Abdullah Usman Morai, hailing from Moro town of Sindh, province of Pakistan, is based in Stockholm Sweden. Currently he is working as Groundwater Engineer in Stockholm Sweden. He did BE (Agriculture) from Sindh Agriculture University Tando Jam and MSc water systems technology from KTH Stockholm Sweden as well as MSc Management from Stockholm University. Beside this he also did masters in journalism and economics from Shah Abdul Latif University Khairpur Mirs, Sindh. He is author of a travelogue book named ‘Musafatoon’. His second book is in process. He writes articles from time to
