Is Medication Needed to Treat High-Functioning Depression?

If you are struggling with high-functioning depression, you may believe that your condition is not severe enough to warrant medication. However, functionality does not indicate severity of suffering. Evidence tells us that medication can play a critical role in the treatment of all forms of depression, even when functionality is intact. Comprehensive treatment that combines medication with psychotherapy and holistic therapies can help you find rapid and durable recovery and restore your quality of life.

Sometimes the internal struggle of depression manifests in external ways. You can’t get out of bed. You can’t stop crying. You stop washing your hair. You stop going out. Sometimes you may not even be able to go to work. When depression severely impacts functionality, it becomes easy to recognize, both for you and for those around you; it’s difficult to deny that you are in serious distress when you stop being able to participate in basic daily activities.

But depression doesn’t always reveal itself so readily to the outside world. Many people living with depression are able to continue participating in daily activities, sometimes even to an extraordinary degree, maintaining prestigious careers and rich social lives. With high-functioning depression, the outwardly markers of mental illness may be nowhere to be seen or overshadowed by impressive accomplishments that stand in contrast to what many assume depression looks like. But inside, depression still dwells, even if it does not express itself through compromised functionality.

One of the greatest dangers of high-functioning depression lies in the way functionality camouflages psychological distress. Without external markers of dysfunction, the severity of mental illness can remain hidden, from your loved ones, from your colleagues, and even from yourself. As such, you may question whether you truly need treatment and be particularly hesitant to seek pharmacological treatment. Is medication really necessary if you’re still able to maintain a high level of functionality? For many, the answer is “yes.”

Functionality Does Not Indicate Severity of Suffering


There is a common misconception that people with high-functioning depression do not suffer from their illness as much as people whose functionality is compromised. But there is no linear relationship between functionality and suffering; the ability to get out of bed, go to work, and take care of your family doesn’t preclude deep psychological turmoil. Many people with high-functioning depression experience pervasive sadness, guilt, emptiness, lack of joy, and self-loathing that are profoundly painful despite the fact that they don’t translate into functional disruption. In fact, these feelings may be exacerbated when you use all your time and energy to keep your depression hidden from view by performing at a high level rather than giving yourself permission to express your internal struggle and attend to your psychological needs.

Dr. K knows this intimately. Years ago, when he was a medical resident, he jumped off a balcony. His suicide attempt came as a shock to those who knew him academically and professionally; he had never disclosed his depression to university staff or faculty. Even his fellow medical residents remained in the dark about his condition. Despite their training, his high-functioning depression had managed to elude a slew of medical professionals until it drove him to attempt to take his own life Today, Dr. K says that his reluctance to have his functionality called into question kept him from finding relief from his illness. “There’s a fear of consequences, of what will happen if you’re open about your condition,” he explains. “You wonder if the college will do anything, if your supervisors will question your abilities, if the medical board will take away your license, restrict your practice and so on.”

But high-functioning depression does not have to escalate to suicidal ideation in order to require intervention. “Depression can is a very heterogeneous condition,” says Michelle Crask, Professor of Psychology and Psychiatry at UCLA. “It takes a lot of different forms in terms of severity and in terms of what it looks like in the actual symptoms. We should not dismiss the mild forms because it’s still a struggle and there’s still a value to getting treatment.” Indeed, even mild depression can rob you of your ability to experience joy, engage in satisfying relationships, and positively engage with the world around you. Depression, regardless of severity or exact symptomatology, requires medical attention in order to restore psychological harmony and improve your quality of life.

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The Role of Medication in High-Functioning Depression Treatment


Today we have more pharmacological options for the treatment of depression than ever before. These medications are designed to modulate neurotransmitter activity in a variety of ways in order restore healthy brain function and provide relief from symptoms. Unfortunately, despite plentiful evidence of efficacy and tolerability, some people with high-functioning depression question the need for these medications due fear, internal and cultural stigma, and simply not recognizing the severity of their symptoms in the absence of functional disruption.

However, even people who are initially reluctant to try medications typically end up realizing their profound benefits as their depression lifts. “My biggest issue was pride,” says one woman who struggled with depression for years before trying medication. “I did not want to admit that I needed medicine to help me navigate my life. I would chastise myself when I felt depressed by thinking if I can just be a little stronger, work a little harder, focus a little better, everything would be okay.” But everything wasn’t okay—she remained consumed by feelings of hopelessness, lethargy, and sadness that escalated to full-blown crisis. It was only then that she finally became receptive to the idea of pharmacological treatment. “The year since I started medication has brought me a new life. Medication helps me to live the life I want, a life that I am proud of, and I have no doubt starting medication was the best decision for my family and [me].”

This story is not unusual. People who put off pharmacological treatment often report that they wish they had started sooner once they understand the difference these medications can make. While some fear that antidepressants will strip them of emotions or change their personality, the vast majority find that they do the opposite; they allow you to experience yourself and the world around you in a more full and authentic way, imbuing you with the ability to feel a broader and healthier array of emotions. A highly trained psychiatrist can work with you to create a treatment plan using medications tailored to your unique needs to optimize these benefits.

The Benefits of Comprehensive Depression Treatment


While medication can be a critical part of treatment for people with high-functioning depression, it is also important to recognize that it is only one piece of the treatment picture. Research consistently shows that the best, most durable outcomes are achieved by combining medication with psychotherapeutic and holistic modalities to create a complete, multidimensional treatment picture. When used together, this broad spectrum of therapies allows each component to build on the other to form a greater whole; by addressing acute symptoms, medication can create the psychological space you need to participate in Cognitive Behavioral Therapy. Meanwhile, art therapy can help you give expression for your feelings and translate emotions into words, increasing your ability to verbally process your experiences in talk-based therapies. As such, a comprehensive model of care offers you multiple avenues toward healing and optimizes your ability to benefit from each.

Unfortunately, participating in truly comprehensive care to find rapid relief from depression can sometimes be difficult in outpatient settings, particularly if you are trying to balance recovery with a demanding career or family obligations. In these cases, residential treatment programs may be a more appropriate setting for you to begin your healing journey. In a residential treatment environment you will have the time and space necessary to focus fully on the treatment process, unencumbered by competing demands. With the guidance of an interdisciplinary treatment team, you can engage in a personalized curriculum of therapies designed to address your symptoms in ways that are meaningful and effective for you. The close monitoring afforded by the residential milieu means that clinicians will have a better understanding of your treatment needs and responses and can continuously tailor your care—including your medication— to meet your needs in the moment.

Depression is profoundly painful condition even if you remain able to function at a high level. Comprehensive treatment can help you explore and resolve your symptoms and create effective strategies for moving forward. With the right supports, you can create a strong foundation for ongoing wellness, resilience, and emotional tranquility, giving you the opportunity to create the life you truly want.

Bridges to Recovery offers comprehensive treatment for people struggling with mental health disorders as well as co-occurring substance use disorders. Contact us to learn more about our renowned Los Angeles and San Diego-based programs and how we can help you or your loved one start on the path to lasting wellness.