Treatment for High-Functioning Depression
Persistent depressive disorder, also referred to as high-functioning depression, is less severe than major depression but persists for a longer period of time. Although people with this type of depression can still function, they are often only going through the motions. Treatment for high-functioning depression, which involves a combination of therapies and medication, can help patients learn to cope with negative emotions, make positive changes, and engage in good self-care for improved mood and functioning.
High-functioning depressive disorder is a diagnosable type of depression that is more accurately called persistent depressive disorder, or PDD.
An important characteristic of major depression is that the symptoms are severe enough to make functioning in daily life difficult to impossible. It can cause someone to struggle with school and work, to maintain relationships, to be able to socialize, and even to leave the house or keep up with basic cleaning and hygiene.
With PDD, on the other hand, a person experiences milder symptoms of depression and as a result is still able to function.
For anyone observing someone with PDD it may seem as if they have it all together and are doing well. But, on the inside, a person with PDD is struggling, feeling sad and hopeless, suffering from low self-esteem and lack of energy, and often just going through the motions of doing the most basic things needed to function.
Getting a Diagnosis for High-Functioning Depression
Just going through the motions is no way to live, but the good news for those struggling with PDD is that it can be effectively treated to reduce symptoms, boost mood, and improve daily functioning. The first step to getting good treatment is to get an accurate and professional diagnosis. A psychiatrist or other mental health professional uses criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose this condition:
- A depressed mood that lasts most of the day, most days, for two years or more
- At least two symptoms when in a depressed mood: changes in eating, changes in sleep, low self-esteem, lack of energy, difficulty concentrating, and hopelessness
- No relief from the depressed mood for longer than two months during a two-year period
- A degree of distress or impairment caused by the depressed mood
The above criteria are used to diagnose PDD, but only if these symptoms cannot be caused by another mental illness, a medical condition, or substance abuse.
The Importance of Treatment for PDD
While it is easy to justify not getting treatment for this condition because of the ability to function normally, basic functioning is not enough. Someone with PDD lives with a near-constant, low level of depression for long periods of time. They may function, but it is a daily struggle. Good treatment can boost mood, improve functioning, restore some of the joy to life, and improve overall quality of life. Without treatment, this condition will not get better.
Treatment can also minimize or prevent some of the potential complications that PDD can cause in a person’s life:
- Difficult relationships, lack of close relationships, and social isolation
- Chronic pain and other illnesses
- Poor performance at work or school
- Substance abuse and addiction
- Other mental illnesses, including major depression
- Suicidal thoughts, behaviors, and attempts
Residential Treatment for High-Functioning Depression
With an accurate diagnosis in hand, someone with PDD can begin to put together a treatment plan with the assistance of professionals. One important initial choice is between outpatient and inpatient, or residential care. Outpatient care is treatment administered while the patient remains at home and goes to therapy sessions and doctor appointments. Residential care occurs when the patient lives in a facility for a period of time, typically two to three months.
While outpatient care works for many people struggling with PDD, there are also benefits of choosing residential care for treating high-functioning depression. These include being able to focus on treatment and to receive more intensive care. A residential facility is a safe place for a patient to spend time and energy on getting better and learning strategies for coping once back at home. A residential center also gives a patient time to try medications to find out if they will work or if they will cause too many side effects.
How to Treat High-Functioning Depression – Individualized Plans
Whether a patient with PDD chooses inpatient treatment or outpatient care, it is important to get a comprehensive treatment plan that is individualized. The most effective way to treat any type of depression is to take account an individual patient’s needs, abilities, limitations, and preferences when developing a comprehensive plan. That plan typically includes both medication and therapy. This combination helps to relieve symptoms while also giving patients a chance to learn healthy coping strategies, good self-management of depression, and ways to recognize and change negative thought patterns.
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Types of Therapy for Treating High-Functioning Depression
Therapy is an important tool for treating all types of depression. There are several different kinds of therapy, and each individual can determine which type or combination works best. In addition to these various types of therapy, sessions can be conducted one-on-one, in a group setting, or with family. Some of the more common therapies used to treat PDD include:
- Cognitive behavioral therapy (CBT). CBT has been proven to be effective in treating depression. CBT therapists help patients recognize their negative thoughts and take steps to change them to more positive thoughts. It is hands-on and practical and allows patients to take control of their recovery.
- Interpersonal therapy. This kind of therapy is helpful for someone whose depression makes relationships with others particularly difficult. It helps patients learn how to better communicate with others and develop healthy relationships.
- Dialectical behavior therapy (DBT). DBT is a specialized treatment used for certain personality disorders, but it can also be useful for depression. It is similar to CBT but includes more mindfulness and the practice of self-acceptance.
- Eye Movement Desensitization and Reprocessing (EMDR). EMDR is a specific type of therapy that uses eye movements to disrupt and minimize troubling thoughts. It is especially useful in overcoming trauma, but it can also help reduce negative thoughts associated with depression.
Medications for High-Functioning Depression
Antidepressant medications may be used to treat patients with PDD but are most often used in combination with therapy for the best results. There are different classes of antidepressants and different drugs within those classes. Most take several weeks to show signs of working and not every medication works for every patient.
But sticking with it can have great benefits. Many people find relief from depression symptoms when they find the right medication that has the greatest impact with the fewest side effects. It is important to follow a doctor’s instructions with antidepressants and to never stop using them without guidance. Abrupt cessation can cause serious harm.
Lifestyle Changes and Self-Care
Also important in treating and managing PDD is positive self-care, which often involves making lifestyle changes. Part of good self-care is using strategies learned in therapy, like stress management, relaxation techniques, mindfulness, and other tools to be aware of and recognize negative thoughts and warning signs of a depressive episode. It can also mean continuing to engage in alternative activities and therapies utilized in treatment, like acupuncture, yoga, or meditation.
After going through residential treatment, patients with PDD must return home and when doing so may find it all too easy to slip back into old habits. Making new, positive lifestyle changes is important for managing depression over the long-term: get regular exercise, eat a balanced diet, get enough sleep, avoid drugs and alcohol, and make time for socializing with friends and family. Support groups and occasional or regular outpatient therapy sessions can also be useful in managing PDD after intensive treatment.
Living with high-functioning depression is challenging because, although it allows an individual to function, it causes low mood, hopelessness, and other symptoms that impair quality of life. The good news for anyone struggling with PDD is that treatment is available and it is effective. With either outpatient care or residential treatment, a person with PDD can take advantage of therapy, medications, and lifestyle changes to overcome depressive symptoms and to be able to enjoy life again.