ON DEPRESSION – and the myth of the high functioning depressive.

by Velleda C. Ceccoli Ph.D. on July 19, 2010


“So you still don’t think I am a high functioning depressive?” my patient asks me this half smiling, she knows my answer, and more importantly, she knows first hand that there is no such thing as “high functioning” when one suffers from depression.

Depression is an illness. A life threatening illness. It is not something that you have a little of. And it is not something that you have to live with. It is treatable.

Depression affects millions of people throughout the world, and ranks first among the psychiatric diagnoses, followed by anxiety. Our diagnostic manuals (DSM-IVR) divide depression into endogenous or primary depression which usually manifests in the early twenties and continues throughout one’s life, and secondary depression, which comes about as a response to particular stressors such as chronic illness, loss, and other major life stressors. In either case, the effects of depression can be devastating and disruptive to an individual’s ability to function and live life fully.

Depression affects both the body and the mind. Physically, depression will impact an individual’s sleep patterns, appetite and energy levels. It will affect one’s ability to focus and concentrate, as well as our access to information and our ability to process it. The depressed brain moves in slow motion making it difficult, if not impossible, to make decisions and exercise good judgment. Environmental stimuli and demands tend to overwhelm the depressed person. The physical effects of depression are well documented, and come about as a result of biochemical changes in our brain structure and neurological system. These changes affect the way certain chemicals associated with brain function are released and reabsorbed into our bloodstream. This in turn affects the way that our neurons fire signals related to motility, cognition, and behavior. For a person who suffers from chronic depression, these biochemical and neurological changes can establish a physical pattern, which then interacts and is reinforced with and through our thoughts, feelings and behavior. This neuro-behavioral loop may require psychopharmacological intervention along with talk therapy.

Psychologically, the effects of depression disrupt an individual’s cognitive, social and interpersonal functioning as well as his/her ability to experience pleasure or joy. There is no such thing as a “high functioning depressed person”. A dark cloud sets up residence, surrounding the person with a black fog that disrupts his/her ability to experience fully, think clearly and participate in life. Depression robs the individual of energy, self- confidence, and emotional range. It disrupts intimacy and isolates him/her from support systems and loved ones. It makes one unreliable in work, relationships, and life in general. Ever have a friend or a colleague just drop out of your life, or drop the ball on an assignment or a date? Ever know someone who continually gets sick and makes excuses at the last minute in order to avoid social situations or commitments? Often these are clues to an underlying depressive condition.

People suffering from depression often attempt to deal with their condition by “rallying”- making a willful effort to interact with others, to go to work, to get out of bed – the old “pull yourself up by the bootstraps” theory.  Or like my patient, they will attempt to appear “as if” they are managing just fine- only to collapse at home, or abuse a number of substances to self-medicate. This tactic might help in the short run, however, because depression is an illness which sets up house in your brain as well as your mind, such attempts are short lived and often leave the individual feeling worse, as if there is something inherently wrong with them for not being able to get on top of their “feelings” and fix it. The truth is, that dealing with depression alone is a very bad idea. It only leads to disappointment with oneself, self-reproach, isolation and a spiraling into further darkness and despair.

Depression cannot be fought alone. Its successful treatment requires a holistic approach, one that takes into consideration all of the life facets of the individual involved and helps to lead him/her back from isolative darkness to an interactive life. The treatment of depression requires using every resource available. Starting with one’s support system- friends and loved ones, psychotherapy, physical exercise, diet, meditation, and if necessary, a medication evaluation.

“I suppose you also don’t believe in the concept of a high functioning alcoholic?” this time she smiles openly. My patient understands that when you are battling an illness, any illness, your functioning is compromised. Regardless of how strong, smart, articulate and capable you are, depression is an illness which disrupts and threatens every aspect of your being. The good news is: there is help.

{ 7 comments… read them below or add one }

Donna October 29, 2012 at 3:30 AM

I don’t get it…so I’m not depressed because I can hold down a job and fake upbeat social interaction?



Velleda C. Ceccoli Ph.D. October 29, 2012 at 9:06 AM

Depression is an illness that impairs cognitive, social and emotional functioning reducing an individual’s ability to interact in a meaningful way in his or her life. While one may be able to “hold” down a job and “fake” upbeat conversation usually this means that one is trying to get on and soldier through, while remaining distressed. In fact having to “fake” anything in one’s life, is often a sign that something is amiss.


Anita June 22, 2012 at 6:39 AM

Thank you so much for writing this, i have been ‘functioning’ on auto pilot for a few years now and have almost convinced myself that it is my environment that is the problem (i’m single and poor etc). But reading this has made me realise that I am the one who has dropped out from society and is scared to try anything. I have suffered from depression a few times before and I really thought that this time i was keeping it away and coping because i wasn’t thinking about killing myself all the time and instead was accepting my fate. If only the drugs didn’t make me feel weird i would probably have gone to the doctors earlier. thanks again….i am phoning my doctor right now i promise…i think its about time.


Anne August 4, 2010 at 9:52 AM

You give a thorough and very accurate description of depression, both physically and psychologically. I know how it feels. I agree that going it alone is a bad idea. Fortunately, when I used the resources available to me…friends, psychotherapy, medication and prayer, it really seemed to help. I also realize it’s important not to “sit” in the depression. I try to figure out what’s going on and not let it take me over. Very compassionate piece!


Erika July 27, 2010 at 8:01 AM

Love to know what the holistic approach means, what our options are and how do I know if I’m depressed or just in a crummy mood?
Information is great, need more specifics please!!!
Love it!!!


Velleda C. Ceccoli Ph.D. August 2, 2010 at 11:31 AM

Right you are! Information is important. What I mean by holistic is an approach that takes both mind and body into account, and looks at the individuals’ lifestyle and choices, as well as his/her relationships. It is an approach that addresses the whole person.
As for feeling crummy- entirely normal when it is related to a situational event or stressor and happens once in a while, but if you find yourself feeling crummy most of the time…something else is up and should be attended to. Even if it is not depression, “crummy” all the time is not ok.


Zoe July 23, 2010 at 6:24 AM

I think this speaks of such truth that is often overlooked, I really agree with the holistic treatment approach and think this article conveys a lot of reality as well as hope. Very thought provoking reading!


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