‘High-functioning’ depression list sparking debate
Mental health counselor Jeffrey Meltzer sees clients nearly every day who suffer from “high-functioning” depression, so he decided to post a video about it on TikTok. He struck a nerve. The video has more than 8 million views and more than 5,000 comments. “This describes me to a tee,” one wrote.
“Does it go away at some point?” another replied.
“Can someone tell me how to fix it?” wrote a third.
Meltzer, who meets with clients in Bradenton, Fla., said it’s not always obvious if someone has depression. “There’s a myth” that somebody with depression can barely get out of bed in the morning, he said. “They can function, they can go to work, they can do all these things. But deep inside, they’re feeling really down, they’re feeling quite empty or lonely.”
The response to Meltzer’s video is “a huge signal about unmet mental health need,” said Jon Rottenberg, a psychology professor at the University of South Florida who has studied the course and prognosis of depression.
The term high-functioning depression “is really resonating with the fact that depression can be quite hidden,” Rottenberg said. “People can harbor it for a long time before they get help.”
High-functioning depression is not a diagnosis or a recognized clinical disorder, and it doesn’t appear in the Diagnostic and Statistical Manual of Mental Disorders, the authoritative guide to mental health disorders.
Exactly where the term started isn’t clear, but “high-functioning depression” is a popular topic on TikTok and YouTube that attracts millions of viewers. It gained traction on social media in 2022 after Cheslie Kryst, a former Miss USA, died by suicide. In statements to the media, Kryst’s mother said her daughter was dealing with high-functioning depression, “which she hid from everyone.”
Some health professionals say the term can be misleading and may stem from a lack of understanding about different mental health disorders. But other therapists and mental health experts say the term has helped people realize that depression isn’t always obvious. It can help people think of depression in ways that “may be different” from the stereotypical symptoms people associate with the disorder, said Vaile Wright, a psychologist and senior director of health care innovation for the American Psychological Association. “There is no one-size-fits-all depression,” Wright said. “In children and adolescents, it looks much more like irritability. Same with men; it looks a lot more like anger and substance abuse.”
In the TikTok video, Meltzer offers seven signs he said may signal high-functioning depression. Other mental health experts say Meltzer’s video does identify many of the feelings that could be symptoms for depression.
“The doctors that I work with and others, even myself sometimes, can feel those things,” said Srijan Sen, a professor and the executive director of the University of Michigan’s Eisenberg Family Depression Center. “Highlighting that and making people know they’re not alone in feeling that is valuable.”
Depression is “a collection of symptoms” with some degree of sadness or melancholy, said the APA’s Wright. Sleeping too much or too little, an inability to concentrate, eating too much or too little, and “a sense of hopelessness” can all be signs of depression.