High-Functioning Depression and Substance Use Disorder

Updated on 09/12/23

Content reviewed by Karen Rubenstein, LMFT, Chief Clinical Officer at Cliffside Malibu

It may seem easy to spot the signs of depression in one’s self and others, but that is not always the case. A person struggling with depression is often assumed to appear lethargic and barely able to accomplish day-to-day functions. While depression looks different for everyone, people with high-functioning depression are better at suppressing and concealing their symptoms.

One of the most common reasons people use substances is to help cope with symptoms of other illnesses. For this reason, high-functioning depression and substance use disorders are one of the most common dual diagnoses.

What Is High-Functioning Depression?

Persistent depressive disorder, or dysthymia, is a form of high-functioning depression that is chronic and persistent over a long period of time. It is diagnosed more commonly in women but can occur in men. High-functioning depression is also common in the United States, affecting nearly three million people annually.

In order for a person to be diagnosed with high-functioning depression, symptoms of depressive episodes must occur, which include:

  • Loss of interest in activities and hobbies that were once enjoyable
  • Mood swings
  • Lethargy
  • Anhedonia
  • Sleep difficulties, insomnia or hypersomnia
  • Changes in appetite
  • Feelings of hopelessness, sadness or despair
  • Poor hygiene
  • Anxiety

What Makes Someone High-Functioning?

To be “high-functioning” means that a person experiences the symptoms of depression but may present themselves as happy, friendly and organized. However, these people suffer from depression and have learned to conceal it when around other people. Unlike other forms of depression, individuals may be able to get themselves out of bed even when they don’t want to. They still show up for daily responsibilities, including school or work, and operate as if everything is normal. When at home or alone, symptoms present and worsen again.

Everyone’s experience with dysthymia is different. For example, some people with dysthymia can live a relatively normal day-to-day life, and dysthymia may resolve on its own. However,  symptoms can worsen over time and lead to a more serious form of depression for some people. With the worsening of symptoms, other conditions such as substance use disorder can arise.

Co-occurring Conditions: High-Functioning Depression and SUD

Mental health disorders rarely occur independently. The existence of more than one mental health disorder is known as having co-occurring conditions, also referred to as a dual diagnosis or comorbidity. Clinicians use these diagnoses when their patient has both a mental health disorder and a substance use disorder that occur simultaneously. People who have a mental health disorder have increased chances of developing a substance use disorder than those who don’t. The most common drugs misused by people with a mental health disorder are:

  • Marijuana
  • Prescription drugs
  • Opioids
  • Tobacco
  • Stimulants
  • Alcohol
  • Hallucinogens, also known as psychedelics

Substance use often begins as an attempt to mask pain or cope with uncomfortable feelings or trauma. Self-medication through substance use is extremely common in people with depression. Because people with dysthymia are trying to mask their symptoms, substance use begins as a form of self-medication. Over time, it can grow to full addiction as symptoms worsen, or the person may develop a dependency on substances to help them function throughout the day.

Diagnosing Persistent Depressive Disorder

To be diagnosed with persistent depressive disorder, a person must show symptoms of depression that severely impact their ability to function and complete daily tasks. It may be difficult to diagnose a person with high-functioning depression because they can hide and suppress depressive symptoms in public. It may even be challenging for someone to recognize these symptoms in their own patterns and behavior because of how well they are able to push themselves to function. However, seeking help is still imperative with high-functioning depression. Speaking to a mental health professional helps uncover the warning signs that may have been missed in both persistent depressive disorder and substance use disorder.

Attempting to treat depression and addiction without professional help is never recommended, especially through any form of self-medication. A mental health professional can perform an extensive and comprehensive psychological assessment for a proper diagnosis and treatment plan.

If diagnosed with persistent depressive disorder and coinciding substance use disorder, finding an addiction treatment center that treats co-occurring disorders is critical to recovery. The first course of action in treatment may be ridding the body of toxic chemicals from substance use, a process called detox. Once the addiction is under control, the treatment center will address depression through different forms of therapy or medication. Sometimes, depressive symptoms may resolve on their own once the underlying addiction is treated.

At Cliffside Malibu, an extensive intake process upon arrival allows the team to gather as much information on their patients as possible. Cliffside Malibu is open to anyone in need of a professional, safe and supportive addiction and mental health treatment facility. If you or a loved one struggles with mental health and substance use, the time to seek help is now. Take the necessary first step towards healing today by calling Cliffside Malibu at (855) 403-5641.

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