High-Functioning Depression & Suicide Prevention

What is high-functioning depression?

The symptoms of depression can vary dramatically from one person to another. The symptoms of classic major depression include persistent sadness, insomnia, low appetite, loss of interest in everyday activities, anhedonia, and more.

While people with severe depression are often visibly suffering, in my experience, individuals with high-functioning depression often go unnoticed. Many people who are depressed still go to work, socialize with their friends, pay their bills, and lead seemingly normal lives. At the same time, they often harbor deep feelings of despair, loneliness, and thoughts of suicide.

What are the standard treatments?

The first-line treatment for depression is typically antidepressants. Antidepressants were developed based on the theory that people with depression have deficiencies in specific neurotransmitters related to mood. The idea is that if we regulate these neurotransmitters with medication, the depression would theoretically improve. This theory holds true for about 40% of people who take antidepressants. It's a common misconception that antidepressants work for most people. In reality, the percentage of individuals who experience full relief is low, while others achieve only partial relief or no relief at all from their depression.

What are the newer treatments?

Fortunately, newer and more effective treatments for depression are being developed. One treatment that’s been receiving a lot of attention lately is ketamine—and for good reason. Ketamine can provide rapid relief to those suffering from depression, much faster than any other medication. However, the downsides are that it is quite expensive, and there is still uncertainty about how long the antidepressant effects of ketamine last.

Dealing with hopelessness

If you’re interacting with someone who has high-functioning depression, chances are they have already sought treatment—and likely, a lot of it. Treatment failure is a significant risk factor for suicide. Individuals who have tried multiple treatments without success often become increasingly hopeless about their future and prognosis. This is especially concerning, as a pessimistic outlook on the future is already a hallmark symptom of depression. Poor response to treatment can easily worsen this, leading to a sense of learned helplessness.

How to get better

The most important step, whether you’re dealing with depression yourself or trying to help a loved one, is to talk. Talk about what’s happening. Many people suffering from depression live in isolation, keeping their pain to themselves. Talk about the difficult topics. Talk about suicide. Talk about your pain. I’d be willing to bet that most people have had these existential thoughts before: "Do I want to live?" or "How do I get through the pain in my life?" These thoughts are normal, but we tend to pathologize them.

And finally, most importantly, don’t give up hope. The field of mental health is evolving, and new treatments are on the way. Over the past decade, we've seen many new medications and therapies introduced, with more innovations on the horizon.