When “Having It All Together” Feels Heavy: Understanding High-Functioning Depression in High Achievers
You’re the one people turn to, the one who makes things happen, hits the deadline, shows up for others, and seems to have it all together to the outside world, even when your tank is empty. We know this scenario well, and while everything on the outside may look fine (maybe even enviable), your inner world may feel heavier than ever.
High-functioning depression (HFD) is described by the National Library of Medicine as “experiencing depressive symptoms such as fatigue, anhedonia, poor concentration, guilt, restlessness, sleep disturbances, and appetite changes without experiencing a lack of functioning or significant distress.”
Whether this hits home for you or you’re curious about how to support someone who’s struggling deeply but still managing to keep everything together, we’ll use this as an opportunity to continue an open conversation about depression and the many ways it may show up.
What is high-functioning depression, really?
Some may feel a heaviness they can’t shake, a numbness, a constant pressure, or a sense that life feels more like a performance than something you’re truly living. There is often this assumption that people experiencing depression are visibly sad, down, sluggish, or unmotivated.
In reality, depression can look many ways and take many forms. Many people are navigating inner challenges and finding work as an outlet to have a sense of normalcy, to distract from what they feel inside, or—for some–the only way they know how to push through a rough period.
“People use work, they use being busy to cope with their pain. So, they don’t process their pain…if you don't feel the feels, then you don't begin to heal. They are really not feeling what they are feeling. And instead, they use other things to distract…they just work, work, work, work work, and then they're depleted. “ - Dr. Judith Joseph on A Certain Age podcast
Though not officially listed in the DSM-5, High-Functioning Depression is a widely recognized experience. At its core, it’s a form of depression where someone maintains their responsibilities (like work, family, and obligations), yet internally feels persistently low, numb, irritable, or disconnected. Many don’t even realize they’re depressed because they’re still “doing the things.” And because culturally, we tend to associate depression with complete collapse, HFD often goes undetected.
Especially in high achievers, there’s a tendency to dismiss emotional pain unless it completely stops you in your tracks. But here’s the truth: you don’t have to fall apart to need or deserve support.
The impact of carrying the weight of depression alongside everything else
People who are ambitious, driven, deeply responsible, or even a bit of a perfectionist often develop patterns that can mask any distress going on inside. This happens especially when stressful life events or demanding daily responsibilities feel unavoidable.
Some ways this shows up:
Powering through pain instead of pausing
Feeling guilty for resting or needing help
Basing worth on achievements
Being the helper, but never asking for help
Seeing slowing down or pausing as failure
Feeling pride in “being able to” keep going
A common thought in these situations is, “It’s not that bad. I’m just tired. I should be grateful. Other people have it worse. Stop worrying about me.”
These beliefs, while well-meaning, can keep you stuck. Eventually, the weight of carrying it all can lead to burnout, where the body will start getting louder and eventually force you to stop.
Signs that it’s getting to be too much can include:
Constant fatigue or lack of energy that doesn’t go away with rest
Irritability or feeling easily overwhelmed by minor stressors
Difficulty concentrating or a persistent mental fog
Loss of interest in social activities, regular exercise, or any moment of mindfulness
Physical symptoms like headaches, chest tightness, chronic pain, or digestive issues
Trouble sleeping (either insomnia or oversleeping), and still feeling unrefreshed
Increased alcohol or substance use to cope or “take the edge off”
Persistent feelings of emptiness, numbness, disconnection or poor quality of life
Withdrawing from relationships or avoiding social contact altogether
Crying spells—or not being able to cry, even when you want to
Thoughts like “What’s the point?” or feeling like a burden to others
Flare-ups of chronic health conditions or a weakened immune system
Panic attacks, frequent anxiety, or a racing heart with no apparent cause
A constant pressure in your chest or body that doesn’t let up
Losing track of time or feeling like you’re in a fog, you can’t get out of
Passive or active thoughts of self-harm or not wanting to be here anymore
-> Preventing Burnout: Symptoms That Might Ask You to Slow Down
Going deeper: Where HFD can begin
High-Functioning Depression isn’t a default setting that all high achievers have. Still, there is a way that layered underlying factors may come out and manifest as HFD when things become challenging and the emotional load is higher.
What are the potential causes of high-functioning depression?
It’s often a layered mix of biological, psychological, and social factors:
Biological: Genetics, hormonal imbalances, or physical illnesses (like thyroid issues or chronic inflammation) can all play a role. Family history of depression or mental illness can also be considered.
-> Menopause and Mental Health: An Empowering Transition
Psychological: Traits like perfectionism, impostor syndrome, past trauma, or high self-criticism are common in those with HFD. Milder symptoms can develop and increase in severity the more they’re left without support.
Social: Cultural norms around success, systemic stress, chronic overwork, or lack of community support add to the burden.
In a post-pandemic world that feels both overstimulated and disconnected, more people than ever are silently managing internal battles while outwardly performing. It’s also important to recognize that certain types of depression can present as high-functioning, especially in people who feel pressure to keep performing no matter what.
Perinatal depression, premenstrual dysphoric disorder (PMDD), and seasonal affective disorder (SAD) are often minimized or misunderstood—yet many people experiencing them continue to meet obligations at work, home, or in parenting while internally struggling.
Think of the new parent showing up for everyone but themselves, or the woman who feels completely untethered during part of the month but pushes through anyway because life demands it. These forms of depression can be masked by resilience and responsibility, making it even harder to spot and treat.
Supporting yourself or others with high-functioning depression
One of the hardest things about finding the right support for high-functioning depression is how good you or those around you are at believing you’re okay, and it’s not that bad yet. Add to that the pressure of a packed schedule or caregiving responsibilities, and asking for help can feel foreign if not impossible.
Y’all we totally get it if you’re thinking, “ok yeah I would love to take a day off but there is absolutely no way to make that happen with everything on my plate, it’s not worth the time I’d lose.”
Before we discuss stopping, slowing, engaging in mediation and mindfulness, or doing less, let’s first discuss a few supportive steps that won’t disrupt your lifestyle or routine too much. These steps are all about doing the next best thing for your overall well-being and starting to step toward relief with an understanding of the experience you’re having.
If you’re looking to support someone else, you can also share some of these steps, but know that we’ll cover a few specific actions for you in the next section.
4 small steps to find relief without coming to a complete stop
1. Start where you are
This isn’t about making drastic changes. It’s about acknowledging what’s true for you right now.
Name it: You don’t have to shout “I’m struggling” from the rooftops, but even saying to yourself in a quiet moment or when you’re feeling particularly hard on yourself, “I think I might be struggling” can open the door to healing.
Be curious when judgement shows up. You don’t need a label or a diagnosis of major depression, and frankly these steps can apply even if you don’t have high-functioning depression. Remember that this is just about checking in to see where things have shifted past a point of tolerable emotional load, and bring some curiosity to any resistance you’re feeling to ask for help.
You might notice some resistance popping up or some judgement about your experience, which is a normal reaction when things feel a bit confusing inside. Remember you don’t have to make sense of it all, but rather bring the curiosity to see what’s showing up, such as:
“I’ve been feeling off lately, but I just don’t want to talk about it right now”
“I’m exhausted more than usual, and I’m afraid people are noticing and will judge me.”
“I feel disconnected even when I’m around people, and the last thing I want is to share what’s going on.”
Notice it: Once you’ve named it, you might start seeing more of the signs that you’re experiencing a level of high-functioning depression, and can use that as a guide to what you may really need. For example, if suddenly sleeping more than 4 hours a night feels foreign, you may simply notice that sleep quality is an area that can have a lot of potential to shift things, even if you’re not ready to make those changes now.
Whether these are passing thoughts, moments to reflect in a journal, or thoughts you express in the safe space of a mental health professional, the key here is to see if you can allow those small observations to be enough for now. Let’s not complicate things, and remove any pressure to explain or justify what comes up.
Take 5-minute action steps
If you notice any urge to release or shift your overall energy (whether in a tough moment or while reflecting), these action steps can be quick ways to do just that.
A five-minute walk outside
Taking a full-body breath before your next meeting.
Walking to the bathroom to feel the hot or cold water running over your hands.
Waking up to a gentle sound, song, or light-based alarm as a built-in moment of peace.
Listening to a song that makes you feel any emotion.
Letting out a cry in the shower, even if you don’t know what it’s about.
These micro-moments matter as you’re finding ways to reconnect to yourself.
Explore what level of support might feel ok to welcome in
We completely understand that there are barriers around asking for support, and it definitely doesn’t have to mean a whole therapy session right away.
First, it may be helpful to normalize the resistance we can feel around asking for help:
“I don’t want to burden anyone”: When you’re used to being the strong one, needing support can feel like a role reversal.
“What if they don’t understand?”: Vulnerability feels risky, especially if you’ve been misunderstood in the past or find it hard to relate to
“I should be able to handle this”: High-functioning depression often comes with self-imposed pressure to be endlessly capable, and it may feel like you’re letting yourself or others down by doing anything that doesn’t meet your usual standards.
“They’ll just make a big deal out of it”: Minimizing your experience is a common coping strategy, and based on your relationship to others, they can have significant reactions that spotlight your struggles.
"I'm worried about opening up Pandora's box:" It may feel scary to let someone in because what you’ve been holding in might come out and be overwhelming to navigate.
While all of these are valid thoughts, it’s also helpful to imagine that the weight you’re carrying would be just slightly lighter if you didn’t have to carry it all on your own. Let’s look at how you might lean into what feels safe and more comfortable for you.
As you feel ready, here are a few gentle ways to see what support can feel like:
Text a friend: “Hey, just wanted to say I appreciate you” to build a micro-connection and feel safe people near you even if you’re not ready to open up.
Thinking about someone not in your immediate circle or work environment to open up with, sharing what you’re comfortable with: “I’m noticing I’m not able to keep up as much, but it’s so hard to find ways to slow down.”
Listening to a podcast, following a therapist online, or seeking other ways of non-direct support to feel less alone on your commute can help build understanding.
If you’re ready to take the next step, therapy (in-person or virtual) can be a safe place to explore what’s going on behind the mask. Taking some of these small steps can help you experience that moment of releasing and feel validated.
Find the resilience in rest
Rest doesn’t always have to be sleep or stepping away from responsibilities (although that can be very helpful!). For now, what if you explored moments of rest throughout your day to slightly lighten the load and remind yourself that you’re acknowledging everything going on internally?
You might try:
Use the in-between moments (those tiny transitions between the things you must do) as mini rest stops, like shutting your laptop and not immediately standing up. Sit for one minute and stretch your neck.
Breathe at red lights while you’re driving, as just a pause to unclench your jaw, exhale, and soften your shoulders.
Drink water or tea with full attention for 30 seconds without your phone or multitasking. Just feel it hit your system. Let your body register that you’re being cared for, even briefly.
Permission to soften is where healing begins.
Managing HFD in a world that keeps moving
How to continue supporting yourself
If you do feel ready for more structured support, here are paths many people find helpful:
Therapy: Working with a trauma-informed or high-functioning-aware therapist can help you explore what's underneath the pressure.
Medication: For some, antidepressants or selective serotonin reuptake inhibitors are a tool, and conversations with medical professionals or a psychiatrist can help you to understand how they would impact your life.
Lifestyle adjustments: It’s not about perfection but returning to the basics. Explore ways to move your body, eat foods that stabilize your mood, sleep well, and reduce overstimulation when possible and realistically.
-> Find support with wellness coaching for body and mind.
Boundaries and pacing: Learn what enough looks like for you instead of measuring it by the world’s expectations. This can be a long process, but know that boundaries take time, and the more you practice them, the stronger they become to support you long-term.
How to support someone with high-functioning depression
When someone seems “fine” on the outside but something in your gut tells you otherwise, it can be hard to know how to help, especially if they’re the person who’s always helping everyone else. Here’s how to approach them with care, respect, and without adding pressure:
Lead with presence, not solutions
You don’t need the perfect words. Most people just want to feel seen and usually won’t want you to approach them differently or treat them like they’re suddenly fragile, when that can be a big reason many individuals won’t seek support.
This may sound like “I’ve noticed you’ve had a lot on your plate lately. I’m here if you ever want to talk—no pressure.”
What to avoid: Jumping in with fixes or advice right away. Focus on connection before correction.
Offer curiosity, not concern
Sometimes, direct concern can feel overwhelming or shaming to someone. Curiosity is softer and less invasive, allowing the individual to share what they feel comfortable with and safe, which can open them up further instead of shutting you out.
This may sound like: “How have you been feeling with everything going on lately?”
“You’ve been carrying so much—how are you holding up?”
What to avoid: Sharing what you’ve researched about depression, telling them the severe symptoms you’ve seen, or jumping to how this impacted someone else and what they did to help.
This gives them permission to open up without feeling like they’re being diagnosed or cornered, and express what they need individually, despite what commonly works for others.
Validate their strengths while naming the weight
High-functioning individuals often minimize their pain because they still function. It helps to reflect what you’re seeing without labeling gently. Sometimes, being praised is a more comfortable place than feeling like people are noticing them as any form of inadequate.
This might sound like: “You do so much for everyone, and it seems like you rarely get a break. That has to be a lot.” or “You’re so thoughtful all the time, and I see how much you’re doing right now. I’ve had moments where I felt like I needed a break. If there’s ever a way I can return that thoughtfulness to you, always let me know.”
Let them know that struggling doesn’t cancel out how capable or strong they are, while opening a moment for them to ask for help from a place of strength rather than weakness. And remember, if they don’t respond to that opening, it’s important to respect that they’re not at a place to talk about it just yet, but they will know you’re there if they become ready.
Extend support in concrete, non-intimidating ways
Instead of a vague “let me know if you need anything,” you might want to offer something tangible and low-pressure for this individual to grab onto. Small moments of support can be less intimidating to accept for someone who’s trying to do it all, but make a big difference.
This might sound like: “I’m grabbing coffee this week—can I bring you one too?”
“Want to go on a walk? I could use some fresh air, I’m feeling some low energy”
These gestures build trust and could open the door to deeper conversations. They also showcase that this person has value even when they’re not “doing”, and normalizes stepping out of work mode for a bit.
Respect their boundaries—and stay consistent
If they brush you off, don’t take it personally. Often, people with HFD have learned to protect themselves by downplaying their needs.
Most of the time, you don’t need to say anything. A trusted and safe presence is a felt sense in healthy relationships, which you can create simply by being consistent and present with this person so they know they’re cared for as they work through what’s happening internally.
It’s common for your friends or co-workers to enter into therapy or seek support but never share that, making it essential not to assume that if they’re not sharing with you, that they’re not ok. Healing is complex and as long as people know they have many outlets for help when things hit a breaking point, they can choose when and how they’re ready to seek it.
You don’t have to wait until you break
You don’t need to wait until everything falls apart to start healing, and you don’t need to know if it’s high-functioning depression or not to want to see things shift. Even amid a busy life, you can always find ways to make more space for yourself.
You deserve more than just survival. You deserve to feel like yourself again. We’re always here to support you in any way you may be ready to explore, whether therapy, coaching, or just talking to someone to see what options are available without commitment.
FAQ: Experiencing high-functioning depression
What is high-functioning depression?
High-functioning depression refers to a form of depression where someone continues to meet external responsibilities, like work, caregiving, or social obligations, while internally experiencing persistent symptoms of depression. It's not an official clinical diagnosis, but it describes the experience of people who appear “fine” on the outside, yet feel emotionally exhausted, disconnected, or chronically low beneath the surface. This kind of depression can be hard to recognize because it hides behind achievement, productivity, or caretaking.
How can you tell if someone has high-functioning depression?
It’s not always obvious. But here are a few subtle clues:
They seem fine, but you can tell their energy feels off or “dimmed.”
They avoid rest or downplay how tired they are
They joke about burning out or being “dead inside,” even while achieving
They support everyone else but deflect when you ask how they’re doing
Their spark, creativity, or emotional availability seems dulled
They may seem more irritable, avoidant, or withdrawn without explanation
If you notice someone powering through without pause or losing their usual light, it’s okay to gently check in, even if they haven’t asked for help.
What happens when high-functioning depression co-occurs with substance abuse?
When high-functioning depression overlaps with substance use—whether it’s alcohol, stimulants, or other substances—it can make the symptoms more challenging to detect and more dangerous over time. People may use substances to cope with emotional pain, numb out, or keep functioning at a high level. This can create a hidden cycle:
Emotional pain → pressure to keep functioning → increased substance use to cope → more emotional dysregulation and isolation.
Because the person is still “performing,” the risks can be minimized or overlooked until they hit a point of crisis, exhaustion, or health decline. Addressing both the emotional root and the coping behaviors is key to healing.
Substance use disorders should always be talked about with a medical professional, a healthcare provider, or other forms of addiction support through inpatient or outpatient therapy to find the best healing path and period of time in which treatment may occur.
