Treating High-Functioning Depression

High-Functioning Depression: When No One Knows You’re Struggling

On the surface, everything looks fine. You keep your commitments, meet deadlines, smile through conversations, force yourself to attend social events. But behind the façade, life feels empty and thoroughly exhausting. You may have even accepted, with a heavy heart, that this is just how you are.

This quiet struggle is often called high-functioning depression. It’s not a medical term, but it’s used to describe a form of persistent, low-grade depression that can quietly undermine your quality of life even as you appear to be managing just fine on the outside.

At Keta Medical Center, we see this more than you might expect. Many of our patients are people who’ve been “holding it together” for years, even as their internal distress grows harder to ignore. If that sounds familiar, we want you to know: your feelings are valid, and it doesn’t have to be this way.

As one of our patients described, “I had it all – a loving wife, two fantastic sons, a nice home in the ‘burbs, personal and professional respect from my peers, employees, partners, even the Judiciary – but I was miserable ALL the time.” Read his full story here.

 

What is High-Functioning Depression?

Everyone experiences depression and anxiety differently. Some people become unable to work, socialize, or even get out of bed. Others continue to function on the surface but pay a steep emotional and physical price behind the scenes.

Unlike major depressive disorder, which can bring life to a standstill, high-functioning depression allows you to keep moving through your responsibilities. However, it drains your sense of purpose and joy. This type of depression is often associated with what’s called persistent depressive disorder, or dysthymia.

 

Signs you might be struggling include:

• Constant fatigue, no matter how much you rest
• Overworking or overachieving to avoid difficult emotions
• Feeling detached from your life, like you’re just going through the motions
• Irritability, perfectionism, or relentless self-criticism
• Trouble sleeping or waking already exhausted
• A vague sense of unease you can’t quite name

The term high-functioning depression captures the experience of living with depressive symptoms that don’t completely derail you but never really let up either. One reason it can be so frustrating is that it often lacks a clear trigger. People with high-functioning depression tend to internalize emotions, mask their struggles, and keep pushing through. And all of it makes the feeling of being drained and isolated even more overpowering.

 

Why Does it Happen?

There’s no single cause of high-functioning depression and anxiety. Instead, it’s often shaped by a mix of personal history, personality traits, and life circumstances.

Common contributing factors include:

• Perfectionism and pressure: Holding yourself to impossible standards and feeling like nothing you do is enough.
• Emotional suppression: Learning early on to hide your struggles and always be the “strong one.”
• Chronic stress and fatigue: Years of unprocessed emotions and unrelenting responsibilities can leave you feeling disconnected and drained.

It’s a pattern that can persist for years if unaddressed — but it doesn’t have to.

 

A New Approach to Feeling Better

Traditional treatments for depression, such as talk therapy and antidepressants, can help many people. But research shows that about 30% of people with depression continue to struggle despite trying standard medications or psychotherapy. For those with persistent or treatment-resistant symptoms, finding relief may seem impossible. That’s where newer options like ketamine therapy come in.

Ketamine works differently from standard antidepressants. Unlike traditional antidepressants, it targets glutamate, a neurotransmitter critical for forming new neural connections. By enhancing neuroplasticity, ketamine can help the brain “reset” patterns of negative thinking and improve mood regulation.

At Keta Medical Center, we offer both IV ketamine infusions and Spravato nasal spray (esketamine) as part of personalized care plans. Multiple clinical studies have proven that Spravato can help maintain remission for up to 5 years. For those who’ve been powering through for years, the possibility of fast, meaningful relief can be life-changing.

 

You Deserve to Live a Fulfilled Life

High-functioning depression can make you feel like you’re living in a bell jar, as the famous writer Sylvia Plath described it: Doing what’s expected, but never really connecting to it. You don’t have to accept that as your normal. If you’ve been quietly enduring these feelings for months or even years, we’re here to help you reconnect with yourself, rebuild emotional resilience, and feel more present in your own life.

Explore whether ketamine therapy or integrated care could be right for you.