Suffering in silence with high-functioning depression | The Excerpt

On a special episode (first released on May 16) of The Excerpt podcast: Many people have some experience with depression. Often the condition goes away, but what if it doesn't? What if it's something you just learn to live with? With a term like ‘high-functioning’ attached to it, it may, by its very nature, be difficult to diagnose. So what is high-functioning depression and what can be done for the people who are suffering with it? Vale Wright, the senior director of Health Care Innovation at the American Psychological Association, joins The Excerpt to help answer these questions.

Hit play on the player below to hear the podcast and follow along with the transcript beneath it. This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.

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Dana Taylor:

Hello and welcome to The Excerpt. I'm Dana Taylor. When a disorder or condition has a term like high functioning attached to it, that could mean it may, by its very nature, be difficult to diagnose at all. Many of us have some experience with depression, but what if it just didn't go away? And worse, no one could tell that's why we weren't acting like our regular selves. So what is high functioning depression and what can be done for the people who are suffering with it? To answer these questions, I'm joined by Vaile Wright, the Senior Director of Healthcare Innovation at the American Psychological Association. Thanks for joining us, Vaile.

Vaile Wright:

Thanks so much for having me.

Dana Taylor:

First, what is high functioning depression?

Vaile Wright:

High functioning depression, it's not an official clinical term. I think that's important for people to know. It really was coined and popularized on social media to represent a certain presentation of depression. And that presentation is somebody who seemingly seems like they have it all together on the outside. They can go to work, they have relationships, they look like they're really engaging in life, but internally they're suffering in a way that others really just can't see.

Dana Taylor:

And how does high functioning depression differ from other kinds of depression?

Vaile Wright:

It's not necessarily that it differs from other kinds of depression. I think what a potential benefit of this term is, is it helps people understand that depression is not a one size fits all. People can be presenting with depression with a variety of different mild or more moderate symptoms. Some people will experience sadness, whereas others experience no sadness at all. So there isn't a typical type, but we have a mental model about what we think depression looks like, and this kind of breaks that mental model a little bit.

Dana Taylor:

What are some of the other conditions that can show up alongside high functioning depression? I want to know, in particular, is anxiety in the mix.

Vaile Wright:

Absolutely. There's a lot of comorbid relationship, or what we mean by that is they go together, anxiety and depression, and they share a lot of the same symptoms. So it can be really hard to decide, which is it. You can have trouble concentrating with both anxiety or depression, difficulty sleeping, difficulty eating or maintaining your appetite. So a lot of overlap exists, but at the end of the day, individuals experiencing these symptoms, it interferes with their life and it often interferes with the lives of people in their homes and in their schools and in their workplaces. So it affects everybody.

Dana Taylor:

What are some of the telltale signs that a person is struggling with this condition?

Vaile Wright:

I think when somebody feels like they're not themselves over an extended period of time, so anybody can feel sadness or just like you're just not into it and you're just not excited about the things you used to be excited about, but when that persists and when it either starts to interfere in your life some way or others start to get worried about you and notice that something's not how it usually is, that's when we know that something's really going on that might need some help.

Dana Taylor:

And what about masking?

Vaile Wright:

I think there's so much stigma attached with mental health, less now maybe than 10 years ago. I think social media and celebrities coming out and being more open about their mental health has really helped. But there's still this sense of we all have to have it together all the time, or even worse that even if I'm feeling sad, I have it better than you do and so I'm not allowed to feel sad. I shouldn't even tell you I'm sad because I have so many other things going on in my life. And that's so isolating and that just perpetuates the problem.

Dana Taylor:

Vaile, other than that, what are some of the barriers that people face in acknowledging their depression and getting help?

Vaile Wright:

There's so much sense that this is just all on your head, and if you just sort of pick yourself up by your bootstraps and you just go to work or do what you like to do or just go out and have fun, that somehow it'll all get better. And that's not the reality. For a lot of people depression is mild and situational and it might go away. For others, it's a lifelong condition that may have periods of wellness and then have periods of debilitation again. And so, again, I think it's often a lack of understanding of how to access care and when you need it, as well as just clear systemic issues within our healthcare for actually getting the care that we need.

Dana Taylor:

And then offering people some help. How is it currently being treated medically? And also is talk therapy an effective treatment here?

Vaile Wright:

Talk therapy is an incredibly effective treatment for all types of depression, particularly mild and moderate forms of depression. Other often avenues for treatment include medication, but what we do know is that when people get treated early on in what's going on, they're more likely to get better quicker. And so that early recognition and then that sort of ability to say or find somebody to help you find the help you need is going to be what is most effective in the long run. It just depends a little bit on what people's preferences are, what their opportunities are, what kinds of depression and symptoms they're experiencing, and that's why working with a trained professional is really critical.

Dana Taylor:

And are there any specific scientific advances that you're looking at right now that people should be watching out for in terms of treating depression?

Vaile Wright:

Certainly there's been a lot of talk about the use of psychedelics and other types of treatments and innovations in that area. I think the research is still awfully early to know exactly what impacts it will have. There's also clearly, I think, a role for technology to be played in how we reach people where there are. How do we get people in their homes, how do we reach them on their phones, which they're off and on anyway. But by delivering actually evidence-based, clinically validated treatments to them, not just an app that you can get off the app store, which may be helpful but likely isn't going to really treat your depression. So I think there's lots of ways that we need to be thinking innovatively because we just can't hope that everyone's going to come into the clinical office and get the treatment that they need. We need to be thinking beyond that.

Dana Taylor:

Okay. So what does a successful path to recovery look like here? Without sharing any identifying information? Can you share a real world example?

Vaile Wright:

It's going to look different depending on what it is that your depression is being caused by, because we know there's a lot of causes. It can be psychological, it can be environmental, it could be biological. But if you are going to receive treatment from a trained behavioral health provider, it's going to start with an intake and some history taking and then a shared decision-making about what type of treatment makes the most sense for that individual. Often we're talking about kind of weekly treatments for maybe six to eight weeks. And over that period of time, you're working with your provider to monitor your symptoms and see if you're getting better. And then ideally, you would end treatment after that phase when you've hit this place of recovery, recognizing that at any point in time you might need a booster going forward, and that's perfectly normal. And that's the kind of discussion you might have with your provider.

Dana Taylor:

Well, depression can be a lonely place for people. What's your recommendation for a patient who is looking for support from the people in their lives?

Vaile Wright:

Well, one of the things to keep in mind is that if you're feeling depressed, you're likely not alone. We know that annually, 17 million Americans will experience a depressive episode. So I think even though there's so much stigma and this fear of reaching out, when we do it can be so incredibly validating. You can find somebody who has experienced what you've experienced and can really understand where you're coming from or have engaged in coping skills that have worked for them that they can share with you. We also know that just having that social connection is a huge buffer for stress. So even though it can be hard to do, reaching out to others, and even more importantly, if you're that friend who's noticing something about your friend that you think is off, take that time, take that onus to do the reaching out yourself because sometimes they just don't have it in them right now.

Dana Taylor:

Vaile, how would you say high-functioning depression and the conversation around it is impacting our society at large?

Vaile Wright:

I think it's increasing our health literacy, in particular our mental health literacy. And it's shining a light on the fact that even though we think depression looks one way typically, that it's a woman who is crying and can't get out of bed. And that is one way that depression manifests itself, it's not the only way. And that different groups may experiencing different symptoms, and again, that somebody might have it looking like they have it all put together on the outside, but internally you don't really know what's going on with them. And so I think it helps to ask the question of, am I reaching out enough? Am I asking the people in my lives how they're doing?

Dana Taylor:

Then finally, what do people most need to know about those with high functioning depression and how to best support them?

Vaile Wright:

I think what's most important is to make sure you're not unintentionally invalidating their experience, because when somebody has it all put together or it looks like they do on the outside, it can be easy to say really unhelpful things like, I don't know why you're depressed, you have a job, or you're married, or you have these great kids. And really that's not taking compassionate routes understanding what they're going through. And so just even asking that question, I'd love to know what you're going through. I can see that you're in pain. Please, let's have a conversation. Just opening that door. You don't have to solve their depression, but just letting them know that you're there and that you hear them and you see them, that's a critical way to validate their experience.

Dana Taylor:

This is great information. Thank you so much for being on The Excerpt Vaile.

Vaile Wright:

Thanks for having me.

Dana Taylor:

Thanks to our senior producers, Shannon Rae Green and Bradley Glanzrock for their production assistance. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to podcast@usatoday.com. Thanks for listening. I'm Dana Taylor. Taylor Wilson will be back tomorrow morning with another episode of The Excerpt.

This article originally appeared on USA TODAY: Suffering in silence with high-functioning depression | The Excerpt