By A. Graham Sterling, PhD, licensed clinical psychologist and former U.S. Navy psychologist
BLUF: High-functioning depression is depression in someone who keeps showing up. They work, care for their families, and meet their responsibilities while struggling with symptoms others rarely see. Masking those symptoms can delay treatment and carry serious risks.
Depression does not always look like withdrawal or an inability to function. Some people continue to excel at work, raise children, and fulfill their obligations while feeling emotionally empty. Activities that once brought pleasure become chores. Ordinary responsibilities require more effort, and getting through the day comes at a cost.
Although high-functioning depression is not a formal diagnosis, it can occur in people with major depressive disorder or persistent depressive disorder. Their outward performance often makes their suffering difficult to recognize.
This creates a challenge for screening. Many assessments focus on impaired functioning, but these individuals work hard to maintain theirs. They may minimize their symptoms, leaving depression undetected.
Emerging research supports this pattern. Joseph and colleagues (2025) found that high-functioning depression was associated with greater anhedonia, or loss of pleasure, and more trauma history. Brown (2025) found that depression masking was associated with greater symptom severity, distress, fatigue, and internalized stigma. An editorial in BJPsych Bulletin (2026) highlighted the risks of delayed diagnosis and worsening depression.
In my clinical work, I see this frequently among veterans, first responders, and executives. Many have learned to remain composed and perform under pressure. That skill can make it difficult to recognize when they need help.
The important question is not whether they can still do their jobs. It is what it takes to keep doing them. How much energy does an ordinary day require? How long does recovery take? What have they stopped doing because they no longer have the energy or interest?
Often, the first things sacrificed are the activities that make life enjoyable. People give them up to preserve the responsibilities they feel they cannot abandon.
Being able to function is not the same as being well. A person can be successful, dependable, and deeply depressed at the same time. Looking beyond outward performance to assess pleasure, energy, emotional connection, and the effort required to get through the day can help identify depression and connect people with appropriate treatment.
Key Takeaways
High-functioning depression can involve significant symptoms despite preserved daily responsibilities.
Loss of pleasure may be more apparent than reduced productivity.
Masking can delay recognition and treatment.
Direct assessment and appropriate treatment can help people move beyond simply getting through the day.
A. Graham Sterling, PhD, is the founder of The Sterling Practice, providing individual therapy and adjunctive EMDR through secure telehealth across Massachusetts and Maine. His practice focuses on veterans, first responders, and high-functioning adults. A free 15-minute consultation is available at tspractice.com.
References
Joseph, J. F., et al. (2025). Understanding high-functioning depression in adults. Cureus, 17, e78891.
Brown, S. (2025). Camouflaging depression. Discover Psychology, 5, 71.
Okereke, P. U., et al. (2026). High-functioning depression: A hidden burden demanding clinical recognition. BJPsych Bulletin, 50(2), 111–113.
