This article deals with the topic of depression and suicide. Reader discretion is advised.
If you are suffering from serious emotional strain or suicidal thoughts, don’t hesitate to seek professional help. You can find information on where to find such help, no matter where you live in this world, at this website:Â https://befrienders.org/
It’s Sunday morning, sometime between 5 and 6, when I suddenly jolt awake. Instantly, a thousand unfinished tasks crowd my mind. I jump out of bed and start moving. It has been this way for years.
I take care of the laundry and the dog and make breakfast. I exercise while thinking about the coming week and how exhausting it will be. I’m tired. I’m always tired.
Shortly afterward, my son tells me that he has lost his bank card. It’s not a major issue, really, but something inside of me gives way and suddenly I’m crying, telling my husband that I’m done with this life. “Can you take care of my child when I’m no longer around?”
My sudden breakdown was triggered by something so small and banal it scares me.
Depression and drive
Two years ago, I was diagnosed with depression. I go to therapy once a week. For a long time, I thought that was enough. After all, I was always able to go to work and take care of my family and our home, even socialize.
Now I am in a day clinic, surrounded by people suffering from depression for whom simple tasks such as doing the dishes requires an enormous amount of effort. Some don’t even have the energy to get out of bed. For many of them, going to work, or doing sport, is simply out of the question.
It’s the opposite for me. The worse I feel, the faster I move, rushing through everyday life. I’ve heard of the non-clinical term “high-functioning depression,” describing those who experience depressive symptoms yet retain their drive. From the outside, those who are affected appear efficient and productive. This describes how my life feels to me: a highly efficient nightmare.
Not an official diagnosis
High-functioning depression is not an official diagnosis in the International Classification of Diseases (ICD‑10). It is therefore not a mental health diagnosis that psychiatrists or psychologists can make.
“I don’t think much of the term ‘high-functioning depression,” said Ulrich Hegerl, a psychiatrist who chairs the board of the German Depression Aid and Suicide Prevention Foundation. “It’s a faddish term that keeps cropping up.”
Hegerl said the fact that some individuals remain driven despite suffering from depression could be attributed to their personalities. “Even when they are well, people who suffer from depression tend to be the ones who are there for others — committed, responsible, unwilling to disappoint and determined to keep going until their very last ounce of strength,” he said.
But, at home, Hegerl said, these types of people fall into bed completely exhausted, their energy depleted.
“A feeling of exhaustion, constant inner tension, feelings of guilt, appetite disorders, sleep disorders, a tendency to worry — these are all typical signs of depression found in people with ‘high-functioning depression,’ just like everyone else,” Hegerl said.
Daniel Huys, a specialist in psychiatry and psychotherapy and head physician at LVR Clinic in Bonn, doesn’t use the term either. Instead, he said, his clinic diagnoses the severity of depression, classifying it as either mild, moderate or severe.
“High-functioning depression isn’t in the ICD-10,” Huys said. “But that doesn’t mean it doesn’t exist.” He said, however, that the patients he has encountered tend to be people who can no longer meet the demands of everyday life and are falling apart.
Depression hidden behind success
That’s precisely the problem. “I think the biggest misconception is that just because that person appears outwardly successful or productive or whatever it might be, that their suffering is typically minimized because of those things,” said Adrianne McCullars, a psychologist at Rogers Behavioral Health, a network of clinics for the treatment of mental illnesses in Tampa, Florida.
She said the term “high-functioning depression” could help make this form of depression easier to recognize. Many people think: As long as I can still get up and get things done, it can’t be that bad. But that is dangerous — depression is the most common factor in suicides in Germany and many other countries.
McCullars also contradicted the assumption that high-functioning depression is a milder form of the illness. “A lot of individuals do in fact become more driven or even over productive when they’re feeling those depressive symptoms as a way to cope or avoid,” she said.
Performance becomes a coping strategy
I experienced this myself. I thought: If I just get everything done quickly, the to-do list will get shorter and I won’t feel so overwhelmed. If I keep moving, the exhaustion won’t hit me until evening, when I can finally go to sleep. If I get enough done, I can keep the nagging guilt I constantly feel at bay — toward my family, my colleagues, my friends.
This efficiency and achievement, highly praised by society, can be a distraction, said Daniel Wagner, a psychotherapist with his own practice in Cologne.
When the profound suffering of depression is hidden behind performance and success, it’s often to avoid silence and quiet, “in which a state becomes apparent that is difficult to bear,” Wagner said.
Mindfulness as a strategy for depression
In therapy, Wagner said, the goal is for patients “to get in touch with their feelings, to enable access to emotions, and to allow for regeneration.” Mindfulness exercises are good for precisely this — the psychotherapist calls it “organized hanging out.”
This can include breathing exercises or guided meditations, in which the aim is not to change anything, but simply to be present and observe. Wagner said he integrates such periods of regeneration into his patients’ daily routines in a structured way.
The psychologists at the clinic proceeded similarly. I received a weekly plan to help me structure each day: work, housework, exercise and things that I enjoy and that are good for me. For me, the last point is still the biggest problem and the most painful issue.
In the quiet, my mind gets louder, the feelings more unpleasant. I desperately want to run away again, to shirk the responsibility of dealing with myself. That means: stopping, enduring, doing nothing.
This article was originally written in German.
