The alarm goes off, and you sigh. Everything feels so heavy. You hit snooze, and again, and are still tired. Wearily you sigh again and get up. It feels like too much today to wash your hair. “I’m so lazy,” but you keep going. Driving to work, you can’t remember how you got there, every day seems like a monotonous blur. Friends text you, and you pretend you forgot to hit send. But really it’s too hard to say, I’m depressed. You don’t cry all the time, but just don’t find joy. You don’t want to hang out with friends, or it takes a huge push to do it.
We think of depression as crying all the time, spending all the days in bed, and wanting to die. While this is the picture of severe major depression, there are variances in the severity of depression. Many people with moderate depression can still push through life. High functioning depression may look like taking a lot more effort, there is less enjoyment, you get enough sleep, even more than usual, but always feel tired.
The typical depression screener that we do to look at these symptoms is called the Patient Health Questionnaire or PHQ-9 (Pfizer, 1999). It asks, in the last two weeks, how often have you been bothered by any of the following problems:
• Little interest or pleasure in doing things
• Felling down, depressed, or hopeless
• Trouble falling or staying asleep, or sleeping too much
• Feeling tired or having low energy
• Poor appetite or overeating
• Feeling bad about yourself- or that you are a failure or have let yourself or your family down
• Trouble concentrating on things, such as reading the newspaper or watching television
• Moving or speaking so slowly that other people could have noticed. Or the opposite- being so fidgety or restless that you have been moving around a lot more than usual
• Thoughts that you would be better or dead or hurting yourself
Major depression, dysthymia, and “high functioning depression” have similar medication treatments, but vary on dosing and aggressiveness of treatment based on the severity of symptoms. Some treatment options may include therapy, exercise, supplementation, and medications. Medications are chosen based on your presentation, family history, length of symptoms, concerns for particular side effects, and co-morbidities. Your clinician should work with your preferences. If you choose to take medication, the goal is not to feel numbed out or unlike yourself.
People with high-functioning depression still struggle with motivation, making phone calls, and attending appointments. It is hard enough getting to work and caring for the family. Telepsychiatry offers another alternative to get care. This practice allows for scheduling within a few days and taking visits from the comfort of your couch in jammies for when motivation is a struggle.