High Functioning Depression and Substance Use Disorder

High Functioning Depression and Substance Use Disorder

Table of Contents

Is High Functioning Depression Considered a Disability?

Depression can be considered a disability but not everyone who is diagnosed with depression is disabled. High functioning depression is unlikely to be deemed a disability.

The World Health Association, Americans with Disabilities Act, and the DSM-V, the standard psychiatric diagnostics journal in the world, recognize that depression can be disabling. However, it affects individuals differently. Depression rears its ugly head in many forms and affects its sufferers in different ways. The symptoms can be categorized as either mild, moderate, or severe. It is a severe form of depression that is considered disabling.

Arrow Passage Recovery will explore the link between high functioning depression and substance use disorders based on experience treating both as a dual diagnosis in addiction treatment.

Depression Defined by Its Effects

The main difference between severe depression and other forms is its effect on the sufferer. While all forms of depression cause symptoms such as persistent sadness, unexplained aches and pains, appetite changes, and excessive fatigue, severe depression forces people to give up on major life functions. Major life functions are tasks like working, sleeping, eating, and having meaningful relationships with others. Severe depression is also classified as a depression that is resistant to all available treatments tried thus far.

Mild to Moderate Depression as High Functioning

When sufferers are diagnosed with severe depression along with losing at least one major life skill, that’s when someone can be classified as clinically disabled.

The other two kinds of depression, mild and moderate, would be more likely to be classified by what is known as high functioning depression.

What is High Functioning Depression?

Functional Depression Defined

Defining what exactly is high functioning depression remains a matter of debate and current scholarly research. Currently, the DSM-V and most mental health professionals do not believe that high functioning depression is a diagnosis on its own because those afflicted with it often do not require drastic medical intervention compared with a more severe major depressive disorder (MDD).

Functioning While Torn Apart Inside

High functioning depression also does not meet most of the criteria for what has traditionally been considered depression.

Depression in its most basic form is characterized by intense periods of sadness that inhibit sufferers from carrying out their daily lives or even basic functions. High functioning depression turns this notion on its head since sufferers seem to carry on normal lives to those around them but on the inside are being torn apart.

A Normal Life?

It is for this reason, the ability to carry on a “normal” life, that many mental health professionals feel as though high functioning depression should not be a diagnosis at all since they feel as though it does not meet the level of depression. But just because the term “high functioning depression” is not a clinical diagnosis, medical health professionals do not discount that what these people are experiencing is not inhibitive and that they need help. Rather, they use a different term to describe it: persistent depressive disorder.

High Functioning Depression Symptoms

The medical community commonly attributes what people call high functioning depression as persistent depressive disorder or PDD. PDD is just like depression only less intense and longer in duration. To be diagnosed with PDD, sufferers must exhibit at least one of the symptoms of depression for a minimum of two years.1 The symptoms are the same ones associated with major depressive disorder with one major difference: the duration.

What Does Persistent Depressive Disorder Look Like?

The best way to describe PDD is like having a dull or aching pain every day. The pain is not enough to prevent a mostly normal life compared to those around them, but it is enough to make those diagnosed with it feel like they could be doing or accomplishing so much more without the nagging sadness. But those diagnosed with PDD can also have flare-ups or “bad days” where the symptoms they are experiencing become more intense than normal just like those with major depressive disorder.

Trudging Through Thick Mud

Those suffering from PDD and high functioning depression describe managing their symptoms as trudging through thick mud. The mud slows them down and is a constant reminder of where they are at in life. It slows them down and prevents their full potential. It also inhibits them from living a fulfilling life due to the constant stress and anxiety from their symptoms.

The Validation Problem

Making matters worse is that those who describe themselves as suffering from high functioning fepression do not feel validated by their friends, family, and co-workers. Often, how they feel inside does not match how society feels a depressed person should be acting. Because of this, getting treatment for this condition, such as those offered for PDD, is often delayed or never obtained which makes the current symptoms worse.

ADHD and Depression

The correlation between depression and ADHD is quite strong with decades of evidence backing up the fact that almost one-third of those diagnosed with ADHD will develop depression.2 Why that is has been attributed to several factors, but one of the most common theories is that ADHD helps cause depression in some patients. Between the two disorders, there are numerous similarities. Difficulty paying attention, struggling to form bonds with family and friends, and not being able to work are all symptoms of ADHD that can cause symptoms like stress, sadness, and hopelessness that lead to depression.

Treating ADHD vs Depression

Because of this interconnected nature, medical professionals commonly diagnose these two as coexisting conditions. That means it is entirely possible to have both at the same time. Traditional treatments for depression and ADHD do differ in several key areas though. For one, ADHD is treated with amphetamine-based drugs while depression is treated with tricyclic antidepressants. These two drug classes have differing effects on the body with one being an inhibitor and the other being a stimulant.

Adderall for Depression

While studies have shown that amphetamines, such as Adderall, are highly effective in treating ADHD, they are less likely to be an effective treatment in cases of mild and moderate depression. However, using Adderall has been proven to be effective in treating depression where one of the major symptoms is fatigue. In a landmark 1999 study, over half of those clinically diagnosed with depression whose major symptoms included fatigue saw significant improvements.

Adderall and High Functioning Depression

What that means for those with high functioning depression or PDD remains less clear. Fatigue is one of the commonly described symptoms of those suffering from high functioning depression. Whether or not drugs like Adderall would also be effective for this group of people remains a subject of intense debate. The medical field remains conflicted over amphetamine use as a treatment for depression for even those with severe depression.

Alcohol and Depression

Alcohol has a direct correlation in risk between drinking and developing high functioning depression.3 Years of clinical research have found that alcohol consumption is an independent risk factor in assessing whether or not someone will likely show high functioning depression symptoms. Simply put, those who drink are at a greater risk of developing high functioning depression and the statistics are shocking. On average, those that drink heavily are almost twice as likely to develop high functioning depression later in life than those who do not drink alcohol. Even those sufferers who drink less than an ounce of alcohol a week are still at an increased risk.

The Strong Connection Between Alcohol and High Functioning Depression

Why there is such a strong connection between alcohol consumption and risk factors for high functioning depression? It’s because of what alcohol and its aftereffects do to the body. Alcohol is a natural depressant and it inhibits a precursor chemical, tryptophan, which is necessary to release serotonin, which is the chemical in the brain that helps control mood. Drinking alcohol also amplifies post-drinking-related feelings such as guilt and anxiety, which increases the risk for depression. Lastly, drinking alcohol as a way to cope is a dangerous practice and is something that can be overcome in therapy.

Failure to Complete Therapy

Unfortunately, the majority of heavy drinkers fail to complete therapy for depressive disorders. While this area is still woefully understudied, the few studies done about the relationship of alcohol and depression have shown that with proper motivationally based interventions psychological treatment is more likely to be effective for drinking levels to go down.

High Functioning Depression Treatment

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a scientifically proven method to help address many underlying issues including physiological disorders like depression.4 CBT’s core principle is that every problem and feeling you have is somehow interconnected. A therapist will work with you to look at large problems in life and help you break them down into smaller pieces. By doing so, therapists can help you tackle barriers to your goals into manageable, actionable, and directed exercises.

CBT helps change the way to frame the core issues causing depression. It is also one of the most scientifically supported, non-medicinal courses of treatment for those suffering from depression. Therefore, it has become a popular alternative to purely medicinal approaches and has shown great results especially in those with severe depression who have not responded to other treatment options.

CBT for High Functioning Depression

Those suffering from high functioning depression pose to be one of the biggest beneficiaries of this treatment. Because the issues behind depression are often complex, those with high functioning depression fit well into the model of breaking down problems into manageable tasks that boost confidence and have measured results.

The Limits of CBT

Despite all of the benefits of CBT, there are some negative aspects. CBT by its inherent nature can only address issues that one has control over. Issues such as traumatic experiences are things that cannot be changed. CBT also relies heavily on individual input. If a patient does not want to do the work, then the treatment is meaningless. Those with high functioning depression would be more at risk for doing this due to the social stigma surrounding their disorder that might inhibit them from fully complying with treatment plans due to peer pressure and fear of opinions from friends and family.

Treating a Dual Diagnosis in Rehab

Dual diagnosis is the treating of mental illness, like high functioning depression, along with substance use disorders. Alcohol, and by extension drug abuse, have a direct impact on the risk of developing disorders like high functioning depression and completing treatment. Many rehab centers around the country have started addressing both health issues at the same time since studies have shown just how important it is to effective recovery.

Depression and substance abuse share many common factors and can cause one another. Both of these disorders affect similar parts of the brain and can be both caused by previous trauma. They are also developmental disorders meaning they usually start to form in a person’s teenage years or young adulthood then continue growing into adulthood.

Getting treatment at a rehab facility is best for people suffering from a dual diagnosis because of the intensive, structured nature of the care. Addressing only one of these disorders and not the other will statistically leads to relapse and a longer recovery, which is why it is so important to treat both concurrently.

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