What living with high-functioning depression is really like

How do we tackle high-functioning depression? Photo / Getty Images

It’s a term that resonates with a huge number of people struggling with their mental health. But what is it and how do we tackle it?

Nick Hussey was a thrusting young founder with a successful cycle-wear brand and a young family who, in his early forties, woke up every morning consumed by dread. “I would have to lock myself in the bathroom, blast out heavy metal from my phone and just slap myself repeatedly around the face,” he says. “I would be shouting at my own reflection: ‘Shape up! Do this!’ I had to force myself to be the person I needed to be that day.”

Like many other high achievers, Hussey’s successful image belied his inner pain. He was overstretched, emotionally avoidant and burying himself in work and exercise as a means of self-medication. “The business was thriving at the time my daughter was born,” he says. “But I have hardly any memories of her first year. I was completely detached. Every day, my hand would shake. I had constant brain fog. I couldn’t sleep properly and my mind was filled with self-criticism. I was depressed but wouldn’t allow myself to admit it.”

It’s a story that is becoming increasingly familiar. Earlier this month, US-based therapist Jeffrey Meltzer shared a video on TikTok and YouTube in which he described the state of “high functioning depression” that an increasing number of his patients are suffering from. The video quickly accumulated over eight million views and five thousand comments including “This describes me to a tee!” and “Can someone tell me how to fix it?” While “high functioning depression” is not a clinically recognised diagnosis, it has become a popular way of describing a set of symptoms that resonate with a generation of outwardly successful people who struggle with their mental health.

“There is a myth that depression always stops you from getting out of bed in the morning,” says Meltzer when I speak to him on the phone from his clinic in Bradenton, Florida. “But since I switched from a public to a private practise, I have begun to see numerous people with successful careers and loving families who get up every day, work hard and seem to hold it together. But inside, they are miserable and they don’t know why. This is made worse by a sense of guilt: they tell themselves that they are lucky and don’t deserve to be depressed. As a result, they keep it all hidden inside, compounding the problem further.”

So, is high-functioning depression just another term for old-fashioned burnout? No, says Selzer. “You can be busy and successful without getting depressed,” he explains. “High functioning depression is usually linked to people’s expectations of happiness not being met. So tackling it requires a shift in perspective.” I spoke to three high-flying men who all found that the trappings of success didn’t just fail to deliver fulfilment - but actively made them depressed.

The signs that their success had tipped into something more sinister chime with the seven Meltzer describes in his TikTok video: isolating from friends; no longer finding joy in activities you loved; persistently criticising yourself; frustration with small irritations or setbacks; turning to mindless habits for hours; feeling low on energy; managing day-to-day tasks but feeling empty inside.

The key to feeling better is to accept your depression is real, says Jeffrey Melzer. Photo / 123rf

Gary Stevenson was in his 20s when he became the City of London’s youngest and highest-earning trader, making millions for both his employers at Citibank and himself. But he felt unable to derive any happiness from his achievements. “I walked out of my own birthday party because I couldn’t bear to be around people,” he says. “I’d hired a club and all of my friends were there. They wanted me to be this larger-than-life, big-money guy. But I just felt in pain, like a wounded animal. I had to hide away. When you’re making money, you don’t feel as if you can open up to anyone because they will judge you and say you don’t have the right to feel that way.”

It’s common for people to feel at their worst just as they have fulfilled their biggest goals, says Meltzer. “It’s confusing. Society has told you that money and success are the things that will finally bring happiness and then it doesn’t arrive. Where does that leave you?” Stevenson agrees: “It can be the worst thing to achieve all of your ambitions because then you realise you’re still unhappy and you have to start addressing the deeper reasons why.”

The key to feeling better is to accept your depression is real, says Meltzer. “So many people think that they have to reach a rock bottom to justify describing themselves as depressed,” he says. “But it can be more insidious than that. Many people are capable of keeping going for years and years with these terrible feelings inside. The message is: you don’t have to wait for your life to collapse before you ask for help.”

Part of asking for that help is to keep a balanced lifestyle, says Meltzer. “I tell my clients to think about watering plants in their garden,” he says. “You only have a certain amount of water. If you don’t share it out carefully, some of the plants will die.” Hussey now runs his new business – high-end outerwear brand Frahm – with a greater self-awareness. “If I am stretching myself too far, I acknowledge that and take time out to rest,” he says. “I have let go of the macho need to keep going non-stop. It makes me more available to my family, happier in myself but also better at business because I have greater reserves of energy and focus with which to make the right decisions.”

For US Congressman Adam Smith, recovery from depression required a mixture of the practical and psychological. He documented it movingly in his book Lost And Broken: My Journey Back From Chronic Pain And Crippling Anxiety. “I eventually undertook CBT (cognitive behavioural therapy) which trained my mind to respond to difficulties in better ways,” he says. “Through therapy, I also realised two important things. Firstly, I needed to better process certain traumas in my life. When I was 26 I found out that I had been adopted as a baby. I only discovered this just after my adoptive parents died. I had tried to put my feelings aside and just get on with my political career.

It’s common for people to feel at their worst just as they have fulfilled their biggest goals, says Melzer. Photo / 123rf

“But eventually the feelings catch up with you. Secondly, I learned that you have to just accept yourself and know that you are of value, regardless of what is going on in your life. When people talk about their sense of success or failure, they tend to mention their career or their relationships. But all that is besides the point. You are a worthwhile person in your own right.”

When his cycle-wear business collapsed in 2017, Hussey was forced to confront the issues that had fuelled his secret depression. “I had a breakdown and thought about suicide,” he says. “The only way back from that was to open up my mind to new ideas. People used to say I was a force of nature with all this extra energy. But I had just been using work like a drug to distract me from difficult feelings. I came to realise that it was possible to have a work ethic that didn’t come at the expense of your own health and happiness.”

Gary Stevenson walked away from his trading career after concluding that money was not the answer to his depression. Now he has written The Trading Game, a best-selling memoir about his career. “I felt very alone during my time on the trading floor,” he says. “Even when I told my bosses I was struggling mentally and needed a break, they just assumed it was a play for more money and offered me a massive pay rise! The turning point for me was having the courage to open up to other people and tell them how I was feeling. Not everyone accepted that a rich person could actually be depressed. But I found some who did and by being honest with them I could start to work out a solution to my feelings.”

That solution can take many forms, says Meltzer. “CBT is a great way of challenging distortions in our thoughts and feelings and adopting a more useful and realistic attitude. Similarly, aerobic exercise, mediation and medication have been proven to be useful tools. But the key thing is to accept that you can be depressed in spite of your seemingly successful life. There is no shame in that. It is a common symptom of the world we live in.

“There is nothing wrong with ambition and you don’t need to give up your career to be happy. You just need to reflect on your motivations: if your ambition is driven solely by an overriding fear of failure or a desire to solve all of your emotional problems, you might well be disappointed.”