High-functioning depression
When everything works on the outside and very little feels right inside
You go to work, answer messages, look after others. Hardly anyone would guess how heavy it is underneath, and sometimes you are not sure yourself whether it counts as a problem.
High-functioning depression is an everyday phrase, not a formal diagnosis. People use it when they keep functioning outwardly, at work, at home and with friends, while inside they feel low, empty, exhausted or joyless for a long time. Some of what they describe can overlap with depression that needs medical assessment, which is why this page also talks about seeing a doctor.
If you searched for this phrase, you may be the reliable one. You meet deadlines, remember birthdays and solve other people's problems. What you don't tell anyone is that the evenings feel empty, that nothing brings real pleasure any more, or that every morning starts with a long negotiation with yourself. Because life still runs, it's easy to decide it can't be that bad.
Not a diagnosis, and still worth taking seriously
"High-functioning depression" is not a formal diagnosis. You will not find it in the international classification of diseases. It is a phrase people use to describe an experience, and the experience can be very real. Some people who use it are going through a heavy period that therapy can help them understand. Others have depression in the medical sense and would benefit from a doctor's assessment as well.
I do not diagnose over the internet, and this page cannot tell you which of these applies to you. The table below is only an orientation.
Ordinary low mood, "high-functioning depression", or depression that needs a doctor
| Ordinary low mood | What people call high-functioning depression | Depression that needs medical care | |
|---|---|---|---|
| How long | Days, usually with a clear cause | Weeks or months, often without one clear cause | Low mood or loss of interest most of the day, nearly every day, for at least two weeks (WHO) |
| Daily life | Runs, perhaps a little slower | Runs, at a growing inner cost | Increasingly hard: work, sleep, eating, relationships |
| Pleasure | Comes back with rest or good news | Muted, things feel "fine" but not alive | Largely gone |
| Who to see | Usually no one, or a friend | A therapist, and a doctor if it persists | A GP or psychiatrist first; therapy can run alongside |
| Thoughts of death or self-harm | Not usually | Should not be ignored | Seek help today; see the crisis lines on this page |
How I work with this
I am a psychologist, psychotherapist in training (Gestalt, Institut Dialog), working under supervision, and I have worked therapeutically since 2009. From 2014 to 2020 I was at ESET, a psychotherapeutic and psychosomatic clinic in Prague, where I worked in the day-care unit for affective disorders, which means depression and other mood conditions.
Sessions are one to one, 50 minutes long, in Prague 1 or online, in English, Czech or Slovak. The Gestalt approach starts from what you bring. For someone who functions well, that often means slowing down enough to notice what has been pushed aside: tiredness, sadness, anger, or a need that never gets a turn. We do not have to find the cause in the first session. A safe, trusting relationship comes first, one where you do not have to perform.
Low mood can come together with other things: with anxiety, with physical symptoms such as fatigue or tension (psychosomatics), or with a quiet conviction that your success was never really earned, which I write about under imposter syndrome. If you are a parent and part of the weight is worry about a teenager, there is also a page on consultations for parents of teenagers.
When this is not the right place
- Thoughts of ending your life, or acute crisis. Please do not use the contact form for this. Use the crisis lines on this page, now.
- Medication. I do not prescribe and I do not advise on starting, changing or stopping medication. That belongs with a GP or psychiatrist.
- Severe depression. If daily life is falling apart, start with a doctor or psychiatrist. Therapy can follow or run alongside.
- Children and teenagers. I work only with adults (18+).
If you are unsure where to start, the page on when to seek help may help you decide. Prices are on the pricing page, and you can contact me by form, phone or email.
Last updated 1 October 2026
Questions and answers
What is high-functioning depression?
It is a popular term, not a diagnosis you will find in the official classifications. People use it for a state where they manage work and daily life while feeling low, numb or worn out underneath. Whether it is depression in the medical sense is something a doctor or psychiatrist can assess.
Can I be depressed and still perform well?
Yes, that is possible. Performing well at work says little about how someone feels at the end of the day, and for some people, keeping going feels safer than stopping. If the low mood has lasted for weeks, a doctor is the right first step.
How do I know if it is just a bad period or something more?
Duration and spread matter. A hard few days, or sadness with a clear cause that slowly eases, is part of life. The WHO describes a depressive episode as low mood or loss of interest most of the day, nearly every day, for at least two weeks; if that sounds familiar, please see a doctor.
Do I need medication?
I cannot answer that, and I do not advise on starting or stopping medication. A GP or psychiatrist can assess whether medication makes sense for you. Therapy and medical care can run side by side.
Is therapy in English possible if Czech is my second language?
Yes. I work in English, Czech or Slovak, so you can choose the language in which it is easier for you to talk about how you feel. Sessions are in person in Prague 1 or online.
Related pages
You do not have to wait until it stops working
Write a few lines about what you notice, without detailed health information. I will reply and we can agree on a first session.