People may suffer from high-functioning depression without realizing it—and the low-grade mental disorder hits pregnant women and new parents especially hard. Here’s how to spot the symptoms and get help.

depressed couple
Credit: Shutterstock

The symptoms of depression can be painfully obvious. Excessive fatigue, anxiety, irritability, and intense sadness are signs that someone needs help. But high-functioning depression isn't as easy to spot—and pregnant women and new parents may be more likely to suffer in silence.

"Someone who has high-functioning depression is usually very good at hiding their problems and perhaps even being in denial they are struggling as much as they are," says Channing Marinari, a licensed mental health counselor at Behavioral Health of the Palm Beaches. They may have a successful career, maintain relationships, and put on a façade of happiness while suffering internally. 

This low-grade mental illness (also known as persistent depressive disorder) is more chronic but less severe than typical depression. A diagnosis requires that someone has been depressed for at least two years.

Here's everything that you need to know about the risk factors, symptoms, and treatment options for high-functioning depression.

Why Are New Parents at Risk for High-Functioning Depression?

Marinari notes that pregnant women and new parents can be prone to high-functioning depression for a number of reasons, including hormonal changes and self-imposed pressures relating to work, home, family, school, and society. 

“The new demands, stress, and expectations of parenthood can trigger high-functioning depression in new parents, particularly if they already have a tendency toward perfectionism,” says Anna Kress, Psy.D., a clinical psychologist in Princeton, New Jersey. “Despite experiencing constant sadness and self-criticism, however, many new parents will try to put their feelings aside in order to care for their baby and appear fine to other people."

Parents who focus on accomplishing daily tasks might not even realize they are depressed, according to Kress. "Given the stigma associated with postpartum depression, they might also fear being identified as someone who is struggling. As a result, they are less likely to seek treatment and their symptoms can become chronic."

Symptoms of High-Functioning Depression

Signs and symptoms of high-functioning depression are different for everyone, but they may include:

  • Feelings of sadness or hopelessness
  • Isolation
  • Avoidance of certain activities or social events
  • Irritability
  • Low self-esteem 
  • Difficulty making decisions
  • Sleeping problems
  • Changes in appetite
  • Lack of energy

The symptoms occur on most days for at least two years, and they don’t go away for more than two months at a time. 

Complications of High-Functioning Depression

Since people don't always realize they’re suffering from high-functioning depression, they may not seek help. In turns, symptoms can become chronic or more severe.

Untreated postpartum depression might also affect stress levels and fetal development in pregnant women. In a 2008 study comparing normal and high-functioning depression in pregnant women, researchers found that women with the lower-grade variety had higher cortisol levels and lower fetal growth rates than women with more severe depression.

Another study, conducted at the U.K.'s University of Bristol in 2013, found that women who experience depression during pregnancy give their children an increased chance of experiencing depression as adults—these kids are 1.5 times more likely to be depressed by 18 years of age. While genetic factors weren't ruled out, the study's lead author suggested "the physiological consequences of depression" may transfer from the mother through the placenta, affecting fetal brain development.

Treatment for High-Functioning Depression

If you suspect you're suffering from persistent depressive disorder, contact your primary care physician (who can screen for depressive symptoms) or check your health insurance plan for an in-network therapist directory or other behavioral health programs. A common course of treatment includes a combination of psychotherapy, antidepressant medication, and lifestyle changes.

"The most important thing is for moms (and dads) to not feel shame if they do feel a sense of depression during their pregnancy or after they deliver their baby so they can get help, talk about their feelings, and consider treatment if necessary," Marinari says.