"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. Also known as persistent depressive disorder, this low-grade depressive disorder is more chronic but less severe than typical depression. A diagnosis requires that someone has been depressed for at least two years.
Marinari notes that pregnant women and new moms can be prone to the disorder for a number of reasons, including hormonal changes and self-imposed pressures relating to work, home, family, school, and society. "We see a lot more moms today having to work throughout their pregnancy and return to work quickly after having the baby, which I believe also contributes to some of this high-functioning depression," Marinari says.
Jillian Kirby was diagnosed with dysthymia, the former name for persistent depressive disorder, when she was 21. She initially rejected the diagnosis, but after having her child, she realized she was indeed depressed and needed help managing her symptoms.
"Motherhood can be incredibly isolating, which greatly magnifies the day-to-day impact of high functioning depression," Kirby says. "During a major depressive episode, I don't want to eat or shower or get dressed, but on an average all-the-time-depressed day, I work hard to present myself well, despite emotionally not necessarily feeling any better than during the major depressive episodes."
Kirby's experience is not uncommon, according to Anna Kress, Psy.D., a clinical psychologist in Princeton, New Jersey. "The new demands, stress, and expectations of motherhood can trigger high-functioning depression in some women, particularly if they already have a tendency toward perfectionism," she says.
"In part thanks to social media, today's moms have more pressure than ever to appear successful and happy," Kress continues. "Compared to carefully curated images, real-life parenting can easily fall short. Despite experiencing constant sadness and self-criticism, however, many new moms will try to put their feelings aside in order to care for their baby and appear fine to other people."
Women who focus on accomplishing daily tasks might not even realize they are depressed, according to Kress. "Given the stigma associated with post-partum 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."
Another risk posed by the disorder is how it might affect stress levels and fetal development in pregnant women. In a 2008 study comparing depression and dysthymia in pregnant women, researchers found that women with dysthymia 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.
Persistent depressive disorder can develop into more serious post-partum depression, particularly if the woman doesn't reach out for help, as many of the warning signs go undetected even to close friends and family. Warning signs include isolation, avoidance of certain activities or social events, irritability, low self-esteem, difficulty making decisions, sleeping problems, and changes in appetite.
A common course of treatment includes a combination of psychotherapy, antidepressant medication, and lifestyle changes. 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. Services like BetterHelp and TalkSpace also offer affordable, online therapy.
"The most important thing is for moms 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.