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As you were growing up, there was seldom a time where your mother didn’t have a bottle of wine within her reach. The older you got, the more you started to recognize her immense sadness. It wasn’t until you started facing some confidence issues of your own that you realized her self-esteem was lower than you thought anyone’s self-esteem could ever get.

It wasn’t that she kept it all hidden per see, but you knew it was slightly different than the depressive or substance abuse disorders you learned about in health class. After all, she took pretty great care of you and maintained a full-time job.

Once you were diagnosed with ADHD, your mom opened up to you about the fact that she had it too. Except that she didn’t seem to struggle with impatience or impulsivity the way you did. While she often repeated herself because she would forget many of your conversations, you figured that was just the alcohol impairing her focus and memory.

It wasn’t until your mom was diagnosed with high-functioning depression that the puzzle pieces began to fit together. Was it possible that her high-functioning alcoholism contributed to or worsened her depression? Yes. But more importantly, you came to understand that multiple conditions can occur simultaneously and that depression and other disorders can look different on different people.

So what exactly is high-functioning depression?

High-functioning depression is a form of major depressive disorder marked by similar depressive symptoms such as lethargy, hopelessness, low self-esteem, trouble focusing, loss of interest in pleasurable activities, and feelings of sadness.

High-functioning depression can be difficult to identify because people who suffer from it may not always recognize that they’re depressed. Although high-functioning depression shares the same symptoms as major depression, the symptoms tend to be far less severe.

Furthermore, one person with high-functioning depression may struggle to focus or make decisions; other individuals, like your mom, perform well at work and stay organized, but their low self-esteem or lack of energy gets in the way.

The differences in how depression (of any kind) look in some people but not in others are one reason why conditions are sometimes overlooked, undiagnosed, or misdiagnosed. The other reason? Comorbidity.

Understanding comorbidity

Comorbidity describes a person with two or more disorders or illnesses. These can occur one after the other or simultaneously, and in some cases, one can exacerbate the other.

For example, many individuals with a substance use disorder are diagnosed with a mental illness, and vice versa. However, it’s important to note that just because some disorders — whether substance use, ADHD, depression, etc. — commonly occur together does not always mean one causes the other.

Due to the various ways depression can look different on different people, it can be difficult to establish which one came first or why. Not to mention, depression can look very different from person to person because comorbid conditions may influence it.

The most important thing to remember in all of this is that what matters more than the label of a condition itself or attempting to label or treat only one is that conditions are best identified and treated as part of a patient’s overall self. Only from there, a healthcare professional can recommend the best comprehensive approach to treatment for their patient.

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