High-Functioning Depression in Women

When depression hides behind productivity.

By Sandra Weatherford, LICSW-S

You show up.

You perform.

You handle it.

From the outside, everything looks fine. Inside, you may feel tired, disconnected, numb, or overwhelmed. You may be wondering why it feels so hard to keep carrying it all. This is often what high-functioning depression looks like in women.

While “high-functioning depression” is not a formal diagnosis, it is commonly used to describe individuals who meet criteria for Persistent Depressive Disorder (PDD). A chronic, low-grade depression lasting at least two years, yet you are continuing to meet daily responsibilities at work, at home and in relationships. Research shows that depression is twice as common in women compared to men. And yet, high-functioning depression is frequently missed.

Clinically, Persistent Depressive Disorder is defined in the Diagnostic Statistical Manual (DSM-5-TR) as a depressed mood lasting most of the day, more days than not, for at least two years, along with symptoms such as chronic fatigue, low self-esteem, difficulty concentrating, changes in sleep or appetite and feelings of hopelessness. Women often feel that these symptoms are “manageable” or they become woven into someone’s identitiy (“I’ve always been this way. It’s just how I am”) which leads many women not to recognize what they are experiencing is depression.

There are several reasons women may be particularly vulnerable to this pattern. Social conditioning plays a powerful role. Women are often socialized to prioritize other’s needs before their own, maintain harmony and hold everything together for everyone. Emotional labor becomes expected, and overextension becomes normalized. Hormonal fluctuations during puberty, pregnancy, postpartum and perimenopause are linked to increased depressive symptoms. Additionally, many high-achieving women carry deeply internalized standards such as “I should be able to handle this,” or “If I slow down, everything will fall apart.” These cognitive patterns, something we explore in Cognitive Behavioral Therapy (CBT), can quietly fuel chronic depressive symptoms.

You may still go to work, take care of your family, meet deadlines and show up for others. At the same time, you might feel emotionally flat or numb, disconnected from joy, easily irritated, or constantly tired despite sleeping. You may feel like you’re going through the motions, overwhelmed by small tasks or guilty for not feeling grateful.

High-functioning depression often goes untreated because “it doesn’t feel bad enough” or women may think no one will understand because they seem fine to others. You might tell yourself it’s just stress, you can keep going and getting things done, or that you don’t have time for therapy. When depression is chronic and familiar, it can begin to feel like a personality trait rather than a treatable condition. However, you deserve support before you reach a breaking point.

The good news is that high-functioning depression responds well to treatment. Cognitive Behavioral Therapy (CBT) has strong empirical support for persistent depressive symptoms. In therapy, we often work on identifying unhelpful core beliefs, reducing perfectionism and self-criticism. We also work to increase behavioral activation to reconnect with meaning and pleasure, building healthier boundaries and strengthening self-compassion. CBT is not about “thinking positive.” It is about thinking accurately and compassionately. For many women, therapy becomes the first space were they do not feel they have to be the strong one or perform.

You can be successful, a dependable professional, a good mother, and a supportive partner and still be depressed. If you’ve been quietly carrying exhaustion, heaviness, or emotional numbness for years, you don’t have to continue managing it alone. Their is relief available. If you’ve felt low most days for at least two years, can’t remember the last time you felt genuinely joyful, feel emotionally disconnected from your life or you are functioning but not thriving, it may be time to consider reaching out for help. Therapy doesn’t have to start when you are in crisis and everything has fallen apart. It’s for when you’re ready to start thriving instead of just surviving.

If any of this resonates with you, I would love to connect.