I’m An Editor In Chief With High-Functioning Depression—What Could Go Wrong?

This article is a personal essay with additional expert advice and is not intended to diagnose a mental health condition. If you or someone you know is struggling, help is available. Call the SAMHSA National Helpline at 1-800-662-HELP (4357) for free, confidential support. 

I can’t pinpoint exactly when my depressed, overwhelmed feelings began—but their magnitude crept up on me like a slow boil. By the time they reached a fever pitch, I didn’t feel like a person who mattered. I felt my only utility was working, and the time I spent not working morphed from robust (Zumba, socializing, meticulously crafting outfits for hypothetical situations unlikely to materialize) to reactive (feeling drained, ruminating on it, attempting to disassociate). I stopped caring about my interests, health, and happiness. While I never stopped caring about my friends, I canceled hangouts for their benefit. I wouldn’t be fun anyway.

I didn’t feel like an empowered editor-in-chief, I felt like a customer service representative with a never-ending shift. And the guilt stemming from that juxtaposition gnawed away at me: How could I not appreciate what I had when so many talented people were losing their jobs?

Outwardly, I put the fun in high-functioning depression, which isn’t an official medical diagnosis. “It refers to people who—despite suffering from depression—appear to be living productive and perhaps even happy-seeming lives,” explains psychiatrist Dr. Mimi Winsberg. “Some people can experience severe depression, even suicidal ideation, while continuing to be functioning in their outwardly facing lives.”

Every Instagram story of a cheese board, lovely work event, or candle was self-medicating, grasping for glimmers of joy that once resonated. People, including family and friends, commented that my life looked amazing. I felt like a dirty fraud. “Social media can be a source of cognitive dissonance as there is dissonance between what people are projecting and actually feeling,” explains Dr. Winsberg. Even though my depression manifested in some discernible ways (weight gain, not partaking in activities I enjoy, self-isolating), no one suspected what I felt inside, and I had visceral pangs of loneliness.

Sleep has always eluded me, but I reached a desperate level of deprivation. I’d lay awake all night, my thoughts racing with no reward. I’d draft emails and have conversations with coworkers in my mind. Then, when I was supposed to be walking the two miles to work, I’d fall into a deep sleep from 8 to 9:30 a.m.

The nights were the hardest part, even though no one was “coming at me”—the phrase I used in my head—that late. I started visualizing falling from up high, and at times, being crushed. I confided in my partner who did some of his most incredible partnering: taking me day by day and espousing sincere positivity I was immune to. I knew I wasn’t being the best partner, friend, or family member. And I felt impotent at work, that regardless of what I did, I finally had too high a deck stacked against me.

As the visualizations became nightly and crept into the daytime, I realized I must be in terrible shape, and assumed I must want to die. I felt utterly hopeless about my life, as if I’d experienced everything worthwhile and it was all downhill from there. I felt I would only bring shame to my partner, family, and company, and everyone would sigh and say, “We were waiting for this to happen.”

As a “logical” thinker, I worked all the way through it. I thought about my geriatric cat whom I love dearly, and how I want to watch my four nephews grow up to be whoever they’ll be.

I realized I didn’t actually want to die: I wanted to fake my death and start over anonymously. I envisioned a small apartment in a tiny town where I wouldn’t be happy, of course, but at least I could be pathetic in privacy.

I was already working with a talk therapist, so I made an appointment with a psychiatrist. Even though it was embarrassing to vocalize, I tried to be unflinchingly honest about my mental state. My doctor first prescribed me a starter dose of Prozac, which didn’t make a difference. The next month, I received a slightly higher dosage of Prozac and Trazadone, a non-benzodiazepine medicine I’d take at night to help me sleep.

I didn’t know of anyone who had taken anti-depressants with any success, only side effects and inefficacy. “The response to antidepressant medications can vary widely among individuals,” says Dr. Sanam Hafeez, a neuropsychologist. “Approximately 50 to 60% of people with depression experience some level of improvement in their symptoms when they take antidepressants.”

Doctors also say that finding the right medication can be difficult. “There are lots of medications to choose from, and it’s not one-size-fits-all,” says psychiatrist Dr. Hafai. People can usually expect to see results from their medication after six weeks of taking it, and though some people will see results in two weeks, that’s a long trial-and-error period.

Of all the things we try to control, our minds are worth it.

I experienced immense relief with my medication duo, and still do. With Trazadone, I know now I will fall asleep every night. I don’t sleep as long as my doctor would like, but what a relief! I know I’ll sleep and that makes me feel like dancing. And on that front, I’m back at Zumba.

Even though I still experience intrusive thoughts and visualizations, I now see them for what they are and nothing more. “These thoughts may symbolize feeling overwhelmed, trapped, or crushed by life’s pressures or responsibilities,” says Dr. Hafeez. “They may not necessarily indicate a desire for self-harm but rather a metaphorical expression of stress or emotional burden.”

Stunningly, they may even be our brains fighting back against depression: “People might experience these thoughts to cope,” adds Dr. Hafeez. “They may represent a subconscious attempt to find relief or release from psychological pressure.”

For many people, anti-depressants won’t work the first time, and the best approach will be multi-pronged, including lifestyle changes and therapy. “The best results are from the combination of therapy and medication together,” says Dr. Safai.

For treatment-resistant depression, the experts I spoke to mentioned Electroconvulsive Therapy (ECT), a procedure that involves passing electrical currents through the brain to induce controlled seizures. “ECT can be effective, but it’s reserved for cases where other options have been unsuccessful or when rapid improvement is necessary,” says Dr. Hafeez. Additionally, there’s Transcranial Magnetic Stimulation (TMS), which harnesses magnetic fields to stimulate specific regions of the brain associated with mood regulation.

I was surprised none of the experts mentioned the emerging evidence of psychedelics to treat mental health conditions. Physician-guided trips can allow people to access (and process) dark memories and have been shown to diminish depression symptoms for up to a year. Ketamine, which can be administered through an IV or in a newer nasal spray by doctors, can “lift depression almost immediately and last for a long time,” according to Mental.

Given all of the intricacies of mental health treatment, finding relief that works for you can feel daunting. But if you’re teetering on seeking medical help, and feel like it’s you—your fault, your mind and it always will be—that’s the moment to just try. Even if no one would believe you’re feeling as bad as you do, and you’re averting their gaze with literal rose-colored glasses. Even if you yourself don’t feel justified in your pain.

I can’t believe how much and for how long I suffered, and I wrote this story because I hope you’ll take action.

Featured Medical Experts

• Dr. Yalda Safai, MD, Master’s in Public Health and medical journalist
• Dr. Mimi Winsberg, Chief Medical Officer and co-founder of Brightside Health, psychiatrist with 25+ years of clinical experience
• Dr. Sanam Hafeez, Neuropsychologist and director of Comprehend The Mind