Young adults may struggle with ongoing irritability, anger, low mood, chronic fatigue, loss of enjoyment in activities they once enjoyed—like biking or snowboarding—and quietly withdraw from friends and social activities. And some do this even while keeping up appearances and outwardly maintaining their daily lives. Sometimes this is called smiling depression.
These are symptoms of high-functioning depression. While not as severe as other forms of depression, and not a formal diagnosis, it can still have a real negative impact on a young adult’s well-being and enjoyment in life.
What Is High Functioning Depression?
Dr. Adrian Ambrose of Columbia University noted, “One of the most common groups I see having high-functioning depression is adolescents and young adults. It is very common for me to hear from well-meaning parents that their kids can’t have depression because they’re still getting good grades. Furthermore, in children and adolescents, depressive symptoms may look more like irritability and anger than sadness” [1].
Despite outward appearances, depression is possible. Characteristic of high functioning depression is a disconnect between external functioning and internal experience. While young adults meet their obligations, it can be at a high internal cost.
Although the term high-functioning depression is often associated with mild to moderate depression, it doesn’t necessarily mean that the symptoms are limited to a moderate level of severity [2].
Signs of High Functioning Depression in Young Adults
It can be challenging to know if a young adult has high functioning depression. Here are some of the most common signs [2]:
Emotional and Internal Signs
- Persistent low-grade sadness, low mood, or emptiness. Feeling “gray”
- Low energy or constant fatigue
- Difficulty feeling pleasure or joy in activities they used to enjoy
- Difficulty sleeping
- Difficulty concentrating or making decisions
- Feelings of being easily irritated or frustrated, often more than sadness
- Low self-esteem or feeling inadequate, guilty, or worthless
- Critical inner voice; sometimes with imposter syndrome
- Overeating or undereating
- Guilt about not doing or feeling better
Behavioral and Performance Signs
- Perfectionism and overachieving which may lead to burnout
- Procrastination followed by hurried all-nighters
- Quiet social withdrawal
- Neglect of self-care
- Rumination and overthinking
Physical and Cognitive Signs
- Chronic fatigue and low energy
- Changes in sleep patterns often waking up feeling exhausted
- Changes in appetite or weight
- Brain fog with difficulty concentrating and making decisions
Why It’s Often Missed in Young Adults
It can be difficult for a family member or friend to recognize these signs for a number of reasons, including:
- It’s “just” stress
- High achievement masks pain
- They become experts at masking with a public persona, saying “I’m just tired”
- They may not realize: Thinking “This is just my personality” or “Everyone feels this way”
If symptoms persist for two years, then it’s very important to see a doctor as this may be Persistent Depressive Disorder or even Major Depressive Disorder, depending on the symptoms. Both are clinical diagnoses.
If safety concerns emerge, such as thoughts of self-harm or suicidality, it’s important to seek clinical care.
How Therapy Can Make a Difference
It’s not hard for a parent to miss the symptoms, or a young adult, for that matter. However, if several of the above symptoms linger for a month or two, it’s advisable to see a medical provider to assess and possibly prescribe antidepressant medications.
Similarly, a therapist can help by working with negative thought patterns and beliefs. Cognitive Behavioral Therapy (CBT) can help reframe negative thoughts. Dialectical Behavioral Therapy (DBT) may help with emotion regulation and mindfulness. If appropriate, a trauma-informed therapist may be seen. And peer support or other groups can be helpful to share experiences and techniques to overcome this condition.
Taking the First Step Toward Healing
Breaking the stigma of high-functioning depression may not be easy but it’s important to reclaim your full identity. Reaching out for a therapist, counselor, or psychiatrist is a critical step. They can accurately diagnose your condition and work with you to create a treatment plan, including lifestyle changes, therapy, or medication. Perhaps start with your school’s counselor if you are attending school.
It can be a challenge to support a young adult with high-functioning depression. Use compassion and speak in a non-judgmental way. Don’t tell them you think they’re depressed. Use “I” statements such as “I’ve noticed you’ve seemed tired all the time. How are you really doing?”. Listen more than you talk and encourage them to seek help with your support.
Offer support using these suggestions [2]:
- Validate their feelings using empathetic and non-judgmental language.
- Encourage self-care and offer practical support and help with daily tasks.
- While offering support, respect their space.
- You can’t “fix” everything. Reinforce that “it’s okay to not be okay.”
- Encourage social connection.
- Advocate for seeking professional help.
Supporting Young Adults in Their Journeys
Engage Young Adult Transitions is a transitional living program and therapeutic community that assists young adults on their path to independence. Using attachment theory, we provide a foundation for forming connections, getting involved with the community, managing mental health, and building life skills for long-term success.
Engage offers structured autonomy—high support without creating dependence. Our therapists and life coaches are here to honor the young adults’ need to gain independence and freely move to a more secure sense of self and their relationships.
Located just steps from Southern Utah University in Cedar City, we offer access to services seven days a week, including academic support, vocational training, career guidance, life skill coaching, mental health therapies, and recreational activities.
Our community offers high levels of therapeutic support that honors autonomy and independence while guiding young adults to a life of freedom, emotional wellness, and success.
Get involved with the Engage Transitions community today!
Sources
[1] ColombiaDoctors.org 2025. Could You Have High-Functioning Depression?
[2] McCullars A. 2025. Dispelling Misconceptions About High-Functioning Depression. ADAA. Anxiety and Depression Association of America.