Signs of High-Functioning Depression in Teens Parents Shouldn’t Miss

When parents think of their teen struggling with depression, they often picture a decline in grades, skipping school, and spending all day in bed. But what about teens who continue to excel both academically and socially yet still struggle with feelings of shame, isolation, and inadequacy? This could be a sign of high-functioning depression. 

High-functioning depression in teens is not a clinical diagnosis, but rather a way to describe teens who experience symptoms of depression but continue to function and appear normal, often even healthy, on the outside. These teens may struggle with feelings of perfectionism, low self-worth, and may cope with these internal struggles through substance abuse or escape into process addictions such as video games.    

Although these teens often appear well, depression doesn't stay hidden forever. Over time, it can have a serious toll on their emotional and physical health. Understanding the subtle signs of high-functioning depression can help you provide early intervention and connect your teen with treatment to avoid symptoms from worsening. 

What is “High Functioning Depression”? 

High-functioning depression is not a clinical diagnosis, but a term that describes people with chronic depression who are still able to function. They may do well at school or work, hold up relationships, and appear happy on the outside. But internally struggle with emotional turmoil, deep shame, and loneliness. It is more common for individuals with persistent depressive disorder (PDD) (symptoms for at least 2 years) to develop high-functioning depression [1]. 

High-functioning depression has also been coined “smiling” depression or “invisible” depression because teens can often appear externally successful and content with life, even if they are struggling with sadness, exhaustion, and low self-esteem [2].

In teens, high-functioning depression is often the silent struggle of a straight-A student or well-behaved kid. These teens often keep up with homework, participate in activities, and maintain friendships, but quietly struggle with sadness, lack of energy for self-care, and negative self-esteem. 

What Are The Signs of High-Functioning Depression? 

Recognizing high-functioning depression in teens can be challenging. Teens with high-functioning depression often suppress their feelings. They may be seen as perfectionists or overachievers, and admitting they are struggling can be difficult.  

6 Signs Your Teen is Struggling with High-Functioning Depression

1. They may be described as a downer or “negative Nancy”. It can be hard for these teens to see the bright side in a situation. They may not outwardly express that they are depressed, but they also struggle to show genuine enjoyment or pleasure in things. 

2. They often excel academically and socially, but struggle with anxiety, perfectionism, or unrealistic expectations. 

3. These teens may maintain the appearance of being functional (e.g., attending school, completing assignments), but lack the energy for basic self-care, such as taking a shower or brushing their teeth. 

4. Their weight tends to fluctuate without a reasonable explanation. They may go through periods of not wanting to eat/lack of appetite, or binge eating. 

5. They struggle to fall asleep at night or wake up feeling refreshed in the morning. 

6. They may struggle with a form of escapism, such as playing video games excessively or scrolling on social media. Teens with hidden depression may use these as an outlet to numb their emotions and cope.  

How To Support a Teen With High-Functioning Depression 

If you believe your teen is struggling with symptoms of depression, it’s important to take steps to provide early intervention and help them build lifestyle patterns that foster their mental well-being. 

Some of the ways to support your teen if they are struggling with high-functioning depression include: 

• Encourage them to stay physically active every day, even if it's just for 20-30 minutes. Have them go on a walk around the neighborhood, ride their bike, or follow a yoga session on YouTube. 

• Make sure they are eating healthy, well-balanced meals. Fast food, frozen dinners, and overprocessed snacks can increase inflammation and the risk of mental health disturbances [3]. 

• Have them spend 10 to 15 minutes each day in the sun. This can increase vitamin D production, which contributes to greater mental well-being [4]. 

• Get to know your teen and take an interest in their life. Know who their friends are, find out what music they are listening to, or the Netflix shows they are watching. This active interest can help them feel more seen, validated, and understood.  

• Connect your teen with professional treatment if they continue to struggle with their mood, general outlook on life, sleep, or appetite. 

What Are The Most Effective Treatment Options for Depression in Teens? 

Teens with depression can benefit from a combination of evidence-based therapies, medication, family, and peer support. 

Inpatient treatment and structured day programs such as partial hospitalization (PHP) are ideal for teens struggling with depression and presenting with harmful behaviors to themselves or others, such as threats of suicide, self-harm, or substance abuse. 

Outpatient treatment programs can help teens develop the necessary, continued skills to cope with triggers, increase their self-esteem, and prevent depression from worsening. Some of the most effective treatment options for teenage depression include: 

• Cognitive Behavioral Therapy (CBT): Encourages teens to identify and reframe negative thoughts that increase feelings of isolation, loneliness, shame, and guilt. 

• Family Therapy: Addresses attachment wounds, inconsistent parenting styles, and communication difficulties that can increase the risk of teenage depression. 

• Group Therapy: Peer support groups offer a safe space for teens to work through feelings of loneliness, isolation, and shame. These help foster connections and improve self-esteem. 

• Medication: Antidepressant medications are sometimes a necessary piece in helping teens recover from symptoms of depression, especially related to mood, sleep, and appetite. These should not be overlooked as they are safe and effective under medical supervision and monitoring. 

• Creative Arts Therapies: Holistic activities such as art therapy, music therapy, and dance and movement can help teens express themselves in nonverbal ways, process difficult emotions, and relieve psychological distress in a structured, creative manner.   

Family-Centered Mental Health Care in Florida: Healing Teen Depression Together 

Lotus Behavioral Health is a residential treatment facility for teens located in Florida. Our structured inpatient and outpatient programs are designed to support teens and their families with the tools they need to recover from substance abuse and co-occurring mental health disorders. 

Our compassionate team understands the complexity of depression in teens and the unique challenges of adolescence. We offer a blend of comprehensive mental health services, such as individual therapy, group therapy, medication management, creative arts therapies, and skill-building workshops to help teens recover from depression, anxiety, and other mental health challenges. 

Contact our admissions team today for compassionate mental health support your teen deserves. 

Sources 

[1] Patel, R. et al. 2024. Persistent Depressive Disorder. Stats Pearl. 

[2] Gunnerson, T. 2024. Smiling Depression: What You Need to Know. WebMD. 

[3] Qorbani, M. et al. (2024). Association between junk food consumption and mental health problems in adults: a systematic review and meta-analysis. BMC psychiatry, 24(1), 438.

[4] Sayon-Orea, C. et al. Predicted vitamin D levels and risk of depression in the SUN Project: A prospective cohort study. Science Direct.