High-Functioning Depression and the Hidden Struggle: A Story of Healing and Hope

Depression does not always look the way people expect it to. Someone can keep earning good grades, showing up to work, or meeting a deadline while privately feeling lonely, numb, frightened, or completely burnt out. Someone else may be so affected that getting out of bed, making a meal, or taking a shower feels out of reach.

In this replayed episode of Giving Voice to Depression, hosts Terry and Dr. Anita Sanz speak with Emily Derecktor about the wide range of ways depression can show up, including in people who appear highly capable from the outside. Emily shares how a first episode in college changed her direction, what happened when later depression became far more disabling, and why she now thinks about healing as a process rather than a finish line.

Depression Can Be Present Even When Someone is Still Achieving

Emily had long measured herself by achievement. She worked hard in school, sang, participated in extracurriculars, and set her sights on an Ivy League education. Getting into Brown University was supposed to feel like success. Instead, she found herself overwhelmed by loneliness and a sense that she did not belong.

She remembers crying often and not understanding what was happening.

“I don't know how to explain it. It was just a very, very deep sense of loneliness, a deep sense not belonging. I would just be crying constantly and I had no idea what was wrong with me.”

Although mental illness, including conditions such as bipolar disorder and borderline personality disorder, ran in her family, Emily had didn’t believe that she had a mental health challenges. When that became clear, she sought care and began an antidepressant. She even transferred from Brown University to the University of Pennsylvania when she realized the environment she was in did not feel sustainable for her.

Functioning is not the same as feeling well.

“I realized that there were a lot of people out there — I used to call them "the walking wounded" — that had symptoms of some sort of mental health problem, but they didn't know that it was the case.”

The National Institute of Mental Health (NIMH) states that depression can affect how a person feels, thinks, and handles everyday activities, and that symptoms and severity vary from person to person.¹ For example, someone may be productive but still experiencing a great deal of emotional turmoil. Another person may not be able to keep up with the tasks that once felt ordinary because their pain is too overwhelming. Neither experience is a measure of how real their depression is, rather an example of how depression can show up.

Depression is Not One Fixed Experience

Emily describes her first experience of depression as sadness and loneliness while still being able to get things done, though with more difficulty. However, later depressive episodes were different. During medical school, depression became much darker and more disabling. She describes experiencing suicidal thoughts, intense panic, and difficulty with basic tasks, all of which led to a spiral of desperately trying to get better.

“I went from this person who was going to be a doctor to a person who is bed bound, getting ECT (electroconvulsive therapy), getting hospitalized one to three times a year, and really struggling. I tried every treatment, and nothing worked. It was absolutely devastating.

Depression does not follow a neat, identical pattern across people or even across one person’s lifetime, and Emily’s story proves that. It can disrupt sleep, appetite, concentration, interest, energy, and daily functioning, but not everyone with depression will experience the same collection of symptoms or the same degree of impairment.²

After years of trying treatments that did not help enough, Emily found a therapist who recognized posttraumatic stress disorder (PTSD) as another part of her picture. She is careful not to frame her life as a tidy recovery story. Instead, she talks about healing.

Healing May Be a Process, Not a Final Destination

“Healing“— that word gives her room for a reality where it is understood that symptoms can wax and wane. Feeling better can bring relief, but it can also bring fear. Emily says that when joy began to return after years of numbness, part of her waited for the other shoe to drop. She also worried she might lose the support of people who had helped her if she seemed healthier.

“When I start feeling better, I get a little bit wary. I'm like, am I going to lose the support that I have had, in terms of my therapist and people like that, that I've had helping me throughout this whole thing?”

Terry responds with an important reminder: support does not have to disappear when symptoms ease. Emily agrees, adding that the fear itself is worth bringing to a therapist. That can be a useful starting point for anyone who worries that asking for help makes them a burden or that doing better means they no longer deserve care.

So, Emily turned some of what she had learned into support for other students during her time at the University of Pennsylvania. There, she helped create a mental-health screening tool with personalized recommendations and the university’s first peer-counseling program. Her aim was not to suggest that peer support replaces professional care, but to help people feel less alone and make it easier to recognize when something was wrong.

Making Room For Difficult Emotions

One idea Emily has taken from therapy is learning how to distinguish an emotion from the fear and judgment that can build around it. She grew up thinking emotions were either positive or negative, and that the negative ones should be avoided. Over time, she began to practice noticing sadness rather than immediately treating it as evidence of danger or failure.

For Emily, naming what she feels and noticing what is happening in her body can interrupt the next layer of panic. For example, instead of telling herself she should not be sad, she may acknowledge the sadness, identify a meaningful loss, and consider what the emotion might be communicating.

“Sadness is something that I can breathe through, that I allow myself to experience, and that ultimately I know I will be okay if I can just get through that moment of extreme sadness.”

This is not an instruction to simply sit with severe depression alone, or a claim that any one strategy works for everyone. It is one person’s hard-won coping strategy that has proven helpful for them. When depression is persistent, worsening, or interfering with life, professional support can help people explore treatment options that fit their needs. Therapies where strategies such as this can be learned include various forms of psychotherapy, medication, or both; some people may also explore brain-stimulation therapy when other approaches have not been enough.²

The “Basic” Things Can Be Anything But Basic

Near the end of the episode, Emily speaks plainly about the scale of impairment that can come with moderate to severe depression. Making a meal, going for a walk, or getting out of bed can be difficult. The hosts connect that reality to the next episode, which focuses on practical ways to make daily life more manageable during a depressive episode.

“The quote unquote basic or fundamental things in your life are impaired in almost every way and I think the largeness of that is underplayed a lot. It is not appreciated enough when it comes to folks that have moderate to severe illness.”

Therefore, it is important to remember that terms like “high functioning” can hide suffering, and “basic” can make someone feel ashamed for struggling. Emily’s story makes room for a truer response: this is hard, it is real, and getting through today may require support and adaptations.

Peer connection can be one part of that support. It may mean telling a trusted person that you are having a rough week, asking someone to sit with you while you tackle one small task, or joining a moderated community where people understand the day-to-day reality of depression. It may also mean working with a mental-health professional to make a plan that accounts for your symptoms and safety.

If You Are Struggling, You Deserve Support Now

Emily’s story does not promise a simple path. What it offers is more honest and, perhaps, more useful: a reminder that depression can look many ways, that support can remain available when things improve, and that moments of joy can return.