High-Functioning Depression and Denial: 11+ Signs You’re Depressed Without Realizing It

This article is a summary of a conversation from the Giving Voice to Depression podcast hosted by Terry McGuire. In this episode, Terry and Carly McCollow speak with psychologist, author, TEDx speaker, and podcaster Dr. Margaret Rutherford about high-functioning depression, denial, and the emotional survival strategies that can prevent people from recognizing they are struggling.

Dr. Rutherford is widely known for her work on Perfectly Hidden Depression, a term she coined to describe people who appear highly functional externally while privately carrying deep emotional pain. In this first half of a two-part conversation, the hosts explore several of the reasons people deny depression, misunderstand it, or fail to identify it in themselves.

One of the central themes of the discussion is that depression does not always look dramatic from the outside. Sometimes it looks like productivity. Sometimes it looks like caretaking. Sometimes it looks like perfectionism, busyness, faith, or achievement. And sometimes, the person experiencing it has become so disconnected from their emotional pain that they no longer recognize it as depression at all.

1. Depression Can Be Hidden in Plain Sight

Many people still picture depression in one very specific way: someone unable to get out of bed, unable to work, openly crying, or visibly overwhelmed. But Dr. Margaret Rutherford explains that depression can take many forms, including forms that are much harder to identify.

As Dr. Margaret Rutherford explained:

One of the criteria for a diagnosis of depression is that it’s observable to you, you notice a change in yourself, or other people notice a change in you.

She goes on to distinguish between what she calls “classic depression,” high-functioning depression, and perfectly hidden depression. High-functioning depression may still allow someone to continue working, parenting, or maintaining responsibilities. Perfectly hidden depression, however, often becomes deeply internalized and compartmentalized.

As Dr. Margaret Rutherford described:

These are people who will say things like, “I just don’t cry,” or “I don’t like to talk about myself” or “My problems are nowhere near anybody else’s and so, you know, who am I to complain?”

These individuals may appear strong, competent, and composed. Yet underneath that exterior may be years of emotional suppression, shame, loneliness, and pain that has never been addressed.

That is part of what makes hidden depression so difficult to recognize. The suffering is real, but it may not look like suffering from the outside.

2. Functioning Well Does Not Mean Someone Is Emotionally Well

One of the most important insights from the episode is that functioning and wellness are not the same thing. Someone can continue meeting obligations while privately feeling emotionally exhausted, disconnected, or hopeless.

Dr. Rutherford explains that people with high-functioning depression may continue to work, care for their children, and fulfill responsibilities while still experiencing significant symptoms of depression internally.

This creates a dangerous misconception that if someone is “still functioning,” they must not really be struggling.

But depression can still impact:

• Self-worth
• Energy
• Joy
• Motivation
• Relationships
• Emotional connection
• Sleep
• Hope for the future

People with high-functioning depression may even minimize their own suffering because they compare themselves to others who appear more visibly impaired.

They may think:

• “I’m still getting things done.”
• “Other people have it worse.”
• “I should be grateful.”
• “I don’t have a right to complain.”

Over time, this self-minimization can deepen shame and delay treatment.

3. Many People Mistake Depression for Personal Failure

Terry McGuire shares one of the most vulnerable moments in the episode when reflecting on her own experience with severe depression. Looking back, she realizes she did not understand she was experiencing a medical condition.

As Terry McGuire reflected:

I think I thought it was me. Yeah. I thought I just straight up lost my value as a human being.

That statement captures one of depression’s most painful distortions. Depression often does not announce itself as an illness. Instead, it convinces people that they themselves are defective.

Dr. Rutherford explains that many people feel relief when they finally realize their suffering has a name and a recognized pattern.

As Dr. Margaret Rutherford explained:

When you give it a name, when you say well you fit criteria for this or that, then they’re almost relieved. It’s like, oh. I have something recognizable that has happened to me. I didn’t cause this, and it’s not some failure of mine.

That shift matters enormously.

Recognizing depression as a condition rather than a character flaw can reduce shame and create space for healing. It can help someone move from self-condemnation toward self-understanding.

4. Depression Can Creep In So Slowly That You Barely Notice It

One of the most memorable moments in the conversation comes when Dr. Rutherford describes how gradual depression can feel.

As Dr. Margaret Rutherford eloquently explained:

The thing about more mild depression is that it’s almost as if the lights can go down so slowly that you don’t realize that you’re squinting to try to see.

This metaphor resonates deeply because depression often does not arrive suddenly. Instead, it slowly dims a person’s emotional world over time.

Someone may gradually experience:

• Less excitement
• Less laughter
• Less motivation
• Less connection
• Less emotional resilience
• Less interest in activities they once loved

Because the changes happen incrementally, people often adapt without realizing how much has shifted.

Carly McCollow expands beautifully on that metaphor by comparing it to theater lighting fades she studied during college. Lighting changes can happen so gradually that the audience barely notices them moment to moment, but eventually the entire atmosphere changes.

As Carly McCollow shared:

It can sort of slowly come upon us and it makes it even harder to know that something’s happening.

That gradual progression is one reason depression can go untreated for long periods of time.

5. Shame Makes It Hard to Ask for Help

Shame is one of the strongest recurring themes throughout the episode. Depression often convinces people that struggling emotionally means they are weak, failing, dramatic, or burdensome.

Dr. Rutherford explains that shame can make people highly resistant to therapy, especially when depression conflicts with how they see themselves.

As Dr. Margaret Rutherford explained:

That’s just shame talking loud and clear, loud and clear.

Many people believe they should simply “push through” emotional pain. Others feel embarrassed that they cannot fix themselves independently. Some even feel ashamed for needing support at all.

This shame can sound like:

• “I should be stronger than this.”
• “I don’t have real problems.”
• “I’m just lazy.”
• “Other people handle life better than I do.”
• “I should be able to fix this myself.”

Unfortunately, shame thrives in secrecy. The more isolated someone becomes, the more powerful those distorted beliefs can grow.

The episode repeatedly emphasizes that asking for help does not require having perfect language or complete understanding of what is happening.

As Terry McGuire candidly shared:

I have no idea what the hell’s going on but I hate it.

That level of honesty is enough to begin.

6. Depression Can Threaten a Person’s Core Identity

For people who are used to being dependable, productive, and capable, depression can feel profoundly destabilizing. Terry points out that many high-achieving people derive part of their identity from getting things done and staying in control.

As Terry McGuire explained:

I think of those of us who are used to getting our stuff done. To not be able to do it threatens our core identity.

Depression can interfere with concentration, motivation, energy, and decision-making. When those capacities begin to fade, many people experience intense fear and confusion.

Dr. Rutherford describes this as a feeling of losing oneself.

As Dr. Margaret Rutherford explained:

There’s a feeling of loss. I’m lost. Where has the me that I’ve known gone?

That emotional disorientation can become deeply lonely. Many people try harder and harder to hide their struggles rather than admitting they no longer feel like themselves.

This hiding often increases shame and isolation, creating a cycle where the person becomes more disconnected from support over time.

7. Faith Can Become Complicated During Depression

One of the first reasons Dr. Rutherford identifies for depression denial is the belief that depression represents a failure of faith.

As Dr. Margaret Rutherford explained:

I have failed my faith, I fail God, I should not be feeling this way.

She notes that this belief is especially common in some religious communities where emotional suffering may be interpreted as a spiritual weakness rather than a health condition.

This can make people reluctant to seek therapy or medication because they fear it reflects insufficient faith.

But Dr. Rutherford strongly challenges the idea that faith alone prevents depression.

As Dr. Margaret Rutherford explained:

Certainly the research shows that faith is a good guardrail against, you know, some of these issues getting more intense, but it certainly doesn’t prevent you from being depressed.

That distinction is incredibly important.

Faith can absolutely provide comfort, belonging, resilience, and hope. But depression is often influenced by many interconnected factors, including:

• Genetics
• Trauma
• Stress
• Loss
• Hormonal changes
• Isolation
• Physical health
• Grief
• Brain chemistry

Healing often requires multiple forms of support working together.

8. A Faith Community Cannot Always Meet Every Mental Health Need

Carly McCollow offers an especially thoughtful perspective on the role faith communities can play in mental health support. She acknowledges that spiritual communities can provide tremendous care and connection while also recognizing that they may not always have the tools necessary to address clinical depression.

As Carly McCollow thoughtfully shared:

One community might not be able to be everything for us.

She compares seeking mental health support to visiting a medical specialist for a physical issue. A supportive faith community may still not have the expertise required to treat depression effectively.

As Carly McCollow added:

Seeking some formal mental health support might be an idea.

This framing removes the false choice between faith and therapy. Someone can deeply value their spirituality while also recognizing the need for professional mental health care.

People can pray and go to therapy. They can attend church and take medication. They can believe in God and still need clinical support.

Those things are not mutually exclusive.

9. Depression Can Make Strengths Feel Inaccessible

Another painful aspect of depression is that it can temporarily block access to the strengths and coping skills someone normally relies upon.

Dr. Rutherford explains that many people become frightened because abilities they once trusted suddenly feel unavailable.

As Dr. Margaret Rutherford explained:

A lot of your strengths, a lot of your skill set doesn’t seem available to you.

This can create tremendous frustration and hopelessness. Someone who was once organized may struggle to complete simple tasks. Someone who was emotionally steady may become irritable or reactive. Someone who was confident may suddenly feel consumed by self-doubt.

Depression often creates:

• Brain fog
• Indecisiveness
• Emotional exhaustion
• Difficulty concentrating
• Low motivation
• Hopeless thinking

Dr. Rutherford explains that therapy can help reconnect people with strengths and coping tools they may have forgotten during depressive episodes.

Sometimes people need someone else to remind them that they have survived difficult seasons before and that the version of themselves they miss has not disappeared forever.

10. You Do Not Need Perfect Language to Seek Help

One of the most comforting parts of the episode is the reminder that people do not need to fully understand their depression before asking for help.

They do not need a diagnosis first. They do not need to explain everything perfectly. They do not need to arrive at therapy with neatly organized symptoms.

Sometimes the most honest beginning is simply admitting that something feels wrong.

Helpful starting phrases might include:

• “I don’t feel like myself.”
• “I don’t know what’s happening.”
• “I’m exhausted all the time.”
• “I can’t seem to enjoy anything anymore.”
• “I feel disconnected.”
• “I hate feeling this way.”

As Dr. Margaret Rutherford explained:

Something has my mind, it has it in its grip, and it has me in its grip.

That recognition alone can become the first step toward healing.

11. Hidden Depression Still Deserves Attention and Treatment

Near the end of the episode, Terry emphasizes a critically important truth: denial does not make depression disappear.

As Terry McGuire emphasized:

Just because you don’t understand you have depression or don’t want to admit you have or somebody else in your life has it, that it doesn’t mean it’s not there, it’s not real, and that it doesn’t need some attention and support and maybe treatment.

Depression can continue deepening quietly beneath the surface if left untreated. That is why conversations like this matter so much. They provide language, validation, education, and hope to people who may have spent years believing their suffering was simply personal weakness.

The episode also reminds listeners that depression is not always obvious. Someone can appear successful, composed, faithful, productive, and outwardly functional while internally struggling immensely.

That hidden pain still matters.

And it still deserves care.

Final Thoughts

This conversation between Terry McGuire, Carly McCollow, and Dr. Margaret Rutherford offers an important reminder that depression does not always announce itself clearly. Sometimes it arrives slowly. Sometimes it disguises itself as perfectionism, overachievement, caretaking, or emotional numbness.

People living with high-functioning or perfectly hidden depression may not even realize how much pain they are carrying because they have become so accustomed to minimizing it, compartmentalizing it, or pushing through it.

But naming depression can be transformative.

Recognizing that emotional suffering is not personal failure opens the door to compassion, support, treatment, and healing. It allows people to stop blaming themselves for symptoms they did not choose.

Most importantly, this episode reminds listeners that they do not have to fully understand their depression before reaching out for help.

They only need to begin telling the truth about how they feel.