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Well-dressed, successful, and depressed: ‘High-functioning’ depression seen in more patients

SINGAPORE — For many "high-functioning" depressives, their conditions can often be hidden from their social circles by a mix of medication, exercise, and knowing when to shut off from the world. While "high-functioning" depression is not a medical diagnosis nor a diagnostic category, more online discourse about mental health, as well as a recent spate of celebrity suicides, have shone a spotlight on it.

Ms Lynette D’Cruz (left), 29, and Ms Tey Siang Fang (right) were both diagnosed with clinical depression, and both women have since found ways to manage their conditions.

Ms Lynette D’Cruz (left), 29, and Ms Tey Siang Fang (right) were both diagnosed with clinical depression, and both women have since found ways to manage their conditions.

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SINGAPORE — On social media, Ms Lynette D'Cruz, 29, appears to have the perfect life. Her Facebook page is filled with photos of her travels and overseas treks, including her mountain climbs in the region.

"I'm always trekking, travelling to places, keeping fit, my friends are in awe of how much weight I've lost," said Ms D'Cruz.

However, some of her friends do not know that she is "struggling to cope with painful depression every day."

The single mother-of-one, who was diagnosed with depression last year, said she deals with her condition by "doing yoga, trekking, pole dancing, running, just generally staying active".

"This is how I fight my battle," added Ms D'Cruz, who spoke to TODAY ahead of World Mental Health Day on Wednesday (Oct 10).

For many like Ms D'Cruz, who are sometimes referred to as a "high-functioning" depressives, their conditions can often be hidden from their social circles by a mix of medication, exercise, and knowing when to shut off from the world. In worst case scenarios, it could result in alcohol and substance abuse.

While "high-functioning" depression is not a medical diagnosis nor a diagnostic category, more online discourse about mental health, as well as a recent spate of celebrity suicides, have shone a spotlight on it.

Psychiatrists also told TODAY that they have seen more "high-functioning" patients in recent years.

Consultant psychiatrist Thomas Lee, medical director of The Resilienz Clinic at Novena Medical Centre, said he has seen a 20 per cent increase in such patients at his clinic over the last three years.

"Over the years, I do see more and more patients who suffer from depression, but they are able to manage and bear with the symptoms, and continue to perform and achieve high-level tasks in life," said Dr Lee, who added that the diagnosis for such patients is still clinical depression.

S'PORE HAD REGION'S HIGHEST DEPRESSION RATE

In 2015, Singapore had the highest rate of depression in Asia, according to a World Health Organisation (WHO) study.

Depression, which has been called the "common cold of mental health problems", is defined by the WHO as a condition characterised by persistent sadness and a loss of interest in activities that an individual normally enjoys, "accompanied by an inability to carry out daily activities for at least two weeks".

But psychiatrists said that it is a myth that depression will incapacitate those with the condition.

Dr Daniel Fung, Chairman of the Medical Board at the Institute of Mental Health (IMH), said: "That's the whole stigma of mental illness, that for those with depression, there's a certain expectation that it is incurable and you behave in a way that is not like anybody else. And that's not true."

Dr Lee from The Resilienz Clinic added that some of his patients are high-functioning individuals who are "often in good and high-ranking positions, (so they) would have to continue performing in those roles". As a result, they "ignore their symptoms and continue to push themselves to achieve whatever expectations they need to fulfil".

This could potentially be a reason why it is hard to spot mental illness in high achieving professionals.

A double exposure image of Ms Lynette D'Cruz, 29, with her hiking shoes and stick on a forest trail. Ms D'Cruz was diagnosed with clinical depression and anxiety in August 2017. She manages her condition by doing yoga, hiking and keeping active. Photo: Nuria Ling/TODAY

WELL-DRESSED & SUCCESSFUL: HOW CAN IT BE YOU?

Once a "high-functioning" depressive, client relation executive Serene Quek, 33, was diagnosed with depression in 2013 after her divorce.

She said: "I was in a relatively high position during my corporate days, (I was) dressed well every day … my job was to give consultations to agents when I was working in insurance."

Only after she left the firm did her colleagues find out about her condition. She added: "When I told them I was actually suffering from depression, they didn't believe me.

"Some said, 'How can you be suffering from depression? You're always smiling!'"

While Ms Quek weaned herself off anti-depressants two years ago, and has successfully overcome depression by focusing on charity work and her new business, she admitted that the condition is something that needs to be managed actively.

"You need to be aware of your mental state and overall well-being, avoid your triggers, and know how to deal with your symptoms," said Ms Quek, founder of health consultancy agency Blanc Medical and Health concierge.

For Ms D'Cruz, depression was something she struggled with throughout her working life, even when she was working as a marketing staff in the beverage industry in 2017.

"My colleagues didn't know, some would probably have guessed when they saw me crying in a corner, but others who didn't pay attention, they just wouldn't know," said Ms D'Cruz, who is currently unemployed.

STILL A STIGMA

Another reason why it can be hard to identify individuals with "high-functioning" depression is because many sufferers hide their conditions.

Dr Lee said that some of his patients "refuse" to take a Medical Certificate of Leave (MC). "They say, 'when I give the MC to human resources, they will think I'm having some psychiatric issue'.

"There's still this notion, especially for high ranked professionals, that you cannot be seen to be weak, otherwise, you lose that respect and credibility. People still view depression as a weakness."

Dr Lee said that one risk of undiagnosed and high-functioning depression is the possibility of social relationships being affected.

It could also result in substance or alcohol abuse, he added, as many smoke and drink, or turn to drugs, "in order to continue functioning at such a high level".

There are others, however, who are on medication, but are high-functioning patients.

Ms Tey Siang Fang, who was first diagnosed with depression in April this year, manages her condition with medical treatment, and her hobby, knitting. She started a knitting business, MadeByFang, in September this year.

"Knitting is therapeutic for me, I can clear my mind of negative thoughts," she said.

A double exposure image of Ms Tey Siang Fang, 32, and her knitting and crocheting implements. She was diagnosed with clinical depression in April 2018, but relapsed after suicide attempts in Aug 2018. Ms Tey has started an online knitting and crocheting business, MadeByFang. Photo: Nuria Ling/TODAY

HIGH-FUNCTIONING, OR RECOVERING?

Despite the widespread use of the term high-functioning, some psychiatrists, however, cautioned that it may not be the best way to present the illness.

IMH's Dr Fung said: "High functioning is a difficult concept to accept in illness because illness, by its very nature must have some impact on function. So if you're high-functioning, you should not be ill. You may be recovering (instead)."

He added that for chronic illnesses such as depression, there could be a "period of good function" in between occasions of relapse.

"Hence, 'high-functioning' could not really be the right way to present illness. Someone could still go to work, for example. But functioning is not just about work, or school. It's about social relationships as well."

However, Dr Fung acknowledged that there is no harm using the term as it could be "validating" for patients as they are still able to achieve their goals.

Patients suffering from depression said that regardless of function, it is crucial for those battling the condition to recognise the need to seek help from family, friends or doctors.

"Accept and love yourself for who you are. Don't give up just because one treatment doesn't work," said Ms D'Cruz. 

"Do something for yourself by taking ownership of your illness."

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