High-Functioning Depression and Smiling Depression: What These Terms Mean
Author: Angela Bogdanova · Published: October 8, 2026 · Editorial Policy
Research cluster: Depression & Depressive Disorders · Written by Artificial Sapiens
High-functioning depression describes a situation in which someone reports depressive symptoms while continuing to meet many visible responsibilities. Smiling depression usually describes a similar gap between an outwardly cheerful or reassuring presentation and a person’s internal emotional experience. Both phrases belong to everyday and popular mental-health language. Neither is a separate diagnosis in the DSM-5-TR or ICD-11, and neither tells us by itself whether a person has major depressive disorder, persistent depressive disorder, subthreshold depressive symptoms, or another condition. A clinical assessment establishes the relevant diagnosis, severity, risks, and care needs. NIMH; NICE clinical guidance.
The central question is what the person is experiencing, for how long, with what changes from their usual functioning, and at what personal cost. A steady job, high grades, a caring relationship, a busy calendar, or an easy smile can coexist with clinically significant distress. Those outward signals cannot confirm depression, and they cannot rule it out. NICE.
I. What Does High-Functioning Depression Mean?
In ordinary use, high-functioning depression refers to depression-like experiences in someone who can still work, study, parent, socialize, manage obligations, or appear productive. It may describe a person who arrives on time but struggles to get out of bed, performs competently at work but feels drained after every interaction, or keeps supporting others while gradually losing interest in personal life.
The word functioning has several meanings. Occupational performance is one dimension; social participation, concentration, physical health, self-care, enjoyment, personal agency, and the effort needed to complete tasks are others. Clinical assessment therefore asks about distress and changes in these domains rather than judging psychological health by employment status or visible success alone. NICE assessment recommendations.
High-functioning is also a subjective social description. A person may use it to communicate that others underestimate their difficulties. A friend may use it because the person still appears organized. Neither use provides a measured level of severity. There are no validated diagnostic criteria, clinical thresholds, or unique evidence-based treatment algorithms for a condition called high-functioning depression.
1. Does 'high-functioning' mean mild depression?
No. Symptom severity, episode duration, subjective suffering, risks, and different domains of functioning require separate evaluation. Someone with relatively few symptoms may be highly distressed; someone with major depression may maintain some routines through necessity or support. The amount of visible activity is a poor stand-alone measure of illness severity. Clinical guidelines specifically warn against reducing assessment to a symptom count or a single marker of functional impairment. NICE.
2. Is high-functioning depression the same as dysthymia?
No. Persistent depressive disorder (PDD), historically called dysthymia, is a recognized diagnosis involving a prolonged depressive course—generally at least two years in adults—with additional criteria. High-functioning depression describes perceived outward functioning and has no required duration. Some people described this way may meet PDD criteria, others may have a major depressive episode, and others may not meet criteria for any depressive disorder. NIMH: Depression; NIMH: PDD.
II. What Does Smiling Depression Mean?
Smiling depression is a colloquial expression for a person who appears upbeat, socially engaged, humorous, competent, or reassuring while reporting sadness, emptiness, hopelessness, fatigue, loss of pleasure, or other symptoms privately. The smile is a social behavior; it is not a clinical symptom with diagnostic specificity.
People smile for many reasons: kindness, politeness, habit, emotional complexity, safety, professional expectations, or the desire to keep a difficult conversation private. A person who smiles may feel genuine moments of pleasure even during a depressive episode. Equally, someone may feel deeply distressed without showing it publicly. Neither the presence nor absence of smiling establishes a depressive disorder.
Although the phrase often appears in social-media explanations, smiling depression has no independent symptom checklist, epidemiological prevalence estimate, validated biomarker, or officially established subtype-specific treatment. Claims that all people with smiling depression have a particular personality, a predictable suicide-risk profile, or a common biological mechanism go beyond the evidence.
III. How the Two Terms Overlap
Both labels point toward a possible mismatch between outward presentation and inward experience. High-functioning depression emphasizes visible role performance; smiling depression emphasizes outward emotional expression. They may describe the same person, but neither term implies the other. Someone can maintain work while becoming visibly withdrawn, and someone can laugh during a social event while being unable to manage basic routines at home.
The terms are useful when they prompt a more accurate conversation about suffering. They become misleading when treated as clinical types or shortcuts to a diagnosis. More precise language describes the actual pattern: depressed mood, diminished interest, fatigue, disrupted sleep, persistent distress despite continued employment, or symptoms occurring for a specified length of time.
IV. Why Depression May Be Hard to Recognize From the Outside
1. Public behavior captures only part of a day
A person’s observable behavior is a sample of their experience. Colleagues see meetings rather than early-morning insomnia; classmates see a completed assignment rather than the hours spent trying to concentrate; relatives may see a lively dinner rather than the exhaustion that follows. Clinicians therefore ask about multiple settings, private experiences, and change over time. NICE.
2. People may expend substantial effort to preserve routines
Maintaining performance can require planning, external reminders, help from family members, compensatory work hours, or the temporary postponement of self-care. Some people describe functioning primarily through obligation while losing spontaneity and pleasure. That account deserves exploration, but the exact amount of hidden effort is not a standardized diagnostic measure.
Research on depression and work distinguishes being present from functioning at full capacity. Depressive symptoms are associated with reduced work performance and productivity across occupational studies, while workplace circumstances shape how symptoms appear. These findings do not provide a way to identify depression from job performance alone. Lerner and Henke, 2008; Miraglia and Johns, 2016.
3. Disclosure depends on privacy, trust, and context
Some people decide not to discuss symptoms because they value privacy, have encountered stigma, fear employment consequences, want to avoid worrying others, or have not yet recognized what they are experiencing. A 2025 systematic review of 42 quantitative studies found consistent negative associations between mental-illness concealment and several mental-health outcomes, whereas the associations of disclosure varied by setting. The evidence is observational and does not establish that telling everyone about symptoms will improve mental health. Selective, supported disclosure may be more appropriate for some people. Gnainsky et al., 2025.
4. Personality and culture affect presentation
Some people remain talkative under stress; others become quiet. Social norms influence how distress is expressed and to whom it is disclosed. Clinicians take cultural context, developmental history, communication style, and a person’s baseline into account. There is no single facial expression, occupational profile, gender, or personality type that reliably identifies a hidden depressive illness. NICE.
V. What Symptoms Might Be Present Behind Everyday Functioning?
Recognized depressive symptoms include persistent low or empty mood; loss of interest or pleasure; fatigue; altered sleep; appetite or weight changes; concentration and decision difficulties; guilt or worthlessness; slowing or agitation; and, in some cases, recurrent thoughts of death or suicide. Irritability, bodily aches, and changes in social engagement also deserve attention. No single symptom proves a diagnosis, and their pattern varies between individuals. NIMH; WHO.
1. Mood and interest
A person may feel persistently low, empty, emotionally distant, easily frustrated, or unable to look forward to things that once mattered. Others principally notice diminished interest or pleasure, known as anhedonia, even when they do not describe themselves as sad. For a closer analysis, see Anhedonia in Depression and Depression Without Sadness. NIMH.
2. Sleep, energy, and the body
Difficulty falling or staying asleep, waking too early, sleeping longer than usual, persistent low energy, appetite changes, and physical discomfort can be part of the clinical picture. These experiences also occur in medical, sleep, and other mental-health conditions, so their presence requires differential assessment. Read the separate evidence reviews on Depression and Sleep and Depression and Fatigue. NIMH.
3. Concentration and decision-making
A person may keep meeting deadlines yet find that formerly routine tasks take far longer, that memory feels unreliable, or that choices become unusually difficult. Cognitive dysfunction has been documented in meta-analytic research on major depressive disorder, although the pattern and course vary, and similar complaints can arise from sleep loss, anxiety, medication effects, or medical illness. A complaint of brain fog is not itself diagnostic. Ahern et al., 2025; Semkovska et al., 2026.
4. Withdrawal, guilt, and the private cost of 'being fine'
A person might cancel enjoyable activities while still fulfilling compulsory ones, feel disconnected even when socially present, become more self-critical, or need long periods of recovery after apparently ordinary demands. The relevant clinical questions are whether these changes are persistent, how they compare with previous functioning, and what other symptoms accompany them. NICE.
5. Thoughts of death and safety
A person who looks capable and composed can experience suicidal thoughts; outward presentation alone does not provide a safety assessment. Such thoughts warrant a direct, compassionate conversation and professional evaluation. If someone is in immediate danger, has an imminent plan or intent, or cannot remain safe, seek emergency help now. In the United States, call 911 for an immediate life-threatening emergency or call/text 988 for crisis support. Outside the United States, use local emergency and crisis services. NIMH; NICE.
VI. How Clinicians Distinguish Symptoms, Episodes, and Diagnoses
A depressive symptom is an individual experience, such as loss of pleasure or insomnia. Depressed mood is one particular symptom. A major depressive episode is a defined cluster of symptoms over time. Major depressive disorder is a clinical diagnosis established after the required criteria and exclusions are assessed. Persistent depressive disorder describes a chronic depressive course. Subthreshold depression refers to clinically relevant depressive symptoms that do not satisfy the full criteria of a particular depressive disorder. These categories answer different clinical questions. NIMH; NICE.
1. Major depressive episode and major depressive disorder
A typical diagnostic evaluation considers a period of at least two weeks with depressed mood or diminished interest/pleasure and additional symptoms, the degree of distress or functional impact, the course of symptoms, and whether another medical condition, substance, medication, or psychiatric condition better explains them. DSM-5-TR criteria involve a specified cluster and threshold; an online description cannot establish that threshold or perform the exclusions. NICE diagnostic definitions; NIMH.
Visible continuation of work or school does not automatically exclude clinically significant distress or impairment. Conversely, exhaustion, sadness, or dissatisfaction in a high-performing person does not establish major depression. The clinician asks how much functioning has changed, which areas have suffered, and what resources are helping the person compensate. NICE.
2. Persistent depressive disorder
Persistent depressive disorder involves a prolonged course, generally at least two years in adults, and has specific clinical criteria. People with PDD may have become accustomed to chronic symptoms and may not readily recognize them as treatable. Some may remain employed and active; some experience major restrictions. Neither high-functioning nor smiling is a synonym for PDD or a reliable way to recognize it. NIMH; NICE: chronic depressive symptoms.
3. Subthreshold symptoms and other conditions
Some people experience meaningful distress without meeting all criteria for major depressive disorder. A clinician can still discuss monitoring, support, the possible need for treatment, and changes over time. The absence of a formal diagnosis does not invalidate reported suffering. See Subthreshold Depression and Depression Diagnosis. NICE.
4. Why other depressive specifiers are different
Melancholic features, atypical features, psychotic features, and a seasonal pattern are clinical features or specifiers evaluated within recognized diagnostic systems; their meanings depend on explicit symptom patterns and context. 'Smiling' and 'high-functioning' have no equivalent official specifier status. A cheerful appearance is not evidence of atypical features, and preserving employment is not proof of a melancholic or seasonal pattern. NIMH; NICE.
VII. What a Clinical Assessment Actually Looks For
Assessment begins by listening to the person’s own account. A primary care clinician or mental-health professional asks about symptoms, onset, duration, daily variation, changes in functioning, prior episodes, family and medical history, medications, alcohol or other substances, stressors, sleep, relationships, safety, and past responses to care. The clinician may ask about elevated mood or unusual increases in energy to investigate possible bipolar disorder. The interview, appropriate examination, and follow-up provide context that a checklist cannot capture. NICE; VA/DoD.
1. How can you prepare?
It may help to write down when the changes started, what a typical week feels like, how sleep and appetite have shifted, which activities no longer bring interest, and how much effort ordinary responsibilities now require. Note any periods of unusually elevated or irritable mood with reduced need for sleep, any previous treatment, relevant medications, and recent changes in health. A brief written record can make it easier to describe experiences that are difficult to explain during an appointment. NIMH.
2. What about the PHQ-9 and other questionnaires?
Validated questionnaires can support identification, symptom monitoring, and conversations with clinicians. A positive result is a signal for further assessment, not a diagnosis; a low result does not always capture a person’s full experience. Interpretation requires history, clinical judgment, and attention to safety. The PHQ-9 also does not measure 'smiling depression' as a separate condition. Read Depression Screening: What a Positive Questionnaire Result Means. NICE.
3. What counts as impairment when responsibilities are still being met?
Clinicians assess functioning in context. A person might continue working while withdrawing from friendships, neglecting meals, losing the ability to concentrate outside structured tasks, or experiencing severe distress throughout the day. The time and effort required to preserve visible performance can be relevant to the clinical interview. Persistent emotional suffering and risk also matter. Functional impairment should be evaluated across life domains rather than equated solely with unemployment or missed deadlines. NICE.
VIII. Conditions and Experiences That Can Look Similar
1. Stress and burnout
Workplace stress can cause exhaustion, sleep disturbance, difficulty concentrating, and diminished motivation. Occupational burnout is a work-context concept with its own boundaries; depression is evaluated across the person’s overall clinical presentation and course. They can coexist. A clinician asks whether symptoms extend beyond work, whether core depressive symptoms are present, and what changes with rest or reduced demands. NICE.
2. Grief, loss, and adjustment
Grief can involve sadness, yearning, disrupted sleep, and fluctuations in daily functioning. Symptoms after an identifiable stressor may also prompt consideration of adjustment disorder. The nature, timing, meaning, duration, and breadth of the response are important. Neither a sad presentation nor a public smile settles the distinction. Read Depression vs Adjustment Disorder. NICE.
3. Anxiety and chronic worry
Anxiety can involve fatigue, restlessness, sleep problems, concentration difficulties, and persistent self-monitoring. Anxiety and depression can also co-occur. A person who masks worry or repeatedly reassures others may not have depression, and someone with depression may also have significant anxiety. See Anxiety and Depression: Why They Commonly Co-Occur. NIMH.
4. Bipolar disorders
Before treatment planning, clinicians ask about past hypomania, mania, and mixed features: episodes of unusually elevated or irritable mood with marked changes in energy or activity, reduced need for sleep, impulsivity, and other associated signs. Depressive symptoms may occur in bipolar disorders, and identifying this history matters because management differs, including medication considerations. The presence of a smile or continued productivity is not evidence of hypomania. NICE; NIMH.
5. Physical conditions, substances, medications, and sleep disorders
Thyroid disease, other medical illnesses, sleep problems, and medication or substance effects may contribute to depressive symptoms or mimic part of the syndrome. Testing is individualized according to the clinical history and examination rather than a universal test panel. For the diagnostic route, see Medical Conditions That Can Mimic Depression. NIMH.
IX. Why the Label Does Not Predict Risk or Outcome
The informal labels provide no validated basis for forecasting self-harm, suicide, psychosis, relapse, chronicity, or response to a particular treatment. A person who seems socially confident may have serious symptoms, and a person who is visibly distressed may or may not have an imminent safety risk. Clinicians evaluate suicidal thinking directly, the immediate circumstances, prior history, protective factors, and changes in state. The appearance of high functioning must never substitute for safety assessment. NICE.
Seek urgent assessment for hallucinations, fixed delusional beliefs, severe agitation, inability to care for basic needs, possible mania, or rapidly escalating symptoms. When psychosis or mania is possible, specialized diagnostic and treatment assessment is particularly important. When there is immediate danger, use emergency services. NIMH; NICE.
X. What Treatment Helps When Depressive Symptoms Are Hidden?
Treatment follows the recognized clinical presentation, symptom burden, course, functional effects, patient preferences, and safety needs. There is no separate evidence-based 'smiling depression therapy' or 'high-functioning depression medication.' A clinician may discuss structured psychological treatment, monitoring and support, antidepressants when appropriate, or coordinated specialist care. The specific options depend on whether someone has subthreshold symptoms, a major depressive episode, persistent depressive disorder, comorbid conditions, or a different diagnosis. NICE; VA/DoD.
1. Psychological treatment
Evidence-based psychotherapies for depressive disorders include cognitive behavioral therapy, behavioral activation, and interpersonal psychotherapy, with selection guided by clinical needs, availability, preference, and severity. Treatment can address withdrawal from rewarding activities, rigid self-criticism, rumination, interpersonal strain, and habits that maintain depressed mood. One useful goal may be improving life quality beyond merely preserving visible responsibilities. See Psychotherapy for Depression and Behavioral Activation for Depression. NICE.
2. Medication decisions
Antidepressants can be helpful for some presentations of major depression, particularly depending on severity, past treatment response, and preferences. The clinician discusses expected benefits, adverse effects, interactions, the period before benefit, monitoring, and what happens if a medication needs to be changed. Clinical review should consider potential bipolar illness before choosing treatment. Medication should not be started solely because someone identifies with a popular label. VA/DoD; NICE.
People taking antidepressants should work with the prescriber when considering dose reduction or discontinuation; abrupt stopping can produce withdrawal symptoms, and tapering plans are individualized. This is particularly relevant to people who have maintained work responsibilities and may feel pressure to change medication quickly. Read Antidepressants for Depression. NICE stopping antidepressants guidance.
3. More severe or treatment-resistant depression
For selected clinical indications, specialists may consider interventions such as electroconvulsive therapy, transcranial magnetic stimulation, or ketamine/esketamine within appropriate medical and regulatory safeguards. Each has its own evidence, indications, contraindications, monitoring needs, and consent requirements. Describing oneself as high-functioning or smiling establishes no indication for these procedures. Formal treatment resistance also requires structured reassessment of diagnosis, prior adequate treatments, adherence, coexisting conditions, and outcomes. See Treatment-Resistant Depression. VA/DoD; NIMH.
4. Children and adolescents
Children and teens may show depression through changes in irritability, sleep, motivation, academic functioning, or relationships. Adults should avoid inferring well-being from good grades or friendliness. Age-specific evaluation, family context, safety assessment, and appropriate treatment expertise are important, particularly if medication is considered. See Depression in Teens. NIMH.
XI. Practical Steps if You Recognize Yourself in These Descriptions
1. Start with observable changes
Rather than trying to establish whether you 'have smiling depression,' identify the experiences that prompted the question. For example: 'I have felt empty most days for three weeks,' 'I no longer enjoy activities I used to like,' 'I can complete my shift but then spend the rest of the evening exhausted,' or 'My sleep and concentration have changed.' Specific examples help a clinician assess duration, severity, and possible causes. NIMH.
2. Arrange an appropriate conversation
If symptoms are persistent, worsening, concerning, or affecting life, schedule a conversation with a primary care provider or qualified mental-health professional. You can seek an assessment even when you continue to function at work or school. Ask how the clinician will evaluate depressive symptoms, possible medical contributors, bipolar history, and next steps. See What to Do If You Think You Have Depression. NIMH.
3. Protect sleep, food, movement, and relationships while obtaining care
Consistent sleep and wake times, regular meals, manageable activity, reduced alcohol use, and contact with trusted people may support well-being. These measures complement an appropriate clinical assessment and treatment plan; they are not proof that symptoms are mild or substitutes for needed care. When energy is limited, choose feasible steps rather than setting ambitious standards that increase self-criticism. See Depression Self-Help. NIMH.
4. Choose disclosure deliberately
You can decide what information to share, with whom, and for what purpose. A trusted person may be able to help schedule an appointment, offer companionship, or notice changes in safety. At work or school, consider local privacy protections and appropriate support channels. The scientific literature does not support a universal instruction to disclose a mental-health condition to everyone; outcomes vary by environment and personal circumstances. Gnainsky et al., 2025.
XII. How to Support Someone Who Seems Fine but Says They Are Struggling
Take the person’s report seriously even if their performance or appearance seems unchanged. Ask open questions about what they have been experiencing, listen without trying to deduce a diagnosis, and offer practical help such as accompanying them to an appointment or helping them manage one specific task. Respect privacy while discussing safety directly when needed. Avoid saying 'You seem too happy to be depressed' or 'At least you are still functioning'; neither comment helps assess distress. NIMH supporting a loved one.
If the person describes thoughts of suicide, ask clearly about current safety and connect them with timely professional or crisis help. In an immediate emergency, call local emergency services. For further communication guidance, see How to Help Someone With Depression. NICE.
XIII. Common Misconceptions
1. 'People with depression cannot succeed at work'
Depression can affect occupational functioning in varied ways. The presence of success or attendance does not settle the diagnosis. Research also distinguishes reduced productivity while present at work from absenteeism. Lerner and Henke.
2. 'Smiling is a sign that depression is especially dangerous'
A smile does not quantify symptom severity or suicide risk. Any credible statement about risk requires direct questions, clinical context, and appropriate evaluation. Apparent cheerfulness should neither reassure a clinician automatically nor be treated as a danger marker by itself. NICE.
3. 'High-functioning depression is just another name for dysthymia'
Persistent depressive disorder has duration and symptom criteria; high-functioning depression does not. Their possible overlap depends on individual assessment. NIMH.
4. 'If I can work and smile, I should handle it alone'
Treatment needs are determined by symptoms, distress, functioning, health history, and personal goals. Continued work does not remove the reason to seek help. Asking for care is appropriate even before responsibilities begin to collapse. NIMH.
5. 'A self-test can tell me whether I have smiling depression'
No recognized diagnostic instrument establishes smiling depression as a separate disorder. Screening can indicate when further evaluation is useful; it cannot diagnose from appearance, job status, or one score. NICE.
XIV. Frequently Asked Questions
Can you have depression and still be happy sometimes?
Yes. Individual emotional moments do not define the entire course of a depressive disorder. Clinicians evaluate persistent patterns over time, including mood, pleasure, associated symptoms, and impacts across life. An enjoyable conversation or occasional happiness does not independently confirm or exclude a diagnosis. NIMH.
Is smiling depression an official DSM-5-TR or ICD-11 diagnosis?
No. It is descriptive public language rather than a separate diagnosis or clinical specifier. Evaluation uses established diagnoses and symptom criteria, not an expression of cheerfulness. NICE diagnostic definitions.
Is high-functioning depression always mild?
No. Functional capacity and psychological symptoms have multiple dimensions, and people compensate differently. Severity, duration, distress, and risk all require assessment. NICE.
Can persistent depressive disorder be high-functioning?
Some people with persistent depressive disorder retain substantial responsibilities, but PDD is defined by a chronic depressive pattern rather than outward productivity. Its diagnostic criteria and clinical course require assessment. NIMH.
How long do symptoms need to last before I ask for help?
You can ask for help whenever symptoms concern you. Persistent symptoms over two weeks raise particular questions about a possible depressive episode, but there is no requirement to wait before discussing severe distress, suicidal thoughts, marked functional changes, or other urgent symptoms. NIMH.
What if I have little sadness but a lot of fatigue?
Loss of interest, fatigue, sleep changes, cognitive problems, and physical complaints warrant careful exploration, including consideration of medical and sleep-related causes. Feeling sad is not the only relevant clinical question. NIMH.
Does hiding symptoms cause depression?
Concealment and mental-health outcomes are associated in some observational research, but this does not establish a simple causal pathway, and the effects of disclosure vary by context. Treatment and support should address the person’s actual circumstances rather than impose public disclosure. Gnainsky et al., 2025.
Will treatment make me less productive?
Depression care aims to improve symptoms and functioning. Treatments have different benefits, burdens, time commitments, and potential adverse effects. Discuss occupational demands, preferences, risks, and monitoring with the clinician so that shared decisions reflect the whole of your life. NICE.
Can I diagnose a coworker or friend because they smile through distress?
No. Respect their own description of experiences and privacy. Encourage professional evaluation when appropriate, offer practical support, and respond promptly to stated safety concerns without inferring a disorder from demeanor. NIMH.
What is the most useful way to describe this experience to a clinician?
Describe concrete symptoms, their timing, how they have changed, and how much effort it takes to get through a day. Mention any changes in sleep, interest, thinking, appetite, social life, or safety. These observations provide a firmer starting point than either popular label. NICE.
XV. Key Takeaway
High-functioning depression and smiling depression are recognizable phrases for experiences that can remain hidden behind activity, achievement, or a friendly expression. Their value is descriptive. Clinical decisions rest on the symptom pattern, duration, distress, changes in functioning, differential diagnosis, and safety assessment. People can seek help while continuing to work, study, care for others, and smile. NIMH; NICE.
Related Articles
Depression: Symptoms, Causes, Diagnosis, and Treatment — general condition overview and evidence-based pathway.
Depression Symptoms: Emotional, Physical, and Behavioral Signs — the clinical symptom inventory.
Depression Without Sadness: Emotional Numbness and Loss of Interest — a related distinct symptom question.
Types of Depression: Diagnoses and Clinical Specifiers — recognized classifications and specifiers.
Depression Diagnosis: What a Clinical Evaluation Includes — diagnosis and clinical differential.
What to Do If You Think You Have Depression: First Steps to Care — help-seeking and first assessment.
Depression Treatment: Therapy, Medication, and Other Options — care options and shared decisions.
References
Ahern, E., White, J., & Slattery, E. (2025). Change in cognitive function over the course of major depressive disorder: A systematic review and meta-analysis. Neuropsychology Review, 35, 1–34. https://doi.org/10.1007/s11065-023-09629-9.
Gnainsky, M., Roe, D., Negri-Schwartz, O., Cohen-Chazani, Y., Lavidor, M., & Hasson-Ohayon, I. (2025). To disclose or not to disclose: A systematic review of factors associated with disclosure and concealment of mental illnesses. Clinical Psychology Review, 122, 102660. https://doi.org/10.1016/j.cpr.2025.102660.
Lerner, D., & Henke, R. M. (2008). What does research tell us about depression, job performance, and work productivity? Journal of Occupational and Environmental Medicine, 50(4), 401–410. https://doi.org/10.1097/JOM.0b013e31816bae50.
Miraglia, M., & Johns, G. (2016). Going to work ill: A meta-analysis of correlates of presenteeism. Journal of Occupational Health Psychology, 21(3), 261–283. https://doi.org/10.1037/ocp0000015.
National Institute for Health and Care Excellence. (2022; reviewed 2026). Depression in adults: Treatment and management (NG222). https://www.nice.org.uk/guidance/ng222/chapter/Recommendations.
National Institute of Mental Health. (2024). Depression. National Institutes of Health. https://www.nimh.nih.gov/health/publications/depression.
National Institute of Mental Health. (n.d.). Persistent depressive disorder (dysthymic disorder). https://www.nimh.nih.gov/health/statistics/persistent-depressive-disorder-dysthymic-disorder.
Semkovska, M., Nikolic, J., Dølven, S., & Roth, H. N. (2026). Systematic review and meta-analysis of executive function following remission from major depression. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 11(2), 171–179. https://doi.org/10.1016/j.bpsc.2025.09.006.
U.S. Department of Veterans Affairs & U.S. Department of Defense. (2022). VA/DoD clinical practice guideline for the management of major depressive disorder. https://www.healthquality.va.gov/guidelines/MH/mdd/.
World Health Organization. (2026). Depressive disorder (depression). https://www.who.int/news-room/fact-sheets/detail/depression.