This article originally appeared on Tonic in the US.

Monique Judge, 46, describes herself as "an extroverted introvert." She's always active and on top of things at work, takes part in regular yoga classes, and frequently goes out with her friends—even though she prefers unwinding in front of the TV at home. But seven years ago, after shooting up the consumer finance career ladder, she started feeling tired all the time. When she wasn't working, she couldn't motivate herself to get out of bed. Instead, she just lay in bed all day, sleeping on and off. A friend recognized her symptoms and eventually recommended Judge see a doctor. The diagnosis, it turned out, was depression.

"I still have extreme low points," Judge says. "I've quit that job and I'm at a brilliant position in my career, but there's always a cloud that I'm trying to avoid, that you might not even recognize from the outside."

On the surface, high-functioning depression may seem like it's easier to deal with, but it can persist for years, leading to more functional impairment over time than acute episodes of major depression, Craske says. Research has shown that the low self-esteem, lack of energy, irritability, and decrease in productivity that accompanies persistent depression is associated with significant long-term social dysfunction, psychiatric hospitalizations, and high rates of suicide attempts. And, ironically, persistent depression also puts people at a higher risk for major depressive episodes with more severe symptoms.

But the stigma around mental illness—or any signs of weakness—prevents people from revealing their stress to friends and colleagues. In some cases, racial and ethnic minorities as well as immigrant populations may feel even more pressured to hide their condition with jokes and laughter. "If you admit that you're depressed or you have a mental health issue, people on the outside, who are not dealing with that, automatically label you as being crazy," Judge says.

That means that many who need help may never ask for it. They may not even know how to identify depression in themselves. It's a trait that's particularly concerning because depression doesn't discriminate, says Srijan Sen, a psychiatrist at the University of Michigan. About 20 percent of Americans can expect to develop mood disorders (which include all forms depression and bipolar disorder) during their lifetime. Yet half of Americans with depression don't get treatment for the condition.

Read the full article at Vice.