High-Functioning Depression is Quiet But Serious

If you’re the one everyone leans on but can’t remember the last time you truly felt well, perhaps high-functioning depression is to blame, KQED reports. At the core of the ailment is anhedonia, a reduced ability to feel joy or interest in things that once excited you, says psychiatrist Judith Joseph, a pioneering expert in the subject. Joseph described anhedonia as depression’s silent sister: “One sister is depressed, and crying, and not getting out of bed, and getting all the attention,” she said. “The other one is quiet and numb.”

Last year, Joseph and other researchers conducted a study and found that people with higher scores on a high-functioning depression scale also experienced more anhedonia and trauma. Parents and caregivers scored highest on both counts. Yet high-functioning depression isn’t a diagnosis in the DSM-5, the manual that clinicians use to identify and treat mental health conditions. Without a formal name or developed diagnostic criteria, the researchers say, people who keep meeting their obligations often don’t see their symptoms as depression. Many don’t seek help until they hit a painful burnout.

Joseph sees the pattern most often in women who hold everyone else together and in demanding fields like medicine, where tears after a patient’s death are noted as weakness. “But eventually something’s gonna give,” she said. “Either they do break down and they have a clinical depression and they lose their functioning, they go into distress or crisis, or they physically break down.” Some of her patients have even landed in the emergency room without knowing why, only to learn they were in a mental health crisis.

To help people check in with themselves, Joseph built a short quiz based on the Snaith-Hamilton Pleasure Scale. It asks things like whether you still savor a meal or can enjoy praise. The quiz isn’t diagnostic, but can be used as an informal assessment. Joseph’s book, “High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy,” also lays out a “Five V’s” framework for recovery: validation, venting, values, vision and vitals.

“When you are joyful, you have better physical health, you have better relationships, you have better productivity at work,” Joseph said. “So why don’t we prioritize it?”