Psychiatrist warns of silent depression that keeps patients moving

Dr. Judith Joseph, a psychiatrist, warns that a large number of people are suffering from a form of depression that does not stop them from working. She identifies this condition as high-functioning depression, a state where individuals continue to meet professional and domestic obligations while quietly losing the ability to feel joy.

Joseph describes this condition as the silent sister of depression. While traditional depression is characterized by crying and an inability to get out of bed, high-functioning depression manifests as numbness. The individual remains active but internally disconnected, a dynamic Joseph argues is an existential crisis that is frequently ignored.

A peer-reviewed study published in the journal Cureus provides data supporting Joseph's observations. The research team, which included Joseph, interviewed adults using questionnaires designed to measure high-functioning depression, trauma, and anhedonia. Anhedonia is defined as a reduced capacity to feel pleasure or interest in activities that previously brought satisfaction.

The study results indicated that participants with higher scores for anhedonia also reported higher levels of high-functioning depression. The data showed a strong correlation between the two conditions, validating the researchers' hypothesis that these symptoms often travel together. The findings suggest that the inability to feel joy is a central component of this specific type of depression.

Parents and caregivers emerged as the group with the highest scores in the study. These participants reported the most severe levels of both anhedonia and high-functioning depression. The results point to a demographic that is often under immense pressure to maintain stability for others, potentially masking their own internal decline.

Joseph notes that high-functioning depression is not an official diagnosis in the DSM-5, the manual clinicians use for mental health conditions. She argues that this lack of a formal label contributes to the problem. People who continue to function often do not recognize their symptoms or seek treatment until they reach a state of burnout.

The psychiatrist frequently encounters this pattern in women who serve as the steady presence in their households and workplaces. These individuals focus so intently on their responsibilities that they fail to notice they are nearing a breaking point. Joseph states that eventually, the pressure becomes unsustainable, leading to a clinical depression, a physical breakdown, or a crisis.

Joseph has observed patients arriving in emergency rooms without understanding their symptoms, only to discover they had been carrying unresolved emotional pain. She says the pattern is common in professions that discourage vulnerability, including medicine, where crying after a patient death was historically viewed as weakness. In these environments, clinicians are often trained to look for mania or psychosis rather than the loss of joy.

To help people identify these symptoms, Joseph developed an anhedonia quiz based on the Snaith-Hamilton Pleasure Scale. The questionnaire asks about everyday experiences, such as the ability to enjoy praise, savor meals, or feel satisfaction from work accomplishments. Joseph emphasizes that the quiz is a self-assessment tool, not a diagnostic instrument, designed to help individuals take stock of their emotional state.

In her book, High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy, Joseph outlines a framework she calls the Five V's. This approach includes validation of feelings, venting through expression, prioritizing values, maintaining a vision for the future, and caring for vitals through sleep, nutrition, and movement. Joseph says anhedonia can appear in midlife and other stages, making detection a necessary skill for both patients and providers.

Those in crisis can call or text 988 to reach the Suicide and Crisis Lifeline. Joseph believes there needs to be more clinical focus on anhedonia, as it is a silent problem that requires active detection.