Psychiatrist identifies 'silent' depression in high performers

Indianapolis psychiatrist Dr. Judith Joseph says a specific form of depression often goes undetected because the people experiencing it never stop moving. She labels this condition high-functioning depression. These individuals continue to meet obligations at work and at home. However, they are quietly losing the capacity to feel pleasure.

Joseph describes the core symptom as anhedonia. This is a reduced ability to experience joy or interest in things that previously brought satisfaction. She calls it the silent sister of depression. The classic presentation involves a person crying and unable to get out of bed. In contrast, the high-functioning individual remains quiet and numb while still functioning.

Joseph argues that this numbness is an existential crisis. It is not just a minor mood shift. She notes that joy contributes to better physical health, relationships, and productivity. Yet society rarely prioritizes the preservation of that joy. When a person stops feeling good, the damage accumulates silently.

A peer-reviewed study published in the journal Cureus supports her observations. Joseph and her colleagues interviewed adults using questionnaires for high-functioning depression, trauma, and anhedonia. The data confirmed that people with high-functioning depression have higher levels of anhedonia and trauma. Participants with higher anhedonia scores also scored higher for high-functioning depression.

The study found that parents and caregivers had the highest scores for both anhedonia and high-functioning depression. The authors note that high-functioning depression is not an official diagnosis in the DSM-5. This lack of formal status means many people do not recognize their symptoms. They often wait until they reach a state of burnout before seeking treatment.

Joseph says she frequently sees this pattern in women who serve as the steady presence for their families. These women focus intensely on their responsibilities. They often do not realize they are close to breaking down. Joseph warns that eventually the pressure leads to a crisis. Patients may end up in the emergency room with physical symptoms, only to discover they were carrying unresolved emotional pain.

The pattern is common in professions that discourage vulnerability. In medicine, Joseph says, crying after a patient dies was historically viewed as weakness. Clinicians are trained to look for mania or psychosis. Joseph believes more attention should be paid to anhedonia. She developed a quiz based on the Snaith-Hamilton Pleasure Scale to help people take stock of their capacity for pleasure.

In her book, High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy, Joseph outlines a framework called the Five V's. This includes validation, venting, values, vision, and vitals. The framework encourages naming feelings, expressing emotions, and caring for the whole self. Joseph says anhedonia appears in many people, particularly in midlife. It is a problem that needs better detection methods. For those in crisis, the Suicide and Crisis Lifeline is available at 988.