#1 Researcher: 7 Signs You May Have High Functioning Depression

KEYPOINTS

• 01

  Many people with depression don't fit the standard checklist

  Psychiatrist and researcher Dr. Judith Joseph says that under the DSM-5, someone with many symptoms of depression but no loss of functioning or obvious distress is often told to come back when things get worse. She calls that model 'broken'. It misses people before they reach crisis, turn to unhealthy coping, or break down physically. The term 'high-functioning depression' has been around for about five years; she didn't coin it, but she is researching it.

• 02

  High-functioning depression can look like being 'the rock'

  These are people who care for their families, meet deadlines and collect praise, the ones others call the rock of the family. Yet they feel something is missing and don't feel much joy. Joseph says some never had words for sadness because of their culture, and others push through because trauma taught them not to feel.

• 03

  The 'joy thief' is anhedonia

  Joseph calls anhedonia, a reduced ability to feel pleasure, a sneaky symptom that strongly correlates with depression, especially the high-functioning kind. It 'steals your joy in the middle of the night' until nothing excites you and everything feels 'meh'. Many people don't recognise it as depression because they picture someone crying in bed all day.

• 04

  Depression can look very different from person to person

  Joseph's research looks at the different faces of depression. Men may show it as irritability, anger, checking out or 'knocking back a couple of beers'. Others stay constantly busy because that's the only way they know, such as children of immigrants raised with 'work, deliver and you'll be okay', or mothers who feel they have no choice.

• 05

  Depression and anxiety often go together

  Mel would have labelled her bolt-out-of-bed, multitasking, wine-at-night days as anxiety. Joseph explains that restlessness is also a symptom of major depression, and many researchers see the two as different sides of the same coin. That's why treatments like SSRIs and cognitive behavioural therapy overlap. Anxiety tends to come with more physical symptoms and excessive worry.

• 06

  There are many possible contributors, and inflammation is getting more attention

  Joseph stresses that these are correlations, not proven causes. Dopamine, serotonin and norepinephrine patterns may differ in depressed brains. Twin studies point to genetic predisposition. Recent data links inflammation to depression, and with some estimates that 70–75% of people have had COVID-19, she says we don't yet know how that has affected brains. Back-to-back collective trauma and constant social media add to the picture.

• 07

  At work, it can look like control and a lost identity

  People with high-functioning depression may believe nobody else can do the job right, tie their identity to their role, and have dropped hobbies like photography or art. Sleep isn't refreshing, appetite swings, concentration and energy dip, and they may over-deliver while denying distress. Joseph suggests some clinicians miss it because the patient looks like them.

• 08

  Scarcity trauma can be passed down

  Joseph describes scarcity trauma: a history of going without, sometimes generations back through refugees, war survivors or farmers, that drives behaviour that doesn't make sense today. Examples include clothes left in the closet with tags on, hoarded expired food, being unable to throw things out, or overspending when money finally arrives. Emotional scarcity, growing up in a cold family focused on survival, works the same way.

• 09

  Naming a feeling helps take its power away

  Joseph calls it affect labeling: naming what you feel calms the body, like turning on a light and seeing the noise was just a book falling. It isn't about diagnosing yourself; it's about bringing the problem out of your subconscious so you can see it separately from you. She says we teach children feelings charts but forget that adults need this too.

• 10

  Depression isn't a competition

  Joseph gets pushback for the phrase 'high-functioning', but argues you should use the language people identify with, because 'you're not depressed enough' is invalidating. Mel agrees: getting through the day doesn't mean you feel better than someone who can't get out of bed.