ZOE Science & Nutrition
Most replayed moment: Do You Have High-Functioning Depression? | Dr Judith Joseph & Professor Sarah Berry
05 May 2026
Transcript generated automatically by AI and may contain errors.
Chapter 1: What is high-functioning depression and how does it differ from typical depression?
Hello and welcome to Zoe Recap, where each week we find the best bits from one of our podcast episodes to help you improve your health. When we imagine depression, we often think of someone unable to get out of bed, someone who struggles to complete daily tasks. However, many people with depression are the exact opposite. They meet deadlines, achieve goals and appear successful.
Yet on the inside, they feel disconnected and distant from joy. This quieter, harder to spot condition is called high functioning depression. I'm joined by psychiatrist Dr. Judith Joseph and Sarah Berry to unpack what high functioning depression looks like, why it's so frequently missed and how we should approach it.
Sarah starts by asking for clarity on a word that is closely connected to this condition.
And hedonia. I have never heard of that word.
Chapter 2: What role does anhedonia play in high-functioning depression?
Could you explain what that means?
So it's actually a word that if you ask any nurse, any healthcare professional, they know what it is. It's such an antiquated old medical word.
Okay. Have you heard of it, Jonathan?
No, no, go on.
I want to know, have you heard of it? No. Most people haven't, that's okay. It was really coined by a French psychologist.
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Chapter 3: How can we identify high-functioning depression in ourselves or others?
I think he may have been a psychiatrist in the 1800s. And what he was saying was this lack of pleasure and interest in things, in people who had substance abuse, in people who had depression, in people who had schizophrenia. And that's where you see a lot of anhedonia. You even see it in people with dementia, right?
So older people who are going through that dementia phase and they just stop being enjoyed or excited about things, anhedonia is prominent there. But people who have depression suffer from anhedonia. People who have trauma suffer from anhedonia. It's a numbing of the things that make life worth living. But it's a sneaky symptom. It's quiet.
Chapter 4: What are the common symptoms of high-functioning depression?
People don't walk around quiet. Saying, I have anhedonia. They say, I feel meh or bleh, right? And if you're not crying or not getting out of bed, no one's going to address it. It's like, well, don't we all feel like that? And I think many of us do feel like that.
I think that many of us process or don't process pain, but many of us process pain by self-soothing and numbing with things like drinking a lot. excessive buying, excessive use of social media, doom scrolling, busying themselves with work just to get through, just to get things done, just to busy from and distracting from these unpleasant feelings or this emptiness that they feel.
A lot of my patients would say that when they're not busy, when they're not working, they feel empty or they feel restless, so they have to be busy. And it's a distraction.
Chapter 5: Why is high-functioning depression often overlooked by healthcare professionals?
So when you don't process these painful emotions, when you don't process the trauma, then you may start to get numb. And anhedonia feels like a numbing of pleasure, a numbing of interest in things that you once loved. When was the last time a doctor said, are you really enjoying life? Do you get out of bed with like joy? No, they are in the business of eradicating disease, not cultivating joy.
And that was what was missing. A lot of patients were not meeting the criteria for depression, but something was off. And I found that after the pandemic, I was seeing more and more of these cases. And then I saw a term floating around on the internet, high functioning depression.
You hear about these celebrities who died, who had a mask of happiness, who were performing, who were doing great things, but suddenly they decided to take their lives, right? They died by suicide. And a lot of their family members were saying that they were having high functioning depression. And doctors in very, very important newspapers were saying, that's not even a thing.
Well, if people are experiencing symptoms, but they don't meet a criteria that probably doesn't apply to everyone these days, because a lot has happened, a lot has changed in the world. If they don't meet this criteria for something that was classified 30 years ago, then are we just gonna leave them alone?
Sometimes we have to let our patients lead us and to use the language that they identify with. So if your patient is saying that you're having symptoms of depression, that you're not enjoying things, but you're still performing, but you're still delivering, But you're having these symptoms. Are we just going to wait for them to stop functioning, for them to be broken to do something about it?
And that's why I thought that that term was so powerful because it shakes to the core what we believe, what we think depression looks like. But we're missing people who don't meet criteria, but we could be helping them before it gets to a crisis, before they stop functioning.
And I'm passionate about this work because, frankly, I was that person who was running a lab, taking care of employees, taking care of a small child at home, married to a frontline worker, seeing the world fall apart, having to help people. There was no way that I could stop. I had to keep going. So I pushed through the pain. I suffered from high-functioning depression.
And I knew that I had to do something about this. And that's why I started studying it.
And if you went to see your doctor, what would generally happen if you're, you know, with this sort of high functioning depression that you're talking about, what would you expect?
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Chapter 6: What steps can be taken to address high-functioning depression effectively?
And the first V is validation. So I mentioned that when I was going through my periods of high function depression, I was just like pushing through pain. And I remember sitting at my desk and giving a talk to healthcare providers who were really stressed. It was April, 2020, and they were in the pandemic. No one knew what this thing was.
And I'm talking to them and I'm supposed to be helping them through this. And I'm just thinking like, I don't even know what to say. I'm scared too. But that was the first time I actually said it out loud. Like, I am afraid. I think I'm depressed. And that validation, the first V is validation. Acknowledging your pain. We don't acknowledge our pain.
We don't acknowledge our negative feelings for whatever reason. It could be cultural. It could be the way that we were raised. But the first step is really acknowledging it.
And could that be just even acknowledging it to yourself? You might not yet be ready to acknowledge it externally.
The second is venting. So that's when you actually start talking about it. So some people have someone to talk to, but others don't feel just ready yet. If you have a therapist, great, but good luck with that. The wait list is very long, at least in America. But you can start venting by writing. You could start, I had one patient who was a singer and she would just start belting out notes.
Some people express it in art, but get it out. And the definition of venting is like, you're letting out air, but we have to let it out because then we're holding it all in. And there's that saying that the body keeps the score, right? And then the third is values. I used to think that collecting all these degrees was important. I have two Ivy League degrees. I have all these certifications.
You go to my office, it's degrees everywhere. I used to think that was what was important in life. But I'm an island girl at heart. And when I visit Trinidad and I put my feet in the sand and I look at the water, I'm like, wow, I value nature. Why don't I get enough of this?
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Chapter 7: How does lifestyle and nutrition impact mental health and high-functioning depression?
I grew up in this. Why am I running from it? So now I make it a point to be out in nature with my daughter. I value family. So I'm not going to stay in the office 30 minutes later just to do some paperwork that when I'm on my deathbed, I'm not going to be thinking about that paperwork, that file. I'm going to be thinking, why didn't I have 30 more minutes with my child?
So really think about what you value in life and invest in that. The things that you thought were valuable. You're not going to be missing those when you're in your deathbed. And then vitals. This is where you come in with your nutrition expertise. So the things that support our body. Food that feeds our brain and our body that decreases inflammation. Movement.
That's another thing that people with high function depression often neglect because they're working so hard they don't get to move. Our relationship with technology. I think that's a vital that's missed in medicine. You know, decreasing that. And also sleep, it's very important. It's restorative. So there are things that support our bodies that we tend to neglect when we're busying ourselves.
And I stuck into vitals, our relationships, because like I mentioned, if you have a toxic person in your life, You know, relationships are the number one predictor of longevity. So think about who you want to spend your time with. You may not be able to cut people out completely, but you can limit the amount of exposure to them. And then the last one is vision.
We don't tend to celebrate our wins. You know, like you have the top podcast. Put moments in the calendar to celebrate it as a team. Take the time to savor a win. If you got a good research study result, celebrate it. Don't just like send an email. Look, this is what our study showed. Okay, what's for dinner? Celebrate your wins. Where are we going for dinner tonight, Jonathan?
Are you taking me out for dinner, Sarah?
I think we've got like a month's worth of dinners for our win.
We are like a long way behind on celebrating our wins.
No, Zoe's very good actually, I think. And not just the big ones.
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Chapter 8: What are practical strategies for cultivating joy in life despite high-functioning depression?
If you're a regular listener, you know just how important it is to take care of your gut. Your gut microbiome is the gateway to better health, better sleep, energy, and mood. The list just goes on. But many of us aren't sure how to best support our gut. I wasn't sure before doing so, which is why we've developed an easy to follow gut health guide.
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