Most replayed moment: Do You Have High-Functioning Depression? | Dr Judith Joseph & Professor Sarah Berry

Introduction to Zoe Recap

0:00Hello, 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.

0:10When 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. Anyway, this quieter, harder-to-spot condition is called high-functioning depression.

High-Functioning Depression

0:34I'm joined by psychiatrists 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.

0:51Anhedonia. I have never heard of that word. 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. Have you heard of it, Jonathan? No, no, go on. I want to know. Have you heard of it? No. Most people have, and that's okay. It was really coined by a French psychologist. 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

1:22abuse, 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. So, you know, 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. You know, people don't walk around saying, I have anhedonia.

1:54They 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

2:25these 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. 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.

2:55They 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.

3:29And 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 going to 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

4:01things, 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

4:35worker, 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 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? So there was a scale that I was using in my research studies. It was the Schaap scale. I believe, I think it's actually developed by someone who's British, but it's an old scale.

5:10And there are items on there that I was using in my lab. But I found that some of the scales on there were a bit antiquated. Like U.S., many people don't drink tea, but tea shows up on that scale. So I had to change some of the items on there to match modern day. And so things that I would ask my patients were, when you eat a meal, do you enjoy it? Most of my patients who were suffering from high-functioning depression were just eating to live. They weren't savoring their meals. Or, you know, do you enjoy social interactions? And some of them would be saying, well, kind of, but most of the times I wish I weren't

5:41there, I wish I would just hurry up and get through it. Do you enjoy intimacy? You know, and a lot of them were saying no. And so the simple pleasures in life are just not exciting you. They're not bringing that same joy that they once did. And those are the things that I ask. Now, I also ask about those other symptoms that I mentioned, the ciggy caps of depression, to see if people are experiencing changes in their appetite, their sleep, their energy, guilt, and hopelessness. And I find that guilt is one of the things that I've noticed a lot with these patients.

6:12There's a guilt if they take a break. There's this feeling as if they're not producing enough, even though they're producing so much, you know, like producing a podcast, running a business. It just doesn't feel like enough. So there's this guilt to keep pushing through and keep making more. But there's a lack of satisfaction. So this busying and this guilt that drives people to produce in order to feel worthy is really tied to high-functioning depression and overachievers.

Tackling High-Functioning Depression

6:38Now, in your book, you reveal that there's five ways that we can tackle high-functioning depression. Could you talk us through those? So a lot of what I talk about with psychiatry is eradicating disease, but we don't cultivate joy. Well, there are actually, I'm not the only one. There are a lot of people, not a lot, but there are a couple of people like me who want to focus on joy. And the first V is validation. So I mentioned that when I was going through my periods of high-functioning depression, I was just like pushing through pain.

7:08And 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.

7:39We don't acknowledge our negative feelings for whatever reason. It could be cultural, 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.

8:11You could start, I had one patient who was a singer and she would just start belting out notes. You know, some people express it in art, but get it out. And the definition of venting is like, you know, 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, you know, collecting all these degrees was important. I have two Ivy League degrees. I have like all these certifications. You go to my office, it's degrees everywhere.

8:43That, I used to think that was what was important in life. But I'm an island girl at heart, you know, 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? 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, you know?

9:13So 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.

9:47And 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.

10:18We 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 where 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 dinner for our wins.

10:49We are like a long way behind on celebrating our wins, I think. No, Sarah is very good, actually, I think. And not just the big wins. Like if I get my daughter to school on time because her school is strict, I will come home and I'll like sip a cup of coffee and take time and savor it. And like, wow, I got her to school on time. That was hard. Right? It's not just the big wins, you know. I love that. The small wins because it's the small wins that I don't think we acknowledge. But it's the things that are occurring hour after hour, day after day that are challenging. And Sarah, just listening to that on the food side, I just wanted to follow up on one thing,

11:21which is I think a lot of listeners think of this will be, well, if I am worrying about my mental health, are there any specific foods or way of eating or anything that can actually help? So I think there's no specific way of eating that would be different to what we would recommend for everyone, you know, specifically for mood. So we would recommend for everyone's physical and also mental health to be following the kind of diet we encourage at Zoe. So this is a diet rich with whole foods, whole plant-based foods, lots of color, as your dad

11:58told you, Judith. So a diversity of different plant-based foods that are rich in color because they contain all these magical chemicals called polyphenols, which we know act on anti-inflammatory pathways. Lots of fiber-rich foods. So whole grains, legumes, pulses, foods that also contain omega-3 and Judith touched on this as well. Omega-3 is a particular kind of fat. It's found in high amounts in oily fish. And that's really important because we know it has a really important functional role in our brain as well.

12:29And avoiding certain foods. I know that we want to think about what we should encourage, but I do think we need to acknowledge, particularly when it comes to mental health and depression, that actually having these very high refined carbohydrates, high sugar foods, high heavily processed foods like your salamis, your heavily processed red meats, for example, we know that that increases the chances of having mental health issues, of having depression, of having low mood. As you can imagine, hosting this podcast, running Zoe, juggling family life, it all keeps me

13:03pretty busy. So I try as best I can to stay energized and show up well in all those parts of my life by fueling my body with the right food, by exercising, and by adding a scoop of Daily 30 to my meals every day. If you haven't heard of Daily 30 yet, it's the gut supplement designed by our gut health scientists here at Zoe. It's made of over 30 high-quality, hand-picked plants, including seaweed, fungi, and different types of fiber. Better yet, it contains ingredients that support gut health, digestion, and energy, which is

13:37ideal for packed calendars and busy lives. Simply add one scoop a day to any meal for an extra boost of fiber and plant diversity. And because it tastes delicious on just about anything and adds a satisfying crunch, it quite quickly slots into your life, becoming a daily healthy habit you'll always have time for. By the way, whenever we talk about Daily 30 as a good source of fiber, we're required to say that it contains four grams of total fat per serving. Obviously, that's all amazing healthy fats from plants.

14:08So, order yours today at Zoe.com slash Daily 30. Thanks for listening and see you next time. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye.

14:38Bye. Bye. Bye. Bye. Bye.