High Functioning Depression: A Psychiatrist's Guide to Signs & How to Reclaim Your Joy

By Hemanta Sundaray

PostedJune 24, 2025

Are you the "rock" for everyone else? The one who is always busy, always productive, always showing up? You’re the first person your friends call in a crisis and the last one to leave the office. From the outside, you have it all together. But on the inside, there’s a quiet, persistent hum of emptiness. A feeling of just going through the motions. A lack of joy in things that once excited you.

If this sounds familiar, you are not alone, and what you’re feeling is real. It has a name: High Functioning Depression.

This condition often goes undiagnosed and untreated precisely because those who have it are so good at hiding it behind a mask of success and competence. To unmask this hidden face of depression, we turn to the work of Dr. Judith Joseph, a board-certified psychiatrist, researcher, and award-winning expert who has pioneered research into this very experience.

This guide, based directly on Dr. Joseph’s groundbreaking work, will help you understand what high functioning depression is, how to recognize its subtle signs, and most importantly, provide a clear, 5-step framework to help you stop surviving and start reclaiming your joy.

What Exactly is High Functioning Depression?

To understand high functioning depression (HFD), it helps to know how clinicians diagnose major depression. A psychiatrist goes through a checklist of symptoms: low mood, changes in sleep or appetite, low energy, and a lack of pleasure in life, a condition called anhedonia. But to receive a formal diagnosis, you must meet the final criteria: a significant breakdown in functioning or a level of distress that stops you in your tracks.

People with HFD check all the boxes except the last one.

They haven’t broken down. In fact, as Dr. Joseph explains, they are often over-functioning. They are the entrepreneurs, the caregivers, the high-achievers who stay busy as a way of coping. They wear what Dr. Joseph calls a "mask of pathological productivity." Because they don't look depressed by traditional standards, they suffer in silence, often convinced they just need to work harder or push through it.

Dr. Joseph found the need for this research to be overwhelming. "My video on high-functioning depression was seen over 20 million times around the world," she notes, with therapists reaching out to say, "This is what I see in my practice every day, but we just don't have a term for it." Validating this experience with science is the first step toward creating support for the millions who feel it.

Is It Burnout or Something Deeper? Unpacking the Difference

Many people mistake high functioning depression for burnout, and it’s an easy mistake to make. Both can involve exhaustion and a lack of motivation. However, their root causes are fundamentally different.

• Burnout is, by definition, a workplace phenomenon. It is a state of exhaustion caused by an external environment. As Dr. Joseph clarifies, "when you remove that person from the workplace, they get better. Their symptoms improve."
• High functioning depression is an internal phenomenon. It is not tied to a specific job or environment. It’s often linked to unresolved past pain or trauma, and the busyness is a strategy to avoid sitting with difficult internal feelings. A person with HFD will simply find another way to stay busy. If they leave a stressful job, they’ll start a side hustle, obsessively clean the garage, or pour all their energy into someone else’s project.

The key distinction lies in the source. With burnout, the environment is causing the symptoms. With high functioning depression, something within the individual drives them to stay perpetually busy, no matter the environment.

The Hidden Signs of High Functioning Depression

Because it doesn’t present like a classic depressive episode, recognizing HFD requires looking for more subtle signs. These are the quiet indicators that something is wrong, even when life looks perfect on the surface.

Anhedonia: The loss of joy and pleasure

This is one of the most significant yet overlooked symptoms. Anhedonia isn't sadness; it’s the absence of feeling. It’s the "meh" or "bleh" that creeps into your life. Dr. Joseph describes it perfectly: "When I used to eat my food, I used to really enjoy it, but now it's like, meh. Or when I used to watch this movie that I love... now I'm like, 'Oh, I have to rewind it. I missed that.'" It's dreading the social gathering you used to look forward to. You’re present physically, but your capacity to feel joy has faded.

Inner restlessness

This isn't just feeling fidgety. It's a deep, internal agitation that makes it impossible to truly relax. People with HFD often can't sit still without feeling empty or anxious. They wake up before their alarm, their mind already racing. In clinical terms, it's called "psychomotor agitation," but it feels like an engine that you can't turn off.

Busyness as avoidance

One of the core symptoms of trauma is avoidance. For someone with HFD, that avoidance takes the form of relentless activity. The constant motion serves a purpose: it prevents them from having a quiet moment to confront the unresolved pain, trauma, or feelings of inadequacy that are fueling the depression. The to-do list is a shield.

The people-pleaser persona

Dr. Joseph notes that many people with HFD have developed a persona as the "people pleaser." This often stems from a deep-seated feeling of not being "good enough." They bend over backward for others, give endlessly, and have an incredibly difficult time accepting help. This constant giving, even when they feel depleted, is an attempt to prove their worth to others and to themselves.

Reclaiming Your Joy: A 5-Step Framework from Dr. Judith Joseph

Feeling seen is the first step, but the next step is action. Based on her research and clinical work, Dr. Joseph developed an evidence-based toolkit called the 5Vs. This framework is a practical guide to start adding "points of joy" back into your life. You don't have to do it all at once. Just start with one.

#1: Validation

The first and hardest step is to acknowledge and accept your own experience. For high-functioning people who are used to pushing down pain, this feels counterintuitive. But you cannot heal what you refuse to see. Dr. Joseph uses a powerful analogy:

Validation turns on the light. It decreases the uncertainty and takes away the shame and blame. You're not broken; you're experiencing a recognized condition.

#2: Venting (with intention)

Venting is about releasing emotional pressure, but it must be done with intention. Mindless complaining or "trauma dumping" can make you feel worse. Dr. Joseph emphasizes venting with a goal.

• Verbally: If you talk to a friend, ask for emotional consent first: "Is now a good time to talk about something heavy?"
• In writing: Journaling is a powerful way to process thoughts without judgment.
• Through art: Singing, painting, or any creative expression can be a profound release.
• Through movement: Exercise or dancing can physically release pent-up emotional energy.

If you don't vent, that pressure builds. As Dr. Joseph illustrates, it’s "like a red balloon and we try to push it under a tank of water... It pops up." It will pop up at work, at home, or in traffic. Venting lets the air out slowly.

#3: Values

High-functioning individuals often get caught up chasing external achievements—the promotion, the perfect house, the impressive title. But these things rarely lead to lasting fulfillment. This V is about reconnecting with what truly gives you meaning and purpose. Think priceless, not price tags.

What matters to you at your core? Family? Creativity? Justice? Nature? Honesty? Take a moment to identify your core values and find small ways to honor them every day. This is what grounds you when the chase for external validation feels empty.

#4: Vitals

Your mind and body are inextricably linked. Taking care of your physical self is non-negotiable for mental health. This goes beyond just diet and exercise.

• Soothe your nervous system: Simple, intentional breathing is a built-in tool to calm your fight-or-flight response. Taking just three deep, slow breaths can instantly reduce stress.
• Embrace play: High-functioning adults forget how to be silly. Dr. Joseph had her audience erupt in laughter, from witchy cackles to Santa's "ho ho ho." Laughter is a physical act that changes your mood in seconds.
• Nourish your brain: A whole field of nutritional psychiatry shows that the food we eat directly impacts brain inflammation and mood.
• Move your body: Movement releases natural joy chemicals. If you hate the gym, dance! Dr. Joseph notes that side-to-side movements like those in Caribbean dancing can be especially healing, as they promote communication between the right and left brain hemispheres.
• Curate your relationships: The quality of your relationships is a vital sign. Surround yourself with people who add to your joy, not drain it.

#5: Vision

For busy people, joy doesn’t just happen. You have to plan it.

As Dr. Joseph says, "If it's not in our Google Calendar, it's not happening." This isn't about scheduling a massive vacation. It’s about intentionally scheduling small moments of joy and celebrating small wins. Did you get a difficult task done? Did you navigate a tough conversation without getting frustrated? Acknowledge it. Celebrate it. Dr. Joseph celebrates getting her daughter to school on time with a cup of her favorite coffee. Your win can be anything. By planning and celebrating these moments, you show yourself that you are worthy of joy.

A Note for the "Strong Friends": How to Offer Support

If you recognize these signs in a loved one, you can help. People with HFD are often the last to ask for support, so you may need to offer it proactively.

• Check in on them, especially when they seem to have it all together.
• Meet their basic needs. Don't ask, "How can I help?" Instead, bring them a healthy meal, offer to run an errand, or take something off their plate.
• Mirror vulnerability. Share something you're struggling with. This creates a safe space and shows them that it's okay not to be okay.

You Deserve to Feel Joy

High functioning depression is real, it is exhausting, and it is not a personal failure. It is the logical outcome of a world that rewards productivity over peace, coupled with a personal history that may have taught you that your worth is tied to what you do for others.

The good news is that joy is not a far-off destination you reach after checking off every item on your to-do list. It is your birthright, built into your DNA. It is a daily practice, an experience you can reclaim one small "point of joy" at a time. You don't have to wait for a breakdown to deserve support.

Start today. Pick one 'V' from the list above. Choose Validation. Choose Vision. Choose one small, manageable step and begin the journey of reclaiming your life.