Psychiatrist identifies anhedonia as hidden driver of high-functioning depression

Dr. Judith Joseph, a psychiatrist, argues that a common form of depression goes undetected because it does not stop people from working. She labels this condition high-functioning depression. These individuals continue to meet their professional and domestic obligations while losing the capacity to feel pleasure. Joseph describes this loss of joy as an existential crisis that is often ignored.

Joseph and her colleagues published a peer-reviewed study in the journal Cureus. The research team interviewed adults using questionnaires that measured high-functioning depression, trauma, and anhedonia. Anhedonia is a clinical term for a reduced ability to feel joy or interest in things that previously brought satisfaction. The data supported the hypothesis that people with high-functioning depression report higher levels of anhedonia and trauma.

The study found a direct correlation between the two conditions. Participants who scored high on anhedonia measures also scored high on high-functioning depression scales. The group with the highest scores in both categories were parents and caregivers. Joseph notes that this demographic is often the steady presence for others, which can mask their own symptoms.

High-functioning depression is not an official diagnosis in the DSM-5, the standard manual for mental health conditions. Joseph says this gap in classification contributes to the problem. People who maintain their daily routines may not recognize their symptoms until they reach a point of burnout. They often do not seek treatment until their functioning begins to fail.

Joseph observes that this pattern is common among women who prioritize the needs of everyone around them. They focus on their responsibilities at work and home until they are near collapse. She warns that the body and mind will eventually reach a limit. Patients often end up in the emergency room without understanding the cause, only to learn they had been carrying unresolved emotional pain.

The condition is prevalent in professions that discourage emotional vulnerability, including medicine. Joseph notes that medical training often focuses on detecting mania or psychosis. She argues that clinicians should look more closely at anhedonia. In her field, crying after a patient died was historically viewed as a sign of weakness.

To help people identify the condition, Joseph developed a quiz based on the Snaith-Hamilton Pleasure Scale. This scale, published in the British Journal of Psychiatry, measures the capacity to feel pleasure. The questionnaire asks about everyday experiences, such as enjoying praise, savoring meals, and feeling satisfied with work accomplishments.

The quiz is not a diagnostic tool. It serves as an invitation for individuals to evaluate what may be blocking their sense of joy. Joseph also outlines a framework in her book, High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy. She calls it the Five V's. These include validation of feelings, venting through expression, prioritizing personal values, maintaining a future vision, and caring for physical vitals like sleep and nutrition.

Joseph says anhedonia appears in many people during midlife and in various other conditions. It requires specific attention because it is often a silent problem. For those in crisis, the Suicide and Crisis Lifeline is available by call or text at 988.