Dr. Judith Joseph On Understanding High-Functioning Depression & How to Reclaim Your Joy

Summary

Podcast Summary: She's So Lucky – Episode featuring Dr. Judith Joseph on High-Functioning Depression & Reclaiming Joy

Release Date: June 10, 2025

In this enriching episode of She’s So Lucky, host Les Alfred engages in a profound conversation with Dr. Judith Joseph, a board-certified psychiatrist, researcher, and author of the groundbreaking book High Functioning. The discussion delves deep into the nuanced understanding of high-functioning depression, its impact on women’s lives, and actionable strategies to reclaim joy.

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1. Understanding High-Functioning Depression

Les Alfred opens the conversation by sharing her personal experiences with high-functioning depression, highlighting how individuals striving for their goals can silently battle unseen struggles. She introduces Dr. Judith Joseph, emphasizing the importance of recognizing high-functioning depression, a condition often overlooked in traditional medical frameworks.

Les [00:01]: "Sometimes when we are busy chasing our goals and creating our own luck, we can be more susceptible to quietly struggling with high-functioning depression that often goes undetected..."

Dr. Judith Joseph clarifies that high-functioning depression isn't officially recognized in medical literature yet but is a real and prevalent condition. It encompasses typical depressive symptoms like low mood, sleep disturbances, and anhedonia (the inability to feel joy), all while maintaining outward functionality.

Dr. Judith Joseph [04:16]: "High functioning depression happens when people experience symptoms of depression... but you're still functioning."

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2. Redefining Depression Beyond Sadness

The conversation shifts to anhedonia, a central feature of high-functioning depression. Gabby Wendy shares her personal struggle with identifying sources of joy, illustrating how anhedonia can be misconstrued as just "feeling meh."

Gabby Wendy [08:52]: "What's bringing you joy? What's making you feel joyful? And I didn't have an answer."

Dr. Joseph emphasizes that depression doesn't always manifest as sadness. Anhedonia, the lack of joy, is a critical indicator that many overlook.

Dr. Judith Joseph [07:08]: "Many of us: feel meh, bleh, you know, things don't excite us anymore. But we don't think that that's a symptom of depression."

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3. Reclaiming Joy: Practical Strategies

To combat anhedonia, Dr. Joseph suggests practical methods to reintroduce joy into one's life:

• Processing Trauma: Addressing unresolved pain and trauma to prevent emotional numbness.
• Reducing Screen Time: Limiting excessive use of devices to reconnect with basic joys like nature, food, and social interactions.
• Celebrating Wins: Taking time to honor achievements, even small ones, to shift focus from constant striving to appreciating accomplishments.

Dr. Judith Joseph [10:32]: "Adults who were on their devices... when you took those devices away from them for two weeks, it was almost as if you were treating them with an antidepressant because their joy points went up."

Gabby Wendy resonates with these strategies, recognizing the importance of breaking down joy into manageable, everyday actions rather than seeking grand, unattainable moments of happiness.

Gabby Wendy [17:07]: "Breaking it down into those little bite-sized pieces feels a lot more doable."

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4. The Science Behind High-Functioning Depression

Dr. Joseph delves into the neurological aspects, explaining how chronic stress and lack of joy points affect brain connectivity. She highlights the limitations of traditional depression treatments that focus solely on neurotransmitters like serotonin, norepinephrine, and dopamine.

Dr. Judith Joseph [34:34]: "We know the brain needs to connect. ... We're now looking at things like gaba, glutamate, other receptors in the brain."

She advocates for a holistic approach that includes mindfulness, meditation, and other activities that promote brain connectivity and overall mental health.

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5. High-Functioning Depression Across the Lifespan

The discussion expands to how high-functioning depression intersects with various life stages, particularly focusing on women’s unique experiences:

• Postpartum Depression: Differentiated by hormonal changes leading to increased anxiety alongside depression.

  Dr. Judith Joseph [36:45]: "Depression and anxiety travel together, especially in postpartum brains."

• Perimenopause and Menopause: Addressed as periods of significant hormonal fluctuations that influence mental health. Dr. Joseph emphasizes the need for early preparation and targeted strategies to manage symptoms, especially in Black women who may experience more severe and prolonged symptoms.

  Dr. Judith Joseph [40:15]: "In black women, we go through perimenopause and menopause sooner, longer, with more severe symptoms."

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6. Building and Leveraging Community Support

A pivotal part of the conversation revolves around the importance of community and support networks in managing high-functioning depression. Dr. Joseph encourages reaching out to true communities—supportive, non-competitive groups—highlighting how historical and cultural bonds in underserved communities foster resilience.

Dr. Judith Joseph [48:22]: "You have to build the true community that you want, and then you'll never feel unsafe."

Gabby Wendy echoes this sentiment, sharing her experiences as a first-generation professional and the challenges of seeking support while being perceived as self-sufficient.

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7. Introducing Dr. Judith Joseph’s Book: "High Functioning"

Concluding the episode, Dr. Joseph discusses her motivation behind writing High Functioning. She aimed to provide a resource for those who cannot immediately access professional help, offering psychoeducation as a tool to reduce uncertainty and empower individuals to understand and manage their mental health proactively.

Dr. Judith Joseph [53:07]: "Psychoeducation is giving yourself the gift of knowledge... to have less uncertainty."

Gabby Wendy shares her appreciation for the book, noting how it validated her experiences and became a valuable resource in her therapeutic journey.

Gabby Wendy [54:49]: "Now I understand why this is happening. So for those of us who are feeling that way, what are some things we can start doing to reclaim those feelings of joy?"

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Key Takeaways

• High-Functioning Depression: Recognizes depressive symptoms without the overt signs of incapacitation, allowing individuals to maintain daily functions.

• Anhedonia: A critical yet often overlooked symptom of depression, characterized by a lack of joy and inability to feel pleasure.

• Holistic Approaches: Emphasizes the importance of processing trauma, reducing screen time, celebrating small wins, and fostering brain connectivity through mindfulness and other practices.

• Lifespan Considerations: Highlights how different life stages, such as postpartum and perimenopause, uniquely impact mental health, necessitating tailored strategies.

• Community Support: Stresses building genuine, supportive communities as a cornerstone for mental well-being, especially in historically underserved populations.

• Psychoeducation: Advocates for self-education as a preliminary step to therapy, empowering individuals with knowledge about their mental health conditions.

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Resources Mentioned:

• High Functioning by Dr. Judith Joseph
• Dr. Judith Joseph’s website: drjudithjoseph.com

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This episode of She’s So Lucky offers a compassionate and insightful exploration of high-functioning depression, providing listeners with both understanding and practical tools to navigate their journey towards reclaiming joy.

Transcript

[Les]

The following podcast is a Dear Media production. Welcome back to she's so Lucky. My name is Les. I am your host and this show spotlights ambitious women who create their own luck. And if you are listening to this, that probably describes you as well. But sometimes when we are busy chasing our goals and creating our own luck, we can be more susceptible to quietly struggling with high functioning depression that often goes undetected because depression is often associated with lower functioning symptoms. Candidly, this is something I have been experiencing for most of this year. So I was really excited to sit down with today's guest, Dr. Judith Joseph. Dr. Judith is a board certified psychiatrist, researcher and author of the new book High Functioning, which I highly recommend giving a read. I just finished it and it has helped me so, so much. In this episode we talk about how some of the signs of high functioning depression can impact us at various seasons of life. And we talk about solutions and ways that we can start feeling joyful again. So let's get into Today's episode with Dr. Judith. Dr. Judith, welcome to the show.

[Dr. Judith Joseph]

Thank you for having me.

[Gabby Wendy]

I am so excited to have you because I've been following your work for a little while and I've been feeling this has been a little too relatable lately and I'm realizing that if I can relate to it, I think a lot of members of my audience probably do as well. But before we get into that, I have recently on the show been liking to talk to guests about lucky moments that they have.

[Les]

The show is now called she's so.

[Gabby Wendy]

Lucky where we talk about creating our own luck.

[Les]

So I would love to hear if.

[Gabby Wendy]

You'Ve had any little magic or lucky moments lately that you want to share.

[Dr. Judith Joseph]

Well, lately I've had so many lucky moments, I don't know if I would call them lucky luck because it's a lot of hard work that led to these moments. But I remember one lucky moment that didn't seem like luck at all. It seemed like work. And it was when I was in training. And at first I felt lucky because my program director was like, come into the er. There's a journalist here and they want to talk to young doctors who are helping children in crisis in the psychiatric emergency room. So I went in and answered all of her questions. And then when the piece came out like two days later, I was like, oh my gosh, I sound terrible. So I went to my director and I was like, why don't we have media training? And they were like, oh, that's a great idea. Why don't you create it. So I was like, oh, why did I have to say something so unlucky? But I developed this course to teach myself how to talk to the press. And it turned into something amazing, incredible. I started working with these film students at nyu and. And now I have this booming media career and I teach other doctors. So that was a moment in time that did not seem very lucky, but it ended up being one of the best things that I had ever done.

[Gabby Wendy]

I love that example and also loved what you said about the work behind the luck, because that is such a big part of what we talk about on this show, where on the surface it will seem like these serendipitous moments. And sometimes we do have serendipitous things happen that are really beautiful, but even then to be able to seize them, there's a lot of luck and preparation behind it. And this idea that when we have lucky moments, it's often because we did a lot behind the scenes to create it. And I think that's such a great example of that.

[Dr. Judith Joseph]

I've been teaching this course for over 10 years now. And they were like, well, how did you do it? And I said, look back 10 years ago. You want to see my first YouTube videos? They'll make you cringe. Because they make me cringe. Yeah, it's a lot of work.

[Les]

Yeah.

[Gabby Wendy]

But also so important because I think one of the things about the Internet and social media that can make it really tricky is there's so many voices out there, there's so much noise that we need qualified people in media who are also, you know, sharing those messages. So it's really important work that you do well.

[Dr. Judith Joseph]

The qualified people don't want to do it. They're afraid of making a mistake or not being perfect. And sometimes you just got to do it. Afraid. Yeah.

[Gabby Wendy]

You know, so I'm excited to talk to you about, you know, your area of expertise that you are really a leading voice in.

[Dr. Judith Joseph]

Absolutely.

[Gabby Wendy]

Leading researcher in. And that is high functioning depression, which is something that I think a lot of us are still learning about because there hasn't been a lot of research on it outside of the work that you do. And so I want to talk about what high functioning depression is, how it may be different from what the average person, such as myself, who is not as well versed in these topics, may think of as depression, and why it's important that we understand the difference.

[Dr. Judith Joseph]

Yeah. So high functioning depression is not yet recognized by medical literature or coding, but it is real, you know, similar to how burnout wasn't in the medical coding until like 30 years ago, but we all knew it existed. High functioning depression happens when people experience symptoms of depression like low mood, problems with sleep, low energy, changes in appetite, anhedonia, which is literally, it means a lack of joy and things that once brought you joy. So all of these symptoms, but you're still functioning. And this is important because in the bible of Psychiatry, the DSM 5 Diagnostic Statistical Manual, you'll need to meet criteria for stopping functioning or significant distress in order to meet criteria for major depressive disorder. But what if you're someone who has all of these symptoms and then you're over functioning? You're not breaking down. In fact, you are the rock, you are the entrepreneur, you're the working mother, you know, you're that student who can't fail. You keep going, that's your way of coping. Then your healthcare professional says, well, there's nothing to code you with, so come back when you break down. Which I thought was a broken model. Because when you look around and what's happening with healthcare today, there's a renaissance, right? We're saying don't wait until stage four cancer, let's prevent the cancer. You know, don't wait until you break a hip, let's use menopause care and let's prevent these health outcomes. In mental health, we're still in dark ages. We're still waiting for people to check that box of you're not functioning, you're in distress, and then we react. We're not proactive. So I wanted to change that because there aren't many people like me out there. The need for mental health providers and professionals, it's so high, but there's just not enough of us. So why are we waiting for people to break down? Let's give them the tools so that they don't break down, so they recognize when they need help even though they're high functioning.

[Gabby Wendy]

Yeah, definitely. It seems so backwards to wait for people to get to the point of breakdown if it's preventable. Are there different stages or degrees of high functioning depression that people can experience before they get to that point? And what kind of is that tipping point for a lot of people?

[Dr. Judith Joseph]

For the people that I work with, it's usually anhedonia. So when you think of depression, people think you're in bed, you're crying, you're not doing things, but no one thinks about the flip side of depression, which is not sad, not weepy, but lacking joy. And anhedonia is that scientific term that's been around for 200 years, but no one knows about it. And many of us experience it. Many of us feel meh, bleh, you know, things don't excite us anymore. But we don't think that that's a symptom of depression. In fact, a lot of people don't know that you don't have to be sad to be depressed. By definition, you can have all those symptoms in anhedonia without being sad, and you still meet criteria for depression. But we're trained to think that depression only looks one way. I'm here to tell you that it doesn't look sad. Sometimes it just feels nothing. And if you can recognize that in yourself, then you can get the support that you need. But if no one tells you about it, then you think that's just life. But that's not life. We were built with a DNA for joy. We were built with that. That's why we have dopamine in our brains. But many of us have forgotten how to access that joy. So we end up with anhedonia.

[Gabby Wendy]

I wanna definitely talk more about anhedonia because it's something that I've been experiencing for quite some time now, and I didn't know what it was until I read your book. And it had coming up actually a lot recently, maybe over the past month or so, where I would continuously ask people, well, what's bringing you joy? What's making you feel joyful? And I didn't have an answer. I go to therapy. My therapist would constantly be asking me, what am I doing that's bringing me joy? And I'm like, girl, I don't know. I'm not feeling it. My audience, as a content creator, the number one question that everybody likes to ask is, like, what's bringing you joy?

[Les]

Come on the podcast and talk about what's bringing you joy.

[Gabby Wendy]

And I'm like, you guys, I. I don't know the last time I felt it. So as I was reading your book, it felt kind of validating of, okay, now I understand why this is happening. So for those of us who are feeling that way, what are some things we can start doing to reclaim those feelings of joy?

[Dr. Judith Joseph]

Anhedonia can be caused by a lot of things. Many of us, if we don't process our pain and our trauma and we cope by pushing things down, not dealing with it, eventually it's hard to even feel because our go to is, I'll deal with it later, I'll push it down, I'll process it later. But then we end up feeling nothing. But for others, it could be that we aren't accessing joy because we're so busy. There was a recent study that showed that people who are on their phones for excessive amount of time, they're missing out on those basic points of joy every day. So things like connecting to people, being in nature, eating your food and tasting it, getting rest, those are all the points of joy that we add up and say, okay, someone's becoming happier. But if you're not engaging in those things because you're so busy or you're always on your device, then you're going to feel blah. You're going to feel meh. You're not going to have joy. You know, so there are many reasons. There was a recent study that showed that adults who were on their devices with the smartphone capacity, like able to go online, able to be on socials, when you took those devices away from them for two weeks, it was almost as if you were treating them with an antidepressant because their joy points went up.

[Les]

Wow.

[Dr. Judith Joseph]

And in research, when we add up happiness and we measure happiness, we're adding up points of joy. Like if you're hungry and you eat and you savor it, that's a point. If you get rest or you take a nap and you feel refreshed, that's a point. If you're lonely and you connect with someone, that's a point. If you're stressed and you're able to soothe, that's a point. So all of these points of joy were being left on the table because people were on their devices. So when you removed the devices or the smartphone capacity, they could still text and call. They were able to access those points again. They were getting better, rest, they were connecting with people. They were in nature. They were actually out in the world doing things because their brains were getting stimulated by joy in different ways. It wasn't just through one way on a phone. They were getting all these rich sensory input and their joy from all these different sources. And so that's why I think many of us feel meh, erbla. Either we're too busy or we're on our phones, or we have this trauma that we never process, which leads us to busy ourselves, to distract from actually dealing with it. Right. And we're leaving these points of joy on the table. And that's important when you reframe the idea of joy as these experiences in life that make being a human worth being a human and living, that's different than chasing an idea of happiness. Like, when I get this job, I'LL be happy when I get that partner. I'll be happy when I get this milestone, whatever it is, I'll be happy. The science shows us that even when we get those things, we're still unhappy. So we have to reframe it. Rather than chasing this idea of happiness, let's try to access these experiences of joy, because that's how we measure happiness in science.

[Les]

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[Gabby Wendy]

I love what you shared about those examples of the things that can bring us joy if we're, you know, feeling stressed, able to soothe, if we're feeling tired and we're able to rest, that feels a lot more attainable. Because I think sometimes when I at least get overwhelmed when people ask me about joy, I feel like I need to have this grand, amazing answer for people. And sometimes it feels like if I don't have an answer, it's like another metric that I'm not meeting. It's another thing on my list that I'm like, oh, I'm not getting done because I don't have a joyful enough answer to give to people. But breaking it down into those little bite sized pieces feels a lot more doable.

[Dr. Judith Joseph]

It is doable. And I'm glad you brought up stress because how many people that you know are really stressed out and joyful? Not me. Yeah, it's almost impossible to access joy when you're so stressed. And in research, that's a point of happiness that we measure. And people used to think, well, isn't stress anxiety and depression depression? No. The brain we know now is so connected that we know what stress does to the brain. We know it makes it harder to access joy. You know, when you're stressed, you're not tasting your food and saying, yummy. You're saying, let me get to what I'm doing next. Right?

[Les]

Yeah.

[Dr. Judith Joseph]

So it's hard to access those basic points of joy when you're so stressed out. And that's why it's important to manage your stress. It's hard to enjoy your wins when you're always onto the next and you're checking the boxes because you're stressed. So for the high achievers that I work with, we have to celebrate our wins. We have to take a moment and honor what we've done, even if we think we're supposed to be doing it, you know. And that's where I think people really need help. They need that guidance in that area. Because once you get into that mindset of going, and you're a human doing, not a human being, it's really hard to slow down.

[Gabby Wendy]

And I think what makes it so tricky is that sometimes the unhealthy behaviors that I think exhibit in like a lot of us, like high functioning people, are celebrated. It's almost seen as a good thing when you do all of the things and when you show up for everybody and when you're super busy and when you keep a really full plate and it's easy to slip into a pattern of continuing to do it because it's almost seen as a good thing.

[Dr. Judith Joseph]

It almost feels like an addiction. Yeah. And not to downplay chemical addiction, but this addiction to the wins. Right. A lot of notable athletes have talked about this and they've said that after a while, it's no longer about winning, it's about not failing. And so like chemical addiction, it's like you're not even getting pleasure from the activity anymore. You're just doing it not to feel the negative outcomes of. Of not doing it. So like with chemical addiction, it's like you don't want to be in withdrawal because it's so physically uncomfortable and distressing. But with achievement addiction, it's like, well, I just don't want to be seen as a failure anymore. So I'm just going to keep going. I'm not even enjoying the work anymore. I just got to keep going because I can't fail, you know? And I think when you reframe it that way, at least with my clients, they see it that way. They're like, oh my gosh, I'm not even enjoying this work anymore. And there's a close tie between behavioral addictions and anhedonia. Right. A lot of anhedonia, lack of joy is seen in addiction work. And people don't even know it. They just think, well, this is how I feel now because I'm no longer doing the thing that brought me joy. But it's because you have to rewire your brain to access joy in many different ways.

[Gabby Wendy]

What are some ways that we can.

[Les]

Rewire our brain to do that?

[Dr. Judith Joseph]

Well, I think slowing down is really important. And with my high achieving clients, when they hear slow down, they think stopping. They have this all or nothing thinking, like, what do you mean stop? And I'm like, I didn't say stop, I said slow down. Right. And I know how that feels. As someone who's a recovering people pleaser, when you slow down, you feel initially very guilty and you feel like you're lazy. But get comfortable with that feeling. You know, it's not gonna go away right away. You will have that guilt and that shame and know that sometimes guilt and shame are trauma responses. So in PTSD research, one of the symptoms of trauma is feeling guilt, shame, low self worth. And so many times people do things they people please, they overperform because they feel like that's the only way they'll be worthy or lovable. So feeling comfortable slowing down and sitting in that discomfort of being lazy and challenging it and showing yourself that nothing bad happened. No one stopped loving you, no one stopped respecting you because you slowed down. That can be very powerful. So when my clients hear like, wait, doing less is powerful? It's yes, it is. Not just for the world, but for you to see that nothing bad happened when you treated yourself like a human being, not a human doing. So that can be one step, a really important step, but self validating and talking to yourself like, why is it that I feel this way? What is it that I'm trying to outrun? And many times it's some past event that people haven't even reconciled. That's where they ended up today. You know, they just pushed away, they don't want to deal with it, they haven't processed it. So a lot of the work that I deal with in my practice is trying to uncover that. And, you know, what is it about you in that narrative that has shaped you to be who you are today? So let's try to reframe that narrative. For some, it's a childhood trauma, like abandonment or rejection or neglect. And so this person believes that if they don't do and show up for others and they're not this role, they are not worthy. And we do a lot of challenging that inner narrative. But for others, it's an adult trauma or an adult event that shaped them or impacted them. And I use the word trauma, not like the major traumas that are studied in classic PTSD work, but things that have shaped you and have shaped the way that you see yourself in the world, the way that you interact in the world. Those are significant traumas. One trauma for one individual may not even be a trauma. You know, one event may not be a trauma, a trauma for one individual, but it is for another person. So we want to tailor it to what's happening for you, because you know, there'll only ever be one you. So let's understand the science of your happiness. What is it about your history, your experiences that we can work on? Because I think people, they feel deflated, they feel discouraged when they're trying things and it's not working. And they're like, oh, well, it worked for my friend, didn't work for me. And then they're like, what did I do wrong? You didn't understand the science of your happiness. You didn't understand what's making you unhappy to begin with. And then we work on how to add back that joy because you're too busy chasing someone else's narrative. Take the time to understand you first.

[Gabby Wendy]

I'm curious if in your work, either in research or with your clients, you've also seen a increased tolerance to maybe certain things that were once helpful. So let's say somebody is experiencing anhedonia or maybe high functioning depression, and something that was once really helpful to them was journaling. And then they reach a point where it's like they're still trying to journal in the same ways they used to, that used to be helpful, but they're not finding relief in that. Or maybe exercise was something that previously was really helpful but isn't. How do you recommend people navigate? You know, maybe their tools aren't working as effectively as they once were. How do they then find what works or are able to tap back into that relief?

[Dr. Judith Joseph]

Well, I mean, I treat a lot of clients. Everyone has a different story. But when that typically happens with my clients, it usually has to do with the fact that the schedule has changed. So something that worked for them when they were in school is not working for them now that they're working in the workplace because they don't have the time for it. Right. Or maybe they don't even have time for reflection the way that they used to, because as a student you're constantly reflecting and writing, but when you're working, you're not, you're delivering, you know, and so it's not uncommon to switch up your skills over time. It doesn't mean that journaling won't work for you down the line, but maybe at this point in time you have to pull out different skills. That is very typical in therapy, not just for high functioning depression. And so I like to tailor it again to the science of your happiness. So what I'll do with my clients is I'll have them draw their biopsychosocials. And a biopsychosocial, it sounds very complicated, but I promise you it's not. Every medical student learns it, but it's information I believe every patient can use to empower themselves. So I liken a biopsychosocial to a fingerprint. We all have a fingerprint, but all of our fingerprints are unique. So biologically, in the biopsychosocial, if you imagine three circles like a Venn diagram, biologically, what are the things that medically may be draining your points of joy? So for one person, it could be that maybe they have an autoimmune condition, or for myself, I have a low thyroid, but it could be something else biologically for another person, or what's their past medical history in their family, what are they more prone to? You Know, are you pre diabetic? Whatever it is for you, do you have sleep apnea? Biologically, where are you losing your joy? So psychologically, what is your past trauma or your attachment style, your resiliency or lack of resiliency factors, your IQ and so forth. And then socially, what's happening in your day to day life? What's your work like, what's your school like, what's your friendships like, your partnerships like, your family life, the way you're eating, your movement, you know, your diet, your access to nature, you know, that's social. So when you look at the biopsychosocial, over time people will have changing biopsychosocials, right? So like I mentioned, sometimes I'm working with students and then they graduate and then something like journaling isn't as effective. Well, why? Because socially they're in a busier environment. There's less time for downtime, reflection. Maybe they're not getting as much movement. So maybe something like exercise or movement is where we're going to target to allow them to add back points of joy versus someone who's maybe retired. And then biologically, they may be dealing with some medical issues. So how can we add supports there? Maybe they need to have a coach, you know, a fitness coach or something like that. There's always changes as you develop over time. We're always developing. It used to be thought that the human brain fully formed by 25, but we're learning about neuroplasticity and how the brain is changing over time until the day you die, right? So knowing that that tool is so powerful, that biopsychosocial, because each person can then understand the science of their happiness in the moment and know where they're losing points of joy, so they know where to target back points of joy. And let's say someone say psychologically, maybe they're dealing with emotional trauma and a bad breakup, right? Something like movement isn't going to work for them because maybe they're too depressed or they're just too shattered emotionally and they're constantly in fight or flight from that bad breakup. So what I'll do with them is more somatic work, more mindfulness work or help with grounding and so forth. So they come and they feel more regulated, right? Because right now psychologically that's what they need. And so that's why I hope this makes sense, that people can see, wow, there are all these avenues that I can get joy. It's not just one way. There are many things, many areas I can get joy and where should I prioritize it at this point in my life?

[Gabby Wendy]

Yeah, that you're able to really tailor what that support looks like for you. Depending on what you need.

[Dr. Judith Joseph]

Yes, Same tool, but different supports. Depending on the individual and depending on where they are in their journey.

[Gabby Wendy]

That definitely makes sense.

[Les]

Heart health really hits close to home for me. My grandmother passed away from heart disease a few years ago, and that loss shifted how I think about wellness, especially for women in my family. Now my mom and I make it a point to check in with each other regularly, especially when it comes to our health. But I know that that kind of open conversation isn't always the norm. That's why I really appreciate what Medtronic is doing with their Letter to My Mother campaign. They're opening up the dialogue around women's heart health, something that too often gets overlooked. Because here's the reality. Heart disease is the deadliest condition women face, and yet most of us aren't talking about it. Conditions like high blood pressure or valve disease often go undiagnosed in women, and the symptoms can be so easy to dismiss. More than 60 million women in the U. S live with heart disease, but we're still more likely to talk about things like body image or relationships than we are to talk about our actual hearts. And for women of color, the risks are even higher, making these conversations even more critical. Sometimes it starts with something as simple as a check in a text or yes, even a handwritten letter. For more information and to take the pledge to talk to your mother or a woman in your life about the importance of heart health, visit a lettertomymother.com Again, that's a lettertomymother.com I first tried Cachava way back in 2016. It was one of the first plant based shakes I'd ever had that didn't taste like chalk. I remember mixing up the chocolate flavor and being shocked at how good it was. And since then it's been something that I keep coming back to, especially during busy seasons. For me, wellness has to be flexible. Some weeks I'm on my morning smoothie grind, others I'm out the door in 10 minutes with Cachava in a shaker. It's just so easy. So my go to is to do two scoops of chocolate cachava, some almond milk, frozen banana, and a spoon of peanut butter. If I'm feeling fancy, I blend it up and it's so good it tastes like a milkshake. It keeps me full energized and focused for hours. Cachava is a true all in one. There's 25 grams of plant based protein, over 85 superfoods adaptogens. There's fiber, omega 3s probiotics. It's like your multivitamin and your protein all in one shake and it has amazing ingredients like Chia seeds and maca root. It's clean, non gmo, gluten free and has no weird fillers or artificial sweeteners. My go to is still the chocolate but I also have been really liking the vanilla and the chai. I also like to blend those with cold brew and it kind of gives a functional Frappuccino. Fuel your day with Kachava. Go to kachava.com and use the code balanceless for 15 off their subscription for a limited time. That's Kachava K A C-H-A-V-A.com code balanceless for 15 off you know that feeling when you're so deep into a romance novel that the real world kind of fades away? The slow burn, the tension, the moment everything changes. You're hooked and you never want it to end? That's exactly what Dipsea gives you. Dipsea is the female founded app for spicy audiobooks and more. Created by women for the female gaze, it's basically your favorite romance tropes come to life in audio form. So whether you're into a little forbidden love, a dreamy slow build, or something more bold and adventurous, Dipsea has something for you. They've got over 1000 stories to choose from, all written by professional writers and narrated by top top tier voice talent. And yes, the voice acting is so good. So whether you're into rugged cowboys, historical flings, dark academia vibes, or even a little romantasy, which is a guilty pleasure of mine that I'm not so guilty about, you will find something to fall in love with on Dipsy. I love to listen when I'm winding down at night, maybe romanticizing, cleaning up or cooking dinner, or when I want to shift into into a softer, more sensual mindset. And with new chapters dropping every week, there's always something new to look forward to. Right now, listeners of this show can get an extended 30 day free trial. Just go to dipseastories.com balanced to start your free trial. That's-I P S A stories.com balanced for 30 days of full access. For free visit dipsystories.com/ balanced.

[Gabby Wendy]

I would also love to talk more about what is truly happening in the brain when we are experiencing anhedonia or we are Maybe in a state of being high functioning. What is happening in our brains and does that make us more susceptible to other conditions? Earlier we had talked a little bit about that addiction to achievement and what that looks like. Does that then make us more susceptible to other types of addiction if we are in that state for a prolonged period? What are some of the risks if we don't treat these feelings while we're having them?

[Dr. Judith Joseph]

The risk of not addressing symptoms of depression is that you do develop a clinical depression, right? Because you go on for years not processing pain and going on with this anhedonia. That's a possible risk. Now, mind you, there's only been one study in high function depression that I did. There's need for more. But what we do know about depression research is that it's not what we used to think it was. We used to think that depression were these three chemicals in the brain, you know, serotonin, norepinephrine, dopamine, and that was it. But we know we're wrong, because when we add antidepressants targeting these chemicals, people aren't getting better completely. In fact, only a small portion of people actually have significant relief. So it's not just about the pill, and it's not just about three chemicals. What we're now understanding is that the brain needs to connect. And it's those branches in between the neurons, the brain cells, and whether or not they're connecting and working well together. That's what a healthy brain looks like. That's what a non depressed brain looks like. And we know that a stressed brain doesn't have as many connections. And we know that certain people who've been through substance use don't have as many connections. People who've been through a lot of trauma don't have as many connections. So the way we're thinking about depression now has to do with a connected, healthy brain. And it's not just those three neurotransmitters. Now we're looking at things like gaba, glutamate, other receptors in the brain that years ago we weren't even thinking about. Because we're learning that this brain is so complex and it needs to utilize a whole bunch of different avenues to feel joyful. So that's really hopeful. You know, knowing that there are all these avenues to getting joy means that we can use things like meditation, mindfulness. Because when you look at brains that are meditating and mindful, they look like healthy, connected brains, as if they were being treated for a depression. So these are tools, each and every One of us hopefully can use every day to get our brains to be more connected, to work in a more healthy way so that we can access more joy.

[Gabby Wendy]

That is really helpful. I'm also curious about how this relates to other types of depression, such as, like a postpartum depression. Let's say a woman is experiencing high functioning depression for a certain amount of time, gets pregnant, has a child, would she be more susceptible to something like postpartum depression after being in a prolonged state of high functioning depression, or are they unrelated?

[Dr. Judith Joseph]

Well, it's hard to know again, because we only did one study. But for postpartum depression, that brain is totally different, totally different than, let's say, a man's brain going through depression. Because when the postpartum brain is experiencing depression, we know that hormones like progesterone drop significantly in the third trimester and after birth, and that brain looks more anxious. Allopregnanolone, which is a neurohormone, is one that's heavily targeted and researched in postpartum depression. Because think about the brain as being peaceful and joyful. Well, that doesn't happen postpartum. Because of that neurohormone and a lot of the recent treatments in postpartum depression, especially the treatments that I've worked on in my lab and partner with drug companies to research postpartum depression, target that mechanism of the neurohormone so that the goal is to get that brain back to a calm state. And that's why you see a lot of postpartum women when they're going through postpartum depression. It's not just sadness, it's also a lot of anxiety. Like, they'll check on the baby, they're worried about the baby getting sick. And you're like, well, I thought this was postpartum depression. Why is this lady anxious? Again, we're not thinking about the brain separated anywhere. We know that, like, depression and anxiety travel together, especially in postpartum brains. So because it's really hard to be joyful when you're stressed, these new medications target calming that brain down so that you're not experiencing as much anxiety and stress, and then you can access the joy more easily.

[Les]

Super, super interesting.

[Dr. Judith Joseph]

Yeah.

[Gabby Wendy]

I love thinking about and understanding just through kind of the lifespan, particularly for women, especially because we experience so many life changes, hormonal changes, we're often caregiving for others, which is a big stressor putting ourselves maybe behind the needs of other people, how all of these things kind of work together to impact how we're feeling mentally at any time in the lifespan.

[Dr. Judith Joseph]

And that's why the biopsychosocial is important, because when you think of that postpartum woman, biologically, she's experiencing a dip in her progesterone versus a man who's experiencing depression, that biological is not there. So that's why we can't just think about depression as one face. We have to realize that it's complex. There are multiple factors involved, biologically, psychologically, socially. And where can we support people at points in time so that they don't break down, so that we prevent a crisis from happening?

[Les]

Yeah.

[Gabby Wendy]

Similarly, as I'm, like, thinking about, just particularly through the women's lifespan, it also made me think about perimenopause, which I think is something that we're beginning to hear a lot more people talk about, which I think is really great, because I think for a very long time, women in that stage were definitely not getting the support that they needed. I'm also curious about how perimenopausal hormones also play into this and what the mental health of those experiencing perimenopause and menopause also look like.

[Dr. Judith Joseph]

Yeah. When you look at the biopsychosocial of someone who's going through perimenopause, biologically, they're going to be having these dips, these ups and downs, more like these less predictable ebbs and flows in their hormonal fluctuations. So that could make a lot of issues happen within the body and in the brain. So in the brain, what you typically see is poor sleep. So a lot of times women will say, like, I can't sleep as deep. So I used to. I don't feel refreshed, or it's taking longer to fall asleep. And then the forgetfulness. So it's not like you don't remember anything. It's more like you're about to say something. You're like, what was I gonna say? Or you're about to go and pick something up, and you're like, you can't remember what you're going to the next room for. Or forgetfulness. Like, you left your keys. You're constantly looking for your earbuds and things like that. Those are like the little things that a lot of people in perimenopause think, oh, I'm just getting older, or I'm just too busy. But they're not realizing that while these changes are happening with their sleep and their mental capacity, they're also experiencing these erratic periods, like heavy flow, delayed periods, or too frequent periods. Right. That's why Again, the biopsychosocial is so important because biologically, when you realize these are things are happening, then you could put the pieces together and then you understand why. Maybe you're more moody or you're more anxious because hormonal fluctuations are happening, and perimenopause can happen for many years. Specifically in black women, we go through perimenopause and menopause sooner, longer, with more severe symptoms. So this is something we need to know. There's nothing wrong with us. We're not moody. It's perimenopause sometimes. Not to excuse all moodiness, but I think that that allows some of the shame to be removed. Like, there's nothing wrong with me. These hormonal fluctuations make it more challenging to feel better. So let me support myself, let me get more sleep, let me stay away from caffeine, Let me not drink as much alcohol, you know, let me get more exercise in and movement in. Let me try to get my points of joy and support so that these symptoms aren't as severe.

[Gabby Wendy]

Yeah, that's really interesting. I didn't know that black women experience differences in perimenopause in that way.

[Les]

Do we know why that is?

[Dr. Judith Joseph]

Well, the thought is that black and indigenous women have more severe, earlier, longer symptoms. And we are also highly traumatized communities, and trauma leads to worsened perimenopause symptoms. But also there are other factors. There are these social determinants of health. Right? We don't necessarily, as a community, have the best access to nutritious foods, to nature, to quality healthcare, to supports financially. And so all of those things play a role in your health outcomes across the board, not just with perimenopause, unfortunately. So knowing these things happen in our community at higher rates allows us to be better prepared and to ask different questions. So rather than going to a neurologist and saying, oh, I have all these different odd symptoms and then being treated for like an autoimmune condition, you know, like, can you actually check me out for perimenopause? Let's go through these physical symptoms. And also, knowing this can happen sooner allows you to be more prepared for it. You know, I always say, like, why do we wait until our 50s to save for our physical health wealth? Right? If someone told you to start saving for your finances in your 50s, you'd be like, where do you get your information from? You wouldn't trust them. So why do we wait until we're in our 50s to prepare for something that we know as a community, or we maybe don't know we need to be preparing for sooner. So rather than doing our elliptical or aerobic exercises, we need to be doing more weight bearing exercises because that'll help us to prepare for osteoporosis. That'll help us with metabolic issues. And belly fat is something that happens a lot during midlife. So let's try to eat more proteins and build up our muscle mass and be aware of not eating over processed foods because inflammation worsens our outcome. Let's really treat our brains in a sacred way and get proper sleep. Limit excess alcohol, smoking, decrease the stress. So start to set boundaries with toxic people. All those things are helpful as we get older, but if nobody tells us, then we don't know how to prepare. And these are all things that we have control over the other things like hormonal fluctuations. And we're gonna need help from healthcare professionals to figure out what are the best supports. Is it hormones? Is it something else? A non hormonal support? Is it a different type of therapy? Because our sleep, you know, is a challenge. We may need a sleep study. We may need help with obstructive sleep apnea because that goes up in midlife as well. So all of these things, if we don't know about it, we don't know how to prepare, we don't know how to set ourselves up for the best outcome.

[Les]

Yeah.

[Gabby Wendy]

Which is something I really strive to do on this show. And it's why even, I mean, I'm in my 30s. A lot of my listeners are in their kind of 20s to 30s. I would say about the 25 to 35 age range is where a lot of our audience is. And I like asking about those types of things because we're going to be entering a period of life soon where the rubber's about to meet the road. Like we're really going to be in it. So I want us to be thinking about these things now. Think about it when you're 30 or 35 instead of being surprised by these things at 45.

[Dr. Judith Joseph]

Absolutely. If you're in your 30s, you know, really start to build up that muscle mass. You don't want to be in your 60s with a broken hip. You want to be able to do things you love doing. You know, start to set yourself up for healthy habits like smoking. It's not very beneficial across the board, but it really isn't helpful when you're going through perimenopause. And unfortunately, you know, many people are in toxic relationships or they have toxic friendships. You may not be able to get out of those situations, but try to limit exposure. You know, anything that decreases your stress levels is going to help you in the long run. But we don't think about these things until we're in the thick of it. And then it's even more difficult to get the support that you need because you're overwhelmed.

[Les]

Right.

[Gabby Wendy]

And especially if we've maybe experienced prolonged stress for decades, it's probably going to be a lot harder to heal versus if we start sooner.

[Dr. Judith Joseph]

Yes. Setting your brain up and your routine to minimize stress is one of the best things that you can do for any mental health condition, for any physical health condition, really. If you can minimize stress, you're already ahead of the game. But we don't think about that. We're so, like, all about hustle and getting to where we're getting to faster that we don't realize that we're literally burning ourselves out and harming our physical health trying to get this thing that we think will make us happy. But ultimately it doesn't. Right. So investing in stress management early on is one of the best things that you can do.

[Gabby Wendy]

I know one of the challenges that I've had when it comes to my relationship with achievement and doing things that definitely have led me on the path to burnout is having this false sense of safety, feeling like I'm chasing achievement so that I can feel safe. If I make a certain amount of money, then I'll feel safe, or if I have this accolade, then I'll feel safe. And I do think right now it's a really difficult time where there's so much just tumultuous things happening that are out of our control. Life is getting really expensive. There's so much uncertainty. And it can feel really hard to manage your stress when it feels like you're kind of unsafe all the time. Do you think that there are other things that we can be doing during this moment where it feels like there's so many things stressing us out and coming at us from different directions that can help as we're navigating that?

[Dr. Judith Joseph]

Yes. What I ask my clients is, what is your definition of safety? You know, what is safe for you? And many times they don't even know. It's like, what is happiness for you? They're like, oh, I think when I get this and that, and like, is it truly happiness? They're like, I think that'll make me happy. You know, I think that'll make me safe. But for communities who tend to not come from a lot of resources, historically, what really Makes them safe, is each other. Right. And there's something called the giving gap, and it's well studied in economic research, where groups of people who come from privilege and resources, they tend to not give. It's like, counterintuitive. Right? You would think, oh, you have all this money, you should give more. But it's the opposite. They tend to not give. So it led people to be like, why is that? So they actually researched it. What's fascinating is they found that communities that have historically very little. They tend to give more. They give. Again, counterintuitive. Why would you give when you don't have. Because what they found is that when people don't come from a lot of resources, they tend to branch out and help each other. And they rely on each other during tough times versus communities that come from a lot, they tend to rely on themselves. So when they're in hard times, they tap into their resources and they don't reach out to others. So what I would say is that reach out to other people in your community, you will never feel unsafe. You will never feel alone. You will always feel supported when you have your people. But we often get this idea of like, oh, I've made it when I've done it on my own. You have strayed far from who you really are. You know, especially when you're coming from a community that is historically underserved. We rely on each other. When you look back in time, slavery, we could not have done it without each other. Civil rights, we could not have done it without each other. Even fairly recently, Black Lives matter. We needed each other. So I think more than ever, we have to reach out. We have to depend on each other. We should not be doing this alone.

[Les]

Yeah.

[Gabby Wendy]

Really leaning into that social piece of.

[Dr. Judith Joseph]

The circle that it sounds like and true community. Not just checking a box like, I went to a woman supporting woman. Like, that's not true community.

[Gabby Wendy]

It's such a buzzword right now where it's like every event is labeled, every meetup is labele community.

[Dr. Judith Joseph]

But it could be nothing further from the truth because half the people there are competing with each other. So you have to build the true community that you want, and then you'll. You will never feel unsafe. Right. If you're feeling unsafe in your current community, that is not true community.

[Gabby Wendy]

Feeling very seen.

[Les]

Very seen.

[Gabby Wendy]

But I do think that that's so prevalent for people right now is just that sense of either not knowing where to get support or even, I think for a lot of people who are maybe first gens, to experience something when you are like, the first, and the pressure that can come with that, or to feel like, okay, I've gone further than I've seen other people go, can people support me? How do they do that? What does that look like? You're often seen as the person who doesn't need support, which I think really relates to how we started off with the conversation. And so it's something that I think a lot of us are navigating.

[Dr. Judith Joseph]

Yeah, a lot of us deal with that. I dealt with that myself, being the first college graduate, first doctor in my family. Anybody who has an ailment, it's like, call Judith. I have this on my back. I'm like, I'm not a dermatologist. But for me personally, I had to develop a true community of allies and people that I looked up to. And it wasn't just during college. I'm just gonna have this person. I still stay in touch with my deans, you know, the one or two black deans that I've been in touch with, I still go to them. If I'm going through something, I'll call them up. We often forget the people that helped us. We think, oh, they're too busy now that I'm established. They have other people to worry about. They always want to hear from you. It's you who feels a certain way. You're projecting that out there. So the advice that I often give people who are younger in their careers, I'm like, don't forget your allies. Even if you've moved on, you've graduated, keep in touch with them, nurture those relationships, because you will never feel alone when you have that true community. And also, like, help others. People who've helped you, they did it for a reason. They want you to pass that on. So start to help others again. It's that giving gap. Even if you feel like, oh, I don't have much, there's always someone who could benefit from you, someone who's two, three steps behind you, who would love your support. And also that person may surpass you, and they may be the ones helping you one day. So, like, lean back into the past and also help other people around you.

[Gabby Wendy]

It's such a good point that I think sometimes we make up these stories about how other people feel or what other people are too busy for and don't want to hear from when we.

[Les]

We don't know.

[Dr. Judith Joseph]

We don't. We assume all the time, you know, and that could be from that low self worth, that unprocessed pain challenge it what's the worst thing they can say is, no, I'm busy. Even if they are busy, they'll say, well, let's meet in a month. They will make themselves available.

[Gabby Wendy]

Such A good point, Dr. Judith. This has been so incredibly helpful. I would also love to just talk more about the book, why it was really important for you to put this resource out there for people.

[Dr. Judith Joseph]

Well, thank you. This was so much fun and really a pleasure. The book was really my way of. Because I create content, giving people more because I would get so many DMs and phone calls to my office, like, are you taking new patients? And, no, I'm not. And then people getting so discouraged, and I'm like, okay, but I am writing something and I'll put it out there. And, you know, hopefully it's a tool that some people can use alongside their current therapy. But also, let's say you're waiting for six weeks to see a psychiatrist or for whatever how long it is, where you're from, see a therapist, at least you can start understanding. People take for granted something called psychoeducation. Psychoeducation is before you're actually doing the work, understanding why the work is important and what the work is. And that allows you to have less certainty, less uncertainty. So the human brain doesn't like uncertainty. And so if you read about, okay, this is what trauma is, this is what depression is. That decreases the uncertainty, decreases the stress, and allows you to engage in the therapy easier versus not knowing anything about it, starting it, and then being so stressed out that you're like, I don't know where to begin, you know, and that's, that's honestly for anything in health, you know, if you are concerned about your heart or, you know, your metabolics, learning about it before you're going in to see the professional is going to give you five steps ahead of other people who are just going in, like, fix me. You know. So psychoeducation is giving yourself the gift of knowledge and curiosity about you understand the science of your happiness, and then you can do the work. But many of us are just doing what we see other people doing, and we're not getting better because we don't even understand ourselves.

[Gabby Wendy]

No, it's so true. I had been, as I mentioned, talking to my therapist about, like, how I have such a hard time answering that question about joy. And so as I was reading this book, I was like, oh, Friday, I know what I'm going to go tell her, because I just learned about this state of being. And it describes how I'm feeling and is a really, really helpful resource.

[Dr. Judith Joseph]

Oh good. I'm glad that you found it beneficial.

[Gabby Wendy]

Definitely. Thank you so much for joining us. Can you please let people know where they can find you and continue following.

[Dr. Judith Joseph]

Your work so you can follow me on all the socials? Dr. Judith Joseph and my book High Functioning is available everywhere that books are sold. You can also get that on my website, Dr. Judithjoseph.com perfect.

[Gabby Wendy]

We'll make sure we have that linked.

[Les]

In the Show Notes.

[Dr. Judith Joseph]

Thank you.

[Les]

Thank you for being here. Thank you for tuning in to this week's episode of she's so Lucky. If you're ready to create your own luck, hit that subscribe button wherever you get your podcasts or on YouTube so you don't miss an episode and head to the Show Notes for resources, links and discount codes.

[Gabby Wendy]

And if you are really feeling lucky, we would appreciate your rating and your review. It really helps us be able to improve the show to get great guests.

[Les]

Sent to understand what you want to hear more of. Thank you for tuning in and I'll see you next week.

[Dr. Judith Joseph]

Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.

[Gabby Wendy]

You guys, I'm Gabby Wendy, your host of Long Winded. You may or may not know me. I'm emphasis on may not. But I did have 26 boyfriends not too long ago and tragically lost Dancing with the Stars and now I'm back with the more freeing and liberating platform than ever. Which, honestly might make you sorry. Anyways, with all of this under my belt, naturally I do have some to say. In my very sweet soft voice and public school education, I'll discuss girly topics with a bit of cheek.

[Dr. Judith Joseph]

Topics like gaslight lighting? Die for it. Internalized misogyny.

[Gabby Wendy]

One of my faves. Honestly, in the depths of the dark dating world, I will beg you again.

[Dr. Judith Joseph]

And again to come and listen.

[Gabby Wendy]

But most of all, I hope you enjoy.