Podcast Summary: The Hidden Epidemic of High-Functioning Depression with Dr. Judith Joseph

Podcast Information:

• Title: The Ed Mylett Show
• Host/Author: Ed Mylett | Cumulus Podcast Network
• Episode: The Hidden Epidemic of High-Functioning Depression with Dr. Judith Joseph
• Release Date: April 22, 2025

Introduction

In this enlightening episode of The Ed Mylett Show, host Ed Mylett delves deep into the often-overlooked topic of high-functioning depression (HFD) with esteemed guest Dr. Judith Joseph, a Columbia-trained psychiatrist and founder of Manhattan Behavioral Medicine. Dr. Joseph introduces listeners to her groundbreaking work and her book, High Functioning: Overcome Your Hidden Depression and Reclaim Your Joy. Throughout the conversation, Ed and Dr. Joseph explore the nuances of HFD, its signs, underlying causes, and effective strategies to combat it.

Understanding High-Functioning Depression (HFD)

Dr. Joseph begins by defining high-functioning depression, emphasizing that it differs from typical clinical depression. Unlike traditional depression, individuals with HFD maintain their daily responsibilities and outward appearances while silently struggling with persistent sadness and anhedonia—the inability to feel joy.

Dr. Judith Joseph [03:31]: "When you understand the science of your happiness, you can use the skills properly."

She critiques the current mental health model, which often waits for individuals to hit a breaking point before providing support. Dr. Joseph argues for proactive interventions to prevent the escalation of mental health issues.

Signs and Symptoms of HFD

The conversation transitions to identifying the subtle signs of HFD. Dr. Joseph highlights that while individuals with HFD may not exhibit overt symptoms like those listed in the DSM-5, they still experience significant distress. Key indicators include poor sleep, anhedonia, fatigue, and concentration difficulties.

Dr. Judith Joseph [09:41]: "Anhedonia is the silent twin, the sneaky twin that comes in the middle of the night and robs you of your joy."

Ed resonates with the concept, sharing a personal story about his father’s high-functioning alcoholism, which underscores the insidious nature of HFD. He emphasizes that functioning well externally can mask deep-seated emotional struggles.

Biopsychosocial Model: The Foundation of Understanding HFD

Dr. Joseph introduces the biopsychosocial model—a comprehensive framework encompassing biological, psychological, and social factors that contribute to an individual's mental health.

• Biological Factors: Hormonal imbalances, medical conditions, and genetic predispositions.
• Psychological Factors: Past traumas, attachment styles, and resilience.
• Social Factors: Work environment, relationships, and lifestyle habits.

Dr. Judith Joseph [06:26]: "All of our biopsychosocials are unique. And that's why this model is so important for understanding the science of what makes you sad."

This model helps in identifying specific areas to address, enabling tailored interventions to enhance joy and reduce depressive symptoms.

Personal Stories and Impact of HFD

Ed shares his father's battle with alcoholism and how high-functioning traits often delay seeking help. This personal anecdote serves to highlight the hidden nature of HFD and its prevalence among successful individuals.

Ed Mylett [11:50]: "Alcoholics and drug addicts are high-functioning. Because they were functioning, it delayed or put off entirely his ability to get help for it."

Dr. Joseph connects this to broader societal trends, noting the rise in anxiety and depression rates since 2020 and the need for early intervention to curb this "quiet epidemic."

Coping Mechanisms and Strategies

Dr. Joseph outlines actionable strategies to combat HFD, introducing her 5V's method:

1. Validation: Acknowledge and accept your emotions without judgment.

   Dr. Judith Joseph [15:08]: "Validate how you feel and accept it, because that act is so important, it's therapeutic in itself."

2. Venting: Express emotions through talking, crying, praying, or journaling.

3. Values: Reconnect with personal values and what truly brings meaning to life.

4. Vitals: Focus on physical health—adequate sleep, nutrition, exercise, and managing technology use.

5. Vision: Plan moments of joy and celebrate small wins to foster ongoing happiness.

Further, Dr. Joseph introduces the "ties method" specifically addressing hormonal changes in women, such as those experienced during perimenopause and menopause, that can exacerbate depressive symptoms.

Dr. Judith Joseph [49:27]: "When you know what you're dealing with, then what does that do? Oh, it's not me. You don't internalize the blame and shame and you're actually able to do something about it."

Impact of Trauma on HFD

A significant portion of the discussion focuses on the role of trauma in developing HFD. Dr. Joseph differentiates between "Big T" traumas (e.g., combat, assault) and "little t" traumas (e.g., disappointments, relationship breakdowns) that accumulate over time, contributing to HFD.

Ed Mylett [41:35]: "Disappointment... is trauma. It's a disappointment of the love of your life left."

She emphasizes that recognizing and addressing these traumas is crucial for mental health, advocating for a more inclusive understanding of what constitutes trauma beyond traditional definitions.

Supporting Loved Ones with HFD

When asked about supporting partners or family members suffering from HFD, Dr. Joseph advises:

• Validation and Presence: Let them know you are there without pushing them to change.
• Model Vulnerability: Share your own feelings to create a safe space for them to open up.
• Practical Support: Help with basic needs and create a supportive environment.

Dr. Judith Joseph [45:32]: "You have to be there for them and you have to validate for them."

Managing Thoughts and Emotions

In addressing thought control, Dr. Joseph introduces the "worry procrastination" technique, allowing individuals to acknowledge their worries without letting them dominate their present moment.

Dr. Judith Joseph [62:36]: "Rather than trying to change the thought, let's try to stay in the present and feel our feels."

This method helps in reducing anxiety and fostering a more balanced mental state by compartmentalizing worries to specific times and places.

Conclusion

The episode concludes with Dr. Joseph reiterating the importance of joy in improving individual lives and, by extension, the world. She encourages listeners to adopt the strategies discussed to reclaim their joy and mitigate the impacts of high-functioning depression.

Dr. Judith Joseph [64:16]: "I truly believe that joy is really the key to a lot of the problems, solving a lot of problems in this world."

Ed Mylett expresses profound appreciation for Dr. Joseph's insights, highlighting the transformative potential of recognizing and addressing HFD.

Key Takeaways:

• High-Functioning Depression is a pervasive yet underrecognized condition where individuals maintain external success while struggling internally.
• Biopsychosocial Model provides a comprehensive framework to understand and address HFD.
• 5V's Method offers practical steps to combat HFD by focusing on validation, venting, values, vitals, and vision.
• Trauma, both big and small, plays a significant role in the development of HFD.
• Support Systems and personal strategies are essential in helping those with HFD reclaim their joy and lead fulfilling lives.

Notable Quotes:

• Dr. Judith Joseph [03:31]: "When you understand the science of your happiness, you can use the skills properly."
• Dr. Judith Joseph [09:41]: "Anhedonia is the silent twin, the sneaky twin that comes in the middle of the night and robs you of your joy."
• Ed Mylett [11:50]: "Alcoholics and drug addicts are high-functioning. Because they were functioning, it delayed or put off entirely his ability to get help for it."
• Dr. Judith Joseph [15:08]: "Validate how you feel and accept it, because that act is so important, it's therapeutic in itself."
• Dr. Judith Joseph [45:32]: "You have to be there for them and you have to validate for them."
• Dr. Judith Joseph [62:36]: "Rather than trying to change the thought, let's try to stay in the present and feel our feels."

This episode serves as a vital resource for anyone seeking to understand high-functioning depression, offering both scientific insights and practical tools to foster mental well-being and reclaim joy.