Transcript
A (0:01)
Hello 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. When 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. They feel disconnected and distant from joy. This quieter, harder to spot condition is called high functioning depression. I'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.
B (0:51)
Anhedonia. I have never heard of that word. Could you explain what that means?
C (0:55)
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.
B (1:03)
Okay, had you heard of it, Jonathan?
A (1:05)
No, no.
C (1:05)
Go on, I want to know. Have you heard of it? No, most people haven't. 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 seeing was this lack of pleasure and interest in things, in people who had substance abuse and people who had depression and 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. They say, I feel meh or bleh, right? And if you're not crying or not getting out of bed, no one's gonna 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 and distracting from these 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. They 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. And 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 things, but you're still performing, but you're still delivering, but you're having these symptoms, are we just gonna 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 worker, 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.