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The Silent Signs of Depression & How To Find Real Joy, From A Psychiatrist
Depression isn’t always what we think it is. While many picture someone unable to get out of bed, the reality is that some people experiencing depression don’t slow down—they speed up. They overachieve, they stay busy, they excel at work and in relationships, all while silently suffering.
This is the reality of high-functioning depression, a condition that psychiatrist and guest on the mindbodygreen podcast Judith Joseph, M.D., M.B.A., is on a mission to bring to light. Joseph, a board-certified psychiatrist and clinical researcher, is spearheading new studies on high-functioning depression and working to change the way we approach mental health.
She argues that we need to stop waiting for people to “break down” before offering support. Instead, she advocates for proactive mental health care—spotting the signs early and taking action before burnout or crisis hits.
What is high-functioning depression?
High-functioning depression looks different from clinical depression in one key way: instead of shutting down, people keep pushing forward. As Joseph explains, clinical depression includes symptoms like low mood, poor sleep, appetite changes, low energy, difficulty concentrating, guilt, and hopelessness. Typically, these symptoms must cause significant impairment in daily life to qualify as a clinical diagnosis.
But what happens when someone checks every box except impairment? “Instead of acknowledging distress, they over-function,” Joseph says. Some may not have the language or cultural framework to express emotional pain, while others numb themselves with work, exercise, or caretaking responsibilities.
The problem? Traditional mental health care often dismisses these individuals, telling them to return when their symptoms cause real dysfunction. Joseph argues this is a mistake: “Why don’t we prevent mental health conditions that cause breakdowns? Let’s not wait for people to break down. Let's give them the tools to prevent a breakdown.”
The subtle signs of high-functioning depression
One of the most overlooked red flags of high-functioning depression is anhedonia—the loss of interest or pleasure in things that once brought joy. “People think this is just life, that you’re supposed to feel ‘meh’ about things,” Joseph says. “But anhedonia is a red flag.”
Joseph estimates that about 75% of people with high-functioning depression experience anhedonia. Other signs include restlessness, feeling constantly busy, or an inability to sit still. For a lot of people, slowing down feels almost impossible—like if they stop moving, everything might catch up with them. So they pack their schedules with work and social obligations or scroll mindlessly just to avoid sitting with their thoughts.
It might look like productivity on the outside, but underneath, it’s often a way to outrun discomfort. This compulsion to stay in motion often masquerades as productivity, but in reality, it’s a coping mechanism—one that can lead to burnout, chronic stress, and a sense of emptiness over time.
The trap of the hedonic treadmill
Joseph connects high-functioning depression to the hedonic treadmill—the relentless pursuit of external achievements to achieve happiness. She explains that many people think happiness is in the next big thing—a bigger house, a promotion, an award. But in research, Joseph and her team don’t measure happiness—they measure points of joy.
She reframes happiness as an accumulation of small, meaningful experiences: savoring a meal, feeling refreshed after a nap, sharing a deep conversation. “Happiness is the idea, joy is the experience,” she says. When people make this shift, they stop chasing an unattainable future and start living in the present.
And when they do, something powerful happens. “Slowing down can be contagious. Joy can be contagious,” she says. “When we prioritize joy, it spreads, and it changes people’s lives and their communities.”
Unprocessed trauma & the urge to stay busy
For many, the drive to stay constantly busy is rooted in unprocessed trauma. “One of the avoidance symptoms of trauma is busyness,” Joseph explains. “Another is feeling unworthy. So what do people do? They keep doing. They keep people-pleasing.”
She challenges people to reflect: What in my past is unresolved that makes me feel I have to constantly be on the move? Often, the urge to stay busy isn’t just about productivity—it’s about avoidance. But by recognizing these patterns, people can start making intentional choices instead of running on autopilot.
Reconnecting with what really matters
Joseph’s solution? A simple but powerful metaphor: the rock and the water. In one of her happiness demonstrations, she asked participants to place a rock into a beaker of water. The rock represents what truly anchors them—family, purpose, deep connections.
Then, she muddies the water with dye, representing external distractions like career pressure or material success. “When we focus on things with price tags, we lose sight of the priceless,” she says.
She encourages her patients to carry a small rock with them as a tangible reminder to stay grounded. In an age where we’re constantly glued to screens, lost in notifications, and pressured to keep up, we rarely engage our senses in meaningful ways.
Holding something real—a rock or a meaningful object—helps reconnect us to the present moment. It’s a physical cue to slow down, breathe, and refocus on what actually brings joy and fulfillment, rather than chasing what society tells us should make us happy.
The takeaway
High-functioning depression is real, and it’s more common than we think. The people who seem like they have it all together may be struggling the most. Joseph’s message is clear: don’t wait until things fall apart. If you notice signs like anhedonia, constant busyness, or feeling disconnected, take action—talk to a professional, prioritize joy, and give yourself permission to slow down.
Because at the end of the day, happiness isn’t in the next achievement. It’s in the small, everyday moments we choose to embrace.