High-functioning depression: when life looks fine and the joy is gone
Psychiatrist Judith Joseph describes people who meet every deadline while feeling empty and names anhedonia as the tell, and Senator John Fetterman, Terry Bradshaw, Will Sasso, the Botez sisters, Greg Lukianoff and Rachel Platten each recount being depressed while performing at a high level. Their accounts show why this form of depression is missed by doctors, colleagues and the person living it, and what finally got each of them help.
A person can meet every obligation and be depressed. The sign to look for is the loss of pleasure, which psychiatrists call anhedonia. It gets missed because doctors look for impairment, other people see the performance, and the person does not fit their own picture of someone depressed. What got the people in these accounts help was usually another person who said something, followed by therapy, medication or both.
Judith Joseph, a psychiatrist who runs a research institute, describes patients who take care of the family, meet every deadline and feel no joy. Under the standard model, someone with many symptoms who is still functioning is in effect told to come back when they are worse. She calls that "a broken model," because it misses people before a crisis. Her sketch of a day: dread on waking, skipped meals, working through lunch, and scrolling on a phone at night too depleted to engage. People tell her they are not depressed because they picture someone in bed crying. Keeping busy becomes the way of not feeling. Men often show irritability or anger in place of sadness. She did not see it in herself until she was midway through giving a talk. The belief she asks people to drop is that they are a burden.
The pattern runs through other lives. John Fetterman's depression got worse after he won a Senate seat, reaching thoughts of harming himself. His children were the emergency brake, he checked into a hospital, and his message is that help works. Terry Bradshaw won four Super Bowls while carrying anxiety and depression, and explains why nobody noticed: "Depression doesn't steal your personality." Medication and three years of counseling helped him. Comedian Will Sasso was told he did not have to white-knuckle it through life and started therapy and medication. Chess streamer Alexandra Botez reminds herself in dark periods that she has come through every time. Greg Lukianoff ran a prominent organization while suicidal, and cognitive behavioural therapy helped him. Singer Rachel Platten thought needing medication was failure until a friend told her to see a psychiatrist.
They agree that achievement does not protect, that a public self conceals it, and that talking helps. They differ on whether a low mood is a signal or a liar. A persistent low mood may point at something that needs attention, while its conclusions about your worth cannot be trusted. Treatments differed too, and Joseph says treatment has to fit where a person carries the most strain. High functioning does not mean mild.
What to do with it: ask whether the things that used to give you joy still do. Name what you feel, aloud or in writing. Compare your day with Joseph's sketch. Tell one person who cares about you. Do not wait until you stop functioning; describe the loss of pleasure to a clinician specifically. Drop the test of strength. Know in advance who or what would stop you at the worst moment. Remember that it has lifted before. Check on the strong people around you, and plan something to look forward to.
If you recognize yourself here, talk to a doctor or a licensed therapist. If you are having thoughts of harming yourself, contact a crisis line or emergency services now.