The more I read and the closer I looked at the patients under my care, I could see High-Functioning Depression (HFD) was everywhere. But people couldn’t go to their doctor and ask for a diagnosis or a prescription for antidepressants for it. If they did, the doctor would run through a quick screening tool for depression that looks for lack of functioning and acute distress. They’d ask, “Is living this way impacting your life? Are you showing up for work? Are you able to take care of your family? Well, then, what’s the problem?”
There was a problem, though.
High-Functioning Depression doesn’t just come with the danger of downshifting into Low-Functioning Depression and bringing our lives to a full stop. It also kept us living a life with our eyes closed. Most people with HFD don’t realize that they have it. They’re not fully aware that the joy has been removed from their life. And even if they do realize something is off, they don’t know how to get back on track.
The millions of us suffering from High Functioning Depression need to remember something crucial — how to enjoy life. We are walking around on autopilot without wondering where our path is taking us. We are in danger of waking up one day burdened by an existential crisis, trying to figure out, “What did I do all of this for? Who and what was I sacrificing for?” We are at risk of opening our eyes, perhaps a little too late, and realizing that we built the wrong lives, allowing ourselves to be used by everyone we encountered, and now it might be too late to reclaim some pleasure in life for ourselves.
Yet, this condition, while serious, isn’t insurmountable. Don’t wait for complete breakdown to acknowledge your suffering. Consider working with a licensed mental health professional who understands the trap of perfectionism and has experience treating HFD. With recognition comes possibility — the chance to recalibrate our relationship with achievement and self-worth. The goal isn’t to abandon ambition but to reclaim the joy that makes our efforts meaningful. At the end of the day the things that one values the most are priceless (connection to family, community, causes,) not things that have price tags or are superficial (accolades, money, power). When we busy ourselves from processing pain and emotions, we busy ourselves to feeling joy and from prioritizing the things that brings us the most joy in life. Slowing down, processing pain and focusing on meaning change us from humans doing to human beings.
Adapted excerpt from HIGH FUNCTIONING by Dr. Judith Joseph. Copyright © 2025 by Dr. Judith Joseph MD MBA PC. Used with permission from Little, Brown Spark, an imprint of Hachette Book Group.
