Depression isn’t always cloaked in tears, lethargy, and withdrawal. Increasing research and expert voices reveal that many silently suffer while appearing energetic, high-achieving, and outwardly successful—a phenomenon now widely called “high-functioning depression”. Recent insights from psychiatrist Dr. Judith Joseph, as highlighted in a widely-shared Mindbodygreen article, have sparked new conversations about how this overlooked mental health challenge is affecting high-achievers globally, including in Thailand, where stoicism and productivity are highly valued traits.
For many Thais, mental health is framed through cultural idioms such as “kreng jai” (เกรงใจ), or the reluctance to burden others with one’s problems, as well as the cultural premium placed on “greng jai” (gratitude) seen in familial and professional life. As a result, individuals with depression often mask emotional distress by overperforming in daily roles—excelling at work, family obligations, and social relationships—while privately struggling. Dr. Joseph defines high-functioning depression as the presence of classic depressive symptoms—low mood, poor sleep, appetite changes, anhedonia (loss of pleasure), guilt, and restlessness—without the apparent functional impairment usually required for a clinical diagnosis of depression. Instead of shutting down, people “over-function,” compounding distress with non-stop busyness and people-pleasing.
Global clinical literature concurs. A recent study published in 2025 in the medical journal “Cureus” characterizes high-functioning depression by the experience of fatigue, anhedonia, poor concentration, guilt, and restlessness—mirroring classic depression—but with sustained outward productivity and performance. These individuals remain under the radar of traditional mental health care, as their symptoms often fail to reach the threshold of obvious dysfunction, leaving them without support until a crisis arises (see study summary via PubMed).
The hidden signs of high-functioning depression, according to Dr. Joseph and supporting research, may include a pervasive sense of “meh” or disinterest—clinically known as anhedonia. Up to 75% of those with this form of depression experience anhedonia. Other red flags are constant restlessness, the irresistible urge to be busy, an inability to sit still, and chronic feelings of emptiness despite external success (source). “People think this is just life, or that they’re supposed to feel numb,” Dr. Joseph warns. “But anhedonia is a red flag.” If left unchecked, experts agree, these coping mechanisms—endless work, exercise, caretaking, or digital distractions—can eventually lead to burnout, chronic stress, and even physical health issues. These findings are echoed in recent news features and expert interviews, such as those published by the Cleveland Clinic (source), MSN (source), and Los Angeles Times (source).
Thailand’s competitive academic and professional environments, combined with ingrained social values of resilience and respectfulness, often mask or even amplify these patterns. “Work hard, endure, and don’t show weakness”—attitudes ingrained in many Thai households—can hinder both self-recognition of mental distress and access to timely care. Experts caution that ignoring these patterns not only risks eventual breakdown but may reinforce unhealthy social expectations that conflate relentless productivity with wellness.
Historically, the medical profession focused on diagnosing depression only when it led to substantial functional impairment: inability to work, care for oneself, or maintain relationships. However, Dr. Joseph and an increasing number of psychiatrists are advocating preventive strategies: shifting from crisis intervention to early recognition and support. “Let’s not wait for people to break down,” Joseph says. “Let’s give them the tools to prevent a breakdown.” This includes education on the hidden signs of high-functioning depression and building mental health literacy from an early age.
For many, the urge to remain constantly busy is rooted in unaddressed trauma or feelings of unworthiness—drivers that can be intensified by societal pressures, as Dr. Joseph points out. She uses a simple metaphor in her work: the “rock and the water.” In demonstrations, the rock stands for core sources of meaning—family, purpose, deep human connections—while dyed water represents daily distractions and materialistic pursuits. Focusing on external “measurables” can cloud or even sink our ability to experience real joy, she says.
Latest interventions are now encouraging a shift from chasing abstract “happiness” towards cultivating “joy”—as measured by small, meaningful, and present moments: enjoying a good meal (อร่อย), a refreshing nap (งีบหลับ), or a heartfelt conversation. “Happiness is the idea, joy is the experience,” Dr. Joseph explains, reframing how we measure and pursue well-being in daily life. This approach resonates with Thai philosophies of “ความสุขเล็กๆ” (little joys) and the Buddhist encouragement to stay anchored in the present moment.
Research is also beginning to examine the biological aspects of high-functioning depression. A 2025 neuroimaging study linked epigenetic changes (such as gene methylation related to stress) with anhedonia—the core symptom of both classic and high-functioning depression—particularly among those with histories of childhood trauma. This supports Dr. Joseph’s observation that high-functioning depression often has roots in earlier experiences, requiring sensitive, trauma-informed intervention (PubMed summary).
What does all this mean for Thais in their personal and professional lives? The implications are profound: high-functioning depression may be widespread among students, executives, caretakers, and even monks who quietly shoulder burdens without complaint. Thai families and workplaces need to recognize that perfection and productivity often coexist with hidden suffering, and that early, compassionate conversations about mental health can make a crucial difference. As one local mental wellness advocate puts it, “If someone always appears strong and never asks for help, that’s when we need to check in with them the most.”
Looking forward, experts recommend several actionable steps for both individuals and organizations:
Self-awareness and Education: Learn to recognize the hidden signs of high-functioning depression—like chronic restlessness, anhedonia, and unrelenting busyness. Self-screening tools, mental health workshops, and public campaigns in Thai can be invaluable.
Proactive Support: Don’t wait for a crisis. If you notice signs in yourself or others, seek or offer support early—whether through professional counseling, community groups, or even peer conversations.
Redefine Success and Well-being: Cultivate “points of joy.” Japanese “ikigai” and Buddhist mindfulness already offer blueprints for savoring the present; applying these can help break the cycle of perfectionist burnout.
Combat Stigma: Normalize conversations about mental health in Thai workplaces, schools, and families. Trust that asking for help is a mark of wisdom, not weakness.
Policy and Institutional Change: Thai health and education authorities should consider integrating mental health literacy into the national curriculum and workplace well-being programs, emphasizing early detection and destigmatization.
Mindful Practices: Simple actions like carrying a “grounding object”—as Dr. Joseph suggests—can remind us to reconnect with what truly matters, even during stressful days.
Real change may require a cultural reset, where showing vulnerability is seen not as a flaw but as an act of courage—inspired by both global science and local wisdom.
For Thai readers, the take-home message is this: if you (or someone close to you) seem productive, social, and high-achieving yet struggle to feel genuine happiness or are always “on the go,” it may not just be life. It could be high-functioning depression. Early recognition, cultural compassion, and redefining personal joy can make all the difference. Reach out—there is strength in seeking support, and real joy is built on authenticity, not accomplishment alone.
For further reading and support, see local resources via the Department of Mental Health Thailand (กรมสุขภาพจิต), explore educational articles from the Cleveland Clinic (link) and international research via PubMed’s database (link), and listen to Dr. Judith Joseph’s insights on platforms like Mindbodygreen (link).