ZOE Science & Nutrition - Signs you may have high-functioning depression – and 5 ways to fix it | Dr. Judith Joseph and Dr. Sarah Berry

Episode Date: May 1, 2025

We often associate depression with withdrawal and low energy - but what if it hides behind a packed schedule and staying busy? Board-certified psychiatrist Dr. Judith Joseph joins Professor Sarah Berry to explore high-functioning depression. Dr. Joseph explains how depression gets missed by medical professionals, explaining what’s really happening in the brain. She shares how traditional definitions of depression often overlook people who appear to be coping, leading many to go undiagnosed and unsupported. We discuss how a busy, high-achieving lifestyle can actually mask the symptoms of depression - and even perpetuate it. Dr. Joseph, the first psychiatrist to run a lab focused on high-functioning depression, shares her latest findings on its causes, signs, and long-term impact. ZOE’s Chief Scientist Prof. Sarah Berry explains how food and the gut microbiome may hold the key to reducing these symptoms. If this sounds familiar, Dr. Joseph introduces a quick self-test to help identify high-functioning depression - and outlines five practical strategies to begin healing, and Sarah gives you the foods that could help. 🥑 Make smarter food choices. Become a member at zoe.com - 10% off with code PODCAST 🌱 Try our new plant based wholefood supplement - Daily 30+ Follow ZOE on Instagram. Timecodes 01:55 Quickfire questions 03:55 How depression has changed 05:34 Do you have Anhedonia? 10:05 What is high functioning depression? 12:22 3 categories you should understand 14:48 The risk of being busy all the time 17:55 How to cultivate joy and purpose 18:28 Why men are at increased risk 21:38 What is trauma? 24:14 Is depression influenced by what we eat? 26:23 Gut microbiome and brain health 27:43 You need these brain foods 30:55 How to beat stress eating 33:50 Try this trick when you eat 36:49 The power of slowing down Get Dr Judith’s new book: UK | US 📚Books by our ZOE Scientists The Food For Life Cookbook Every Body Should Know This by Dr Federica Amati Food For Life by Prof. Tim Spector Free resources from ZOE Live Healthier: Top 10 Tips From ZOE Science & Nutrition Gut Guide - For a Healthier Microbiome in Weeks  Have feedback or a topic you'd like us to cover? Let us know here. Episode transcripts are available here.

Welcome to ZOE Science and Nutrition, where world-leading scientists explain how their research can improve your health. Do you feel burnt out? Like you want to take a day off, but you just feel like you can't? Maybe things appear to be going well from the outside, but on the inside you're unhappy. And you're thinking, I can't be depressed. I'm way too busy. It turns out depression can hide in a busy schedule. In fact, that busy schedule can make your depression worse. It fuels a thing that today's guests calls the thief of joy.

And it keeps you stuck in a cycle where you're burnt out, unhappy, and you have no idea why. I'm talking about a new form of depression that will keep you up. High functioning depression. And today we're going to learn how we might break this sinister cycle. Dr Judith Joseph runs the world's first study on high functioning depression. Her breakthroughs will publish in her 2025 book, High Functioning, but she'll also share them with us today. She's a board certified psychiatrist

and her lab works around the clock to find causes, symptoms and cures of this new form of depression. You'll finish today's episode, ready to break the cycle of burnout and begin to feel happier. Judith, thank you for joining us today. Thank you for having me. I'm really excited. This is a new topic, but we always start in the same way

at Zoe, which is we have a quick fire round of questions from our listeners. We have these very strict rules. You can say yes or no, or if you absolutely have to, you can give us a one sentence answer. And it's designed to be really difficult for doctors and academics. Are you willing to give it a go? Of course.

All right. If you can't get out of bed in the morning, could you be depressed? Absolutely. If you're out of bed every morning at 6am for a busy day, could you be depressed? 100%. Do men and women typically express depression the same way? No. Could you improve your mood with the foods you eat?

Of course. Last question, and this one you're allowed a whole sentence for. So generous. What is the most surprising thing you've found from your research into depression? The most surprising thing that I've found is that you don't have to be sad to be depressed. In the description of your new book, you describe people who look fine on the outside, but don't feel fine on the inside. And I found that incredibly powerful, Judith, and I'd like to talk about something that

I've never mentioned on the podcast before actually. So frequently over the last few years, I think I felt exactly as you described in this book. So that on the outside I appear fine, I'm CEO of this successful startup, I'm hosting this amazing podcast, but on the inside actually I feel really numb and unable to enjoy myself. I feel pretty overwhelmed by the pressure of making Zoë success and it feels very alone, right? Lots of people are relying on you and and unable to enjoy myself. I feel pretty overwhelmed by the pressure of making Zoe success and it feels very alone, right? Lots of people are relying on you and I'm sort of doing this on my own. And in that situation, even when people say how great it is,

I can't actually source any joy. While pretending that I do because your expectation is just supposed to look like you're really happy. And I know you're basically the first doctor to really start researching this as a phenomenon. Can you start by explaining like what classical depression is and what's going on in the brain and then take us into this new form of depression you're talking about? Well, first, thank you for sharing that story. It's vulnerable and I think people need to hear that.

Thank you. Because you're not the person that a doctor's going to say, let's address this. You're someone who you'll go into a doctor's office, they'll ask you symptoms of depression, you may say yes to some of them, but then they'll ask you, are you functioning? Are you delivering?

You'll say, yep. And then they'll say, we'll see you next year. And in my lab, I was seeing cases like this throughout the pandemic, after the pandemic. People coming in and I was checking the box of the DSM-5. Could you explain what the DSM-5 is? So in America, in the United States, we use the Diagnostic Statistical Manual for Psychiatric Conditions. And version 5 has criteria for depression.

So symptoms of depression, in medical school, we learned it as CIGI caps, that was our acronym. Sleep, lack of interest, guilt, low energy is the E. C is concentration, A is appetite, P is pleasure or psychomotor retardation, and S is suicide. So you have to have five of these nine criteria plus low mood or anhedonia. But the thing that a lot of people miss is the anhedonia part. So if a doctor asks you how you're feeling, and you don't say that you're sad,

and you just say, I'm okay, which is most of our auto response, right? We say, I'm okay. And you say no to sadness, doctors don't dwell on anhedonia. And Judith, you've said a word a few times, anhedonia. I have never heard of that word. Could you explain what that means?

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. Okay. Have you heard of it, Jonathan? No, no, 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 saying 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 anadonia. You even see it in people with dementia.

So 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, that make life worth living. But it's a sneaky symptom, it's quiet.

People don't walk around saying, I have anhedonia. They say, I feel meh or meh. And if you're not crying or not getting out of bed, no one's going to 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 from 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 going to 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 the 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. And if you went to see that I had to do something about this, and that's why I started studying it. And if you went to see your doctor, what would generally happen if you're, you know, with this sort of high-functioning depression that you're talking about? What would you expect? So there was a scale that I was using in my research studies.

It was the Schaap scale. I believe, I think it's actually developed by someone who's British, but it's an old scale, and there are items on there that I was using in my lab. But I found that some of the scales on there were a bit antiquated. Like, you ask, many people don't drink tea, but tea shows up on that scale.

So I had to change some of the items on there to match modern day. And so things that I would ask my patients were, when you eat a meal, do you enjoy it? Most of my patients who were suffering from high-function depression were just eating to live. They weren't savoring their meals. Or, you know, do you enjoy social interactions?

And some of them would be saying, well, kind of, but most of the times I wish I weren't there or I wish I would just hurry up and get through it. Do you enjoy intimacy? You know, and a lot of them were saying no. And so the simple pleasures in life are just not exciting you. They're not bringing that same joy that they once did. And those are the things that I ask.

Now, I also ask about those other symptoms that I mentioned, the CIGI caps of depression, to see if people are experiencing changes in their appetite, their sleep, their energy, guilt and hopelessness. And I find that guilt is one of the things that I've noticed a lot with these patients. There's a guilt if they take a break.

There's this feeling as if they're not producing enough, even though they're producing so much, you know, like producing a podcast, running a business, it just doesn't feel like enough. So there's this guilt to keep pushing through and keep making more. But there's a lack of satisfaction. So this busying and this guilt that drives people to produce in order to feel worthy

is really tied to high functioning depression and overachievers. And Judith, do you think that it's increasing in prevalence given the demands of the modern way we live our lives? Do you think this is something that existed 100, 200 years ago? Or do you think it is purely because of the expectations that I think are placed on so many of us now? It's an excellent question. In medical school, we learn the biopsychosocial model. So it sounds fancy, but it is very straightforward.

Break it down. So there are three circles, and I love this diagram because it's very easy to explain to patients. Biologically there are risk factors that everyone has and biologically you have genetic loading, you have people who have medical conditions, physical conditions that contribute to depression. Psychologically you have past traumas, you have your inner resilience, your IQ, whether or not you are pessimistic or

optimistic, your attachment styles. And then socially, the things in the environment that contribute to symptoms or disease states, right? So your relationships, if they're unhealthy or stressful, that's a pressure. Your diet, which I know that you're an expert in, your habits, such as smoking and drinking and so forth. So the biopsychosocial model is really important. But I think in today's day and age, in the social aspect of that model,

we do have to consider capitalism and the wage gap. And the fact that the rich are just getting richer and the poor are getting poorer. The fact that there's social media, that we have this never ending amount of content being thrown our way. It's a lot. So there are pressures from a societal standpoint

that were not there 30, 40 years ago. And that's why it's important to revisit the biopsychosocial model. It's an old model, but it's a good one because it changes over time. And you can fashion it to the patient in front of you. For example, if I have a patient who has an autoimmune disorder,

well, you know, looking at the biopsychosocial model, I can say, oh, I could focus on the relationships and your boyfriend who's not really treating you well, or, you know, what if the autoimmune condition is the thing that's really stressing the system here, right, the biological? Let's get that under control first. Or if it's someone who's perfectly healthy,

you know, from a biological standpoint, and then psychologically they're okay, but their current situation, let's say the's perfectly healthy, from a biological standpoint. And then psychologically they're okay, but their current situation, let's say the job is toxic, then that's where I'm gonna spend my time and focus my effort. So the biopsychosocial model is really important. So to answer your question, absolutely capitalism, technology, all of these changes, a post pandemic world,

these political uprisings, all of these things impact us today. So what I'm understanding, Judith, you're saying that you can have someone who's almost like hiding a set of underlying symptoms. And I was sort of, as I said, describing a bit my own story, reading your book. So they look very non-depressed, but what you're saying is sort of underneath quite a few of these symptoms of depression are there. and that in a way being busy is in part a response to this. So like in some sense, a mask, but also it's a sort of way to try and like deal with it. Like you feel like this is, well obviously you have some purpose, there's something you're supposed to do, so you do this.

Am I sort of playing this back right? Somewhat, yeah. More of like a prodromal state to a depression or to a physical breakdown or to a substance abuse, right? Because eventually something's going to give. You can't continue doing that. Something will break. Either you physically will break down or you may develop low functioning or clinical depression or an unhealthy habit, an unhealthy addiction. So eventually, this is something that we want to prevent.

In modern medicine, we are in the business of fixing things, not preventing conditions. So Judith, can we dive a little bit into your research? Because I know that you're the one that's really led this area of high-functioning depression. What do you think are the main causes of this? I do look at what's been happening over the past couple of years, like I mentioned. I think that in a post-pandemic world, we didn't really process the pandemic. At least there's

no memorial. There's no recollection of, well, let's reflect and get through this. It was more like, let's forget that ever happened. Let's just, you know, continue moving forward. And then like I mentioned with the biopsychosocial model, the richer just getting richer, the poorer getting poorer. There's just so many factors that make depression today so different than depression 34 years ago. So I think that looking even at technology, we didn't have nonstop exposure to technology. Our brains weren't overwhelmed the way they are. Who knows what that's going to do to the adult brain? We know already what happens to the pediatric brain.

We're seeing it. I treat children as well. And so I think that the stressors in the world are just different. You're from a nutritional standpoint and you know that the foods these days are ultra-processed. We're not getting the things that we used to 50 years ago that fed our brain, that fed our bodies. So there are so many factors. And that's why I think this is a new depression.

And I think that we have to think about the biopsychosocial model, we have to think about preventing it. Because we have a mental health epidemic on our hands. In some parts of America, there's one psychiatrist for 50,000 patients. One one psychiatrist for 50,000 patients. One of me for 50,000 people. I can barely handle 50 patients. I like to use words like the new depression because it gets your attention.

If I call up my colleagues who work in the ER and I say, I have a patient who's suicidal, they'll be like, well, bring them in. But if I call them up and I'm like, I have a patient who has anhedonia, they're like, well, when they're suicidal, bring them in. That is not okay. But that is our current system. I studied cultural psychiatry in different countries throughout my training. And it's so interesting because in some cultures, I would see doctors who are not psychiatrists

approaching mental health in so many creative ways. They talk to patients from a spiritual level like, so how is your family and what are you doing in terms of making yourself happy? And they were talking about praying and meditation and things like that. That is what we should be doing. We need to focus on cultivating joy and purpose versus preventing disease and crisis. And when we shift that, you won't need one of me for 50,000 people, because you will be preventing this crisis from happening. And with high functioning depression, do you see the same differences between men and women that we see with, maybe I should call it the old depression?

There are some colleagues who are at major institutions who are saying that men are particularly at risk because men, at least in our country and in the United States, are not acculturated to express feelings. So they are told to suck it up and you see a lot of irritability. So a lot of times these bad actors, you see them misbehaving and they're like, oh, that guy's a jerk or it's an untreated depression, right? They're irritable and angry. And irritability is one of those other

not well-known symptoms of depression. In my laboratory, some of the clinical rating skills that I use look at symptoms, not just of sadness, but of irritability. But when people think about irritability, they don't necessarily think of depression. So someone who's irritable doesn't get the sympathy or the empathy. They're just a bad person. They're just a bad mood, right? Think about other people, you know? But irritability is one of the hallmarks of depression. And I see that a lot in men. So I think that men express it that

way. And they may cope with the depression by substance abuse. So one of my patients over the years, I would try to do a family true with them to see who in the family may have had depression because I talked about the biological component, right, the biopsychosocial, and that's the family history part. And he was like, well, you know, no one in my family had depression, but my dad did come home and yell a lot and drank every day.

And I was like, so do you think he was happy? And then he was like, oh do you think he was happy? And then he was like, oh my gosh, never thought about it. I just thought he was a jerk. So you're saying, I just want to make sure I understood it, that that might be a consequence of being really unhappy, which you're saying is also close to being depressed. And then you potentially start abusing substances, alcohol you're talking about here. And then obviously, you know, someone might become an alcoholic and we know all the bad things that come have for that. But you're saying that's not necessarily the starting point is not necessarily sort of innocently drinking too much and falling into this. Actually, this might be a like a crutch, a coping mechanism.

Because it's a way of coping, which makes sense to me. And I can definitely think of friends of mine for whom that's clearly been the case. Yeah. I mean, so what you're saying is, basically the person expressed the depression instead of sadness with irritability, and the coping with the sadness, the coping with the emptiness, that they don't necessarily identify as being sad, because a lot of people who are angry

will not say that they're sad, right? They'll say, I'm angry. But it really is a depression, right? And so they'll cope with that, with with drinking to escape whatever they're running from. There's a lot of comorbidity with trauma, so people who have unprocessed trauma, and not trauma in terms of what meets criteria for PTSD, post-traumatic stress disorder,

trauma in terms of emotional pain. So, you know, to meet criteria for PTSD in the DSM-5, the diagnostic manual, I'll tell you about, it has to be life-threatening, or it has to meet criteria for PTSD in the DSM-5, the diagnostic manual I'll tell you about, it has to be life-threatening, or it has to be something like a sexual assault, right, or combat. You had to have experienced or witnessed it to meet criteria.

But there are other things that classify as traumas that are not in the DSM-5. For example, I had patients during the pandemic who told me that they experienced their loved one having prolonged cancer. Well, that's traumatizing, but it didn't meet criteria for DSM-5. But no one would deny that that is trauma, right? Or people who've been through terrible divorces or bankruptcies.

I mean, that's traumatizing, but it doesn't meet criteria for the DSM-5 diagnosis of PTSD. So a lot of painful emotional experiences that have shaped who you are and how you perceive yourself in the world, those are traumas. And a lot of times we don't talk about them because one of the symptoms of trauma is shame. We somehow believe that we did something to deserve it, so you hide it and you turn on yourself. You cope in negative ways, like drinking a lot, by yelling at people. With high-functioning depression, anhedonia

and not processing your pain are key. And we're not having those conversations. We are being okay with people getting through life just working and then dying. But what's the point, right? What is the point of life if there is no purpose and meaning? And so, I may sound more like a spiritual leader than a physician. I was actually loving that. I think my parents would say, my parents are both workaholics.

I love them very much. They're complete workaholics, Judith. So are you, Jonathan. Well, I wonder where that comes from. So my parents are both workaholics, and I think they would be like, what do you mean that there is some purpose other than work? And then they're like, surely that is the prime, and they care about their family as well.

But it's interesting that you mentioned that while also telling me maybe I am high functioning depressive. So this is all somehow linked, is that what you say? I feel like this is becoming a therapy session for me now, Sarah. Well, I'm identifying a lot of this in me as well. Well, a lot of high achievers, you know, you're doing wonderful things and people depend on you. You were just telling me you're one of the, you're the top podcast in the UK. You can't let your followers down.

Well done, John. Nutrition podcast, but thank you. It's not uncommon for leaders like yourself to experience it. And Sarah, this is Zoe, and you're one of the world's leading nutrition professors. Do we know if depression can be influenced by what we eat? So, if you'd have asked me that 20 years ago, I'd say nothing. Nothing. But it's phenomenal now how much our knowledge is growing around how food impacts our mood, our mental health, anxiety, depression, and so forth. There's still so much more to learn. But we now know that we need to stop thinking about just how food impacts

our body below our neck, that actually it has such a profound impact also on the way our brain functions. We know from studies, for example, that there can be up to a 30% reduction in rates of depression just by changing our diet. There's a fantastic study called the SMILES study, which was run by Professor Felice Jaco, who we've had on the show before, who randomly allocated people who had major depressive disorder either to follow a kind of Mediterranean diet or follow just a controlled typical diet. And they saw really huge reductions in rates of depressive symptoms.

30% of people actually were able to meet the criteria for coming off their medication. And so that's in people that have clinically diagnosed depression. In addition to that, we know that food impacts our general mood, our general levels of happiness and contentiousness. And we know this, you know, even from our own research, Jonathan. And so Judith, we recently published a study where we compared individuals who are following the ZOE program, which is Personalised Nutrition Program, versus the average US diet. And what we found was that for those who are following the ZOE program, over 30% of people

reported significant improvements in their mood. And this is people that don't necessarily have any kind of clinical diagnosis, but are saying that, yes, I feel better. And this is people that don't necessarily have any kind of clinical diagnosis but are saying that, yes, I feel better. And we're starting to understand that partly it's to do with inflammation, it's to do with reductions in oxygen stress, but what we're also really starting to understand, I think this is what's really exciting, that there's a link between our microbiome, which we know is heavily influenced by food and our brain function, and particularly related to the mood areas of this as well. Mr. Judith, when I first co-founded Zoe eight years ago,

if you told me that food could have any impact really on how I feel, I would say that's like some crazy Californian thing, like totally mad. And I think even three years ago, when we were talking about setting up that randomized control trial, and Sarah, my co-founder professor,

Inspector basically said, you have to do this randomized control trial of Zoey membership. If you don't like prove that it works properly, like you would anything other scientific, we won't keep working with you. So I was like, okay, we'll have to do it. So it's a bit scary, right?

You have to publish the results as you know, as a scientist and as a CEO of a company, I was like, so if it proves it doesn't work, I have to publish to everybody and tell them does work. It was very scary. So I was very pleased when it turned out that Zoey membership really works, but we were very focused on long-term health.

Like a lot of this was around improving your gut microbiome and how this would change long-term health. We were not focused, and you weren't focused, right, Sarah, on like how would you change mood and energy and sleep? But actually what's amazing is these were some of the biggest changes that we saw. Now, you're nodding as if you're not surprised. Well, there's a whole field called nutritional psychiatry dedicated to that, and there are studies out field called nutritional psychiatry dedicated to that. And there are studies out of Harvard that show the key brain foods. I'm sure you know like those leafy greens, blueberries,

foods rich in omega-3 fatty acids, eating foods that don't promote inflammation, right? The foods that are processed, those are inflammatory foods. So knowing where your food comes from is also important. A lot of us don't know where our food comes from. And I'm from the Caribbean, so my father used to say, make sure your plate is colorful. And he knew what he was talking about, right? Did he really say that?

He really did, yes. We say that a lot as well, but I have to say that none of my parents or grandparents ever told me that my plate should be colorful. That may be growing up in the United Kingdom versus elsewhere. So yes, he clearly did know. So that's really interesting. Well, in Trinidad, I remember, because I was born there, I remember waking up and I heard the milkman coming and the fishman coming.

Everything was fresh. And so when we moved to the United States, my dad would be like, we have to keep eating fresh foods. And, you know, I don't think he knew about nutritional psychiatry because he's a pastor, but there's something to it. Having fresh food that's not processed, that's not promoting inflammation in your body, because inflammation is not just bad for your body, it's bad for your brain. And we're learning that food is truly medicine.

So when we think about the biopsychosocial model, there's an overlap between biology and social because our social habits, picking the foods that we eat, overlaps with our biological. So when you look at that diagram, they overlap because the oxidative stress, the inflammation can impact the way that you feel. But it's really hard to change what you eat.

These programs that you're talking about, these studies, they're controlled. You have people on these plans, but it's really difficult to implement that in your home for some individuals. So it's something that you don't just give a book. With my patients, I recommend two or three books from authors that I personally know who are leaders in nutritional psychiatry. But I tell them it's not just about reading a book, you really do have to practice it because sometimes if you're not feeling great in life, if you're feeling stuck, you fall

back into patterns. So you do need that reminder. That's the big challenge that we know that low mood and what accompanies low mood, the kind of factors you've talked about. So for example, poor sleep as well. That alters how our brain thinks about food. So we know that if you have low mood, if you have poor sleep, for example, the reward centers in your brain are crying out saying, okay, I need a quick fix. They're crying out for those refined carbohydrates, those sugary foods, for example. All the foods that we know are going to make our mood even worse, but also set us up on a rollercoaster that day that we're having these foods of these peaks and troughs in blood glucose, then set

off inflammation, et cetera, as well. And so I think it is that real kind of catch-22. We have to work really hard, I think, to enable people to understand just how important food is for mood and give them small, actionable insights and tips that they can take forward. Yeah, I think what you're talking about is similar to metacognition, like learn to think about the way that you think. So with myself, I know when I'm stressed, I want to reach for that sugary processed food. But then I'm like, wait, I'm thinking that way because I am stressed. So then I'm like, I really have to stay away from that.

And I just eradicate it from my house. So I think when you work with your patients, or at least when I work with my clients, I really teach them, all right, let's think about the way that we think. And let's not have those items within reach because you are going to reach for those things. Studies show that when you're stressed and anxious, you are gonna make those poor decisions. So like, let's not keep it in the house whatsoever. And Sarah, one of the things that we've been talking

a lot more about just in the last couple of years is sort of ultra processed foods, as opposed to just sort of junk food in the way that we've all known about it since we were children. Is there any evidence to suggest that ultra-processed foods might be having an impact on mental health beyond just the fact that they've got lots of sugar or fat in them?

Yes, this is, and again, an emerging area of research because it's a relatively new term, the term ultra-processed food. There's some interesting research, particularly in children and adolescents, and this is where there's some quite robust findings now that there is a relationship between mood and depression in children and in adolescents in relation to the amount of ultra-processed food that they're having. We need to now do studies in adults and these are the kind of studies that as far as I understand are ongoing at different, like at the Food and Mood Centre that Felice Jaco runs as well. So I think we're just going to see more and more evidence come out about the relationship of these unhealthy, ultra-processed foods and our mood and depressive disorders. So, Judith, I'd love to start talking about

actionable advice now, because I think you've painted this picture around high-functioning depression. I bet there's loads of people like me, and apparently Sarah has been listening, saying like, oh, maybe I at least have some aspect of that. Could we maybe start actually with those listeners? Imagine they are thinking about this and saying, maybe I do have high-functioning depression. I feel like some of what Judith is describing,

like, resonates. How can they identify it? Well, I do think that I have this rating scale on my website where I break down high functioning depression into symptoms and scores and anhedonia. And so you'll get a score of anhedonia, which is that lack of pleasure feeling, and then you can get a score of high functioning.

So one of the most common things I see, I'll ask my clients, what did you eat for lunch today? Can you describe it? Sandwich. Okay, what did it taste like? It's good. Let's go more into that. Well, I don't really know, I didn't think about it.

Okay, well tomorrow when you have lunch, I want you to close that computer, no phones on, and I want you to just focus on that food and practice something I call 5-4-3-2-1. It sounds super cheesy and granola, but it works. So I want you to really immerse yourself in that experience of eating that sandwich that you said was just good.

And I want you to tell me five things that you can see. And I'm going to ask you about this the next time. So I want you to describe it. So you can see. And I'm going to ask you about this the next time. So I want you to describe it. So you may see like this red tomato and you see the green lettuce, you get the idea. Four things that you can feel. So it could be like the bread or the texture of it

or whatever you're drinking. Three things that you hear. And I want people to be intentional about that experience. Two things you can smell, one thing you can taste. When I practice that with people, even in my office I'll have like these little mints or a reason, and they're doing that, they're not thinking about anything else. They're present in that moment. And they actually start to enjoy it versus the shoveling the food in the face and just

eating to get through the day. And it sounds so simple, but it's very difficult for people to do. That's a very quick and dirty way to start challenging and pushing back on anedonia. What it does is it forces you to slow down. It forces you to savor a moment and to actually find pleasure in something that we all have access to.

We all have access to food, hopefully. And once you start with those baby steps, then I move on to people in their lives, right? People, a lot of times the mothers that I work with, they'll say, like, I just, I get home and I'm just so tired. I'm going to play with my kid. Well, we're going to teach you how to be present, even in that five minute interaction with your child. And the more you do these things,

that you're intentional and mindful and still in these things, you actually start deriving pleasure again, you start feeling again. But remember how I said that that anhedonia, that numbing is probably a product of, you know, not processing pain or it's a coping mechanism. Well, when you don't process, when you don't feel that pain,

you're not going to be able to feel joy. So it is a step in feeling again and being human again. Another common thing I hear is I'll ask my client, how many times did you use the bathroom today? And they'll be like, maybe once, maybe when I got here. Well, I want you to be mindful and I want you to set alarms in your phone. You're gonna take bathroom breaks like you did when you were in the first grade. And it sounds funny, but how many of us have just powered through

and we had to really go? Why are we doing this to ourselves? Who's benefiting? What's the worst thing that will happen if we actually listen to our bodies and we're kind to ourselves and use the bathroom. So these sound like very simple things like, oh, I don't need a psychiatry degree to know that. But sometimes you do, you need a reminder to just start feeling your body again,

to start being human again, to enjoy those basic things, those basic sensations again. I think a lot of what you're describing to me sounds like, just slow it down. And I think what really resonates is the being present. And it's something that I've really struggled with my children. They're now getting to their teens. And I look back and even during, you know, while they were children, I kept thinking, I wish I could be more present. And I tried to be very conscious about being more present, but I still really struggled. Now, in your book, you reveal that there's five ways that we can tackle high-functioning depression. Could you talk us through those?

So, a lot of what I talk about with psychiatry is eradicating disease, but we don't cultivate joy. Well, there are actually, I'm not the only one, there are a lot of people, not a lot, but there are a couple of people like me who want to focus on joy. And the first V is validation. So I mentioned that when I was going through my periods of high function depression, I was just like pushing through pain. And I remember sitting at my desk

and giving a talk to healthcare providers who were really stressed. It was April, 2020, they were in the pandemic. No one knew what this thing was. And I'm talking to them and I'm supposed to be helping them through this. And I'm just thinking like, I don't even know what to say. I'm scared too. But that was the first time I actually said it out loud. Like, I am afraid. I think I'm depressed. And that validation,

the first V is validation, acknowledging your pain. We don't we don't acknowledge our pain. We don't acknowledge our negative feelings for whatever reason. It could be cultural, it could be the way that we were raised, but the first step is really acknowledging it. And could that be just even acknowledging it to yourself? You might not yet be ready to acknowledge it externally. The second is venting. So that's when you actually start talking about it. So some people have someone to talk to, but others don't feel just ready yet.

If you have a therapist, great, but good luck with that. The wait list is very long, at least in America. You can start venting by writing. You could start, I had one patient who was a singer and she would just start belting out notes. Some people express it in art, but get it out. And the definition of venting is like, you're letting out air, but we have to let it out because then we're holding it all in.

And there's that saying that the body keeps the score, right? And then the third is values. I used to think that collecting all these degrees was important. I have two Ivy League degrees. I have like all these certifications. You go to my office, it's degrees everywhere. I used to think that was what was important in life. But I'm an island girl at heart, you know?

And when I visit Trinidad and I put my feet in the sand and I look at the water, I'm like, wow, I value nature. Why don't I get enough of this? I grew up in this. Why am I running from it? So now I make it a point to be out in nature with my daughter. Value family. So I'm not going to stay in the office 30 minutes later just

to do some paperwork that when I'm on my deathbed, I'm not going to be thinking about that paperwork, that file. I'm going to be thinking, why didn't I have 30 more minutes with my child? So really think about what you value in life and invest in that. The things that you thought were valuable, you're not going to be missing those when you're in your deathbed. And then vitals. This is where you come in with your nutrition expertise.

So the things that support our body. Food that feeds our brain and our body that decreases inflammation. Movement. That's another thing that people with high function depression often neglect because they're working so hard they don't get to move. Our relationship with technology, I think that's a vital that's missed in medicine, you know, decreasing that. And also sleep, it's very important, it's restorative. So there are things that support our bodies that we tend to neglect when we're busying ourselves.

And I stuck into vitals, our relationships, because like I mentioned, if you have a toxic blood vessel, things that support our bodies that we tend to neglect when we're busying ourselves. I stuck into vitals relationships because, like I mentioned, if you have a toxic person in your life, relationships are the number one predictor of longevity. Think about who you want to spend your time with. You may not be able to cut people out completely, but you can limit the amount of exposure to them. Then the last one is vision. We don't tend to celebrate our wins.

You have the top podcast. Put moments in the calendar to celebrate it as a team. Take the time to savor a win. If you got a good research study result, celebrate it. Don't just send an email, look, this is where our study showed. Okay, what's for dinner? Celebrate your wins. Where are we going for dinner tonight, Ethan? Judith, you're welcome to join us. Are you taking me out for dinner, Sarah? I think we've got like a month's worth of dinners

for our win. We are like a long way behind on celebrating our wins, I think. No, so he's very good, actually, I think. And not just the big wins. Like if I get my daughter to school on time because her school is strict, I will come home and I'll like sip a cup of coffee and take time and savor it. And like, wow, I got her to school on time. That was hard.

Right. It's not just the big ones, you know. I love that. The small wins, because it's the small wins that I don't think we acknowledge, but it's the things that are occurring hour after hour, day after day that are challenging. And Sarah, just listening to that on the food side, I just wanted to follow up on one thing, which is I think a lot of listeners

think that this will be, well, if I am worrying about my mental health, are there any specific foods or way of eating or anything that can actually help? So I think there's no specific way of eating that would be different to what we would recommend for everyone You know specifically for mood So we would recommend for everyone's physical and also mental health to be following the kind of diet we encourage at Zoe So this is a diet rich with whole foods, whole plant-based foods

Lots of color, I, as I told you, Judith. So a diversity of different plant-based foods that are rich in colour because they contain all of these magical chemicals called polyphenols, which we know act on anti-inflammatory pathways. Lots of fibre-rich foods, so whole grains, legumes, pulses, foods that also contain omega-3, and Judith touched on this as well. Omega-3 is a particular kind of fat. It's found in high amounts in oily fish and that's really important because we know it has a really important functional role in our brain as well. And avoiding certain foods. I know that we want to think about what we should encourage

but I do think we need to acknowledge, particularly when it comes to mental health and depression, that actually having these very high refined carbohydrates, high sugar foods, high heavily processed foods like your, you know, salami, your heavily processed red meats, for example, we know that that increases the chances of having mental health issues, of having depression, of having low mood. So your dad was completely right about eating the sort of food that he was eating before you came to the States, it sounds like. Yes, I tell my patients if you can't pronounce it, don't eat it. Which if you look on most food labels is quite limiting. Judith and Sarah, thank you. That's I think been amazing, really interesting.

I would like to do a quick summary and Judith, will you correct me I get this wrong because it's a completely new topic for me. So you started with this idea that basically you've been trained like most doctors with this idea of eradicating disease and not at all about worrying about creating joy with people who don't have joy, but actually they're sort of this epidemic of people who are managing to function, but just have sort of got their joy switched off. And if they don't do anything about it, they can end up getting worse. And then you end up treating them

because it's gone to a full depression or something like that. So for you, that doesn't make any sense. And actually this is a real thing, this high functioning depression. And if you can help people to identify it, then what I think is exciting is just saying there are things that can be done. The men and women don't necessarily

express it in the same way. We then talked a bit about food and that food really does make a difference for mental health. This is not some like woo woo thing that as I thought it was a decade ago but it's like real and I think Sarah just shared something I'd never heard before which is that like there's this latest research showing that there's actually a link specifically between ultra processed food and depression, you said? Mood disorders in children and adolescents. Which I think is, again, this sign that the food that we're eating is doing really terrible things, I think that none of us understood.

And then you talked about the fact you can do something about this. And I think my takeaway was, your number one thing you're trying to say is, can you start to be present? And if you can be more present, you might be able to start to connect and start to source joy. And so you talked about like this noticing lunch and paying attention to it with this rule, which I love and I know is in the book. And then you talked about these different Vs. And interesting, there's a sort of pathway, it sounded like, between like just acknowledging yourself

that you're unhappy and in pain, being able to talk about it, which if you were brought up with a stiff British upper lip and a family that didn't talk about emotions is really hard. It's not at all, you know, where you are, even if it's in a very loving family, it's not what you're supposed to do. Doing the things that you actually value, like you talked about the family and all the rest of it, because this obsession to work hard actually maybe pulls you away from the things that you really care about. Look after your body. And then I love the last one, actually go and celebrate your wins, because I think that is really interesting what you said. I was thinking back to this description I was saying about times that I felt at Zoe,

I think, unable to celebrate any of those winds of things that were going on, is definitely part I think of how I would describe, you know, how I was feeling. Excellent. That is spot on. And Jonathan, may I celebrate what you have done in the last seven years is incredible. I'm sorry, Judith, I know this is about high functioning. This is therapy session. But honestly, like the joy that you have brought to all the zoonetists that have the pleasure of working with you for you, the joy that you brought to my life, the phenomenal science

we have produced. Honestly, it's like I always talk about our research at Zoe as being like science on steroids. It's just crazy and fun and incredible. The breakthrough is everything. And then what you're doing to all of the people that get to listen, the millions of people that listen to your wonderful podcasts, the hundreds of thousands of people that have actually done Zoe that are following the Zoe diet and the new discoveries that are helping hundreds of thousands of menopausal women as well. So well done. Thank you, Zara. Well, we don't normally do that on the podcast. I'm really embarrassed

and not in touch with my emotions, but I appreciate it. We're going to go and have a private consultation, I think, after this. Judith, thank you so much for coming on the show. Thank you. It was my pleasure. It was a real pleasure. Thank you, Judith. Now, if you listen to the show regularly, you already believe that changing how you eat can transform your health,

but you can only do so much with general advice from a weekly podcast. If you want to feel much better now and be on the path to live many more healthy years, you need something more. And that's why more than 100,000 members trust Zoe each day to help them make the smartest food choices. Combining our world-leading science with your Zoe test results, Zoe is your daily companion

to better health for life. So how does it work? Zoe membership starts with at-home testing to understand your unique body. Then Zoe's app is your health coach, using weekly check-ins and daily guidance to help you shift your food choices to steadily improve your health. I rely on Zoe's advice every day,

and truly it has transformed how I feel. Will you give Zoe a try? The first step is easy. Take our free quiz to find out what Zoe membership could do for you. Simply go to zoe.com slash podcast, where as a podcast listener, you'll get 10% off. As always, I'm your host, Jonathan Wolff.

Zoey's Science and Nutrition is produced by Julie Pinero, Sam Durham and Richard Willen. The Zoey's Science and Nutrition podcast is not medical advice, and if you have any medical concerns, please consult your doctor. See you next time. is not medical advice. And if you have any medical concerns, please consult your doctor. See you next time.