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Smiling Depression: Symptoms & Treatment Options

Mary Lucas, RN

Medically reviewed by Mary Lucas, RN

Written by Our Editorial Team

Last updated 4/21/2022

Some people wear their hearts on their sleeves, making it easy to see when they’re feeling their best, as well as when they’re feeling far from their best. Others may be more of an enigma, with feelings that don’t always match their outward-facing expressions and appearance.

If you have “smiling depression,” you may suffer from the symptoms of depression, all while you look happy, cheerful and unaffected to the people around you.

Smiling depression isn’t a clinical diagnosis, but it’s a real problem that can affect your thoughts, feelings and behavior. Because it’s hidden from other people, it’s often hard to identify, making it more difficult for your friends and family members to help you.

Like other types of depression, smiling depression is treatable, usually with a mix of changes to your habits and lifestyle, psychotherapy and medication.

Below, we’ve explained what smiling depression is, as well as the symptoms you may develop if you’re affected.

We’ve also discussed the range of options that are available for treating smiling depression and other forms of depressive illness.

What Is Smiling Depression?

Smiling depression is a term that’s used to refer to depression that isn’t immediately obvious to others. If you have smiling depression, you might feel sad, anxious or empty but make an effort to appear cheerful, confident and mentally healthy to the people around you.

Unlike many other people who withdraw from society when they’re depressed, you might still be able to maintain an active social life, with your symptoms limited to behind closed doors. 

Overall, your life might appear to be full of success and self-belief. However, when you’re alone, you may experience the classic signs and symptoms of depression in women, from a low mood and irritability to pessimistic, despondent feelings. 

Currently, there’s no diagnosis in the DSM-5 for smiling depression, or happy depression. Instead, it’s usually considered a form of major depressive disorder, or depression with atypical features. 

Because smiling depression isn’t recognized as a specific mental illness, there’s limited data on how common it is. However, it’s far from uncommon for people with depression to take steps to hide their symptoms from other people, including their friends and family members.

According to the National Alliance on Mental Illness, depression that’s hidden from other people is often particularly worrying, as it has a troubling connection to suicidal ideation and behavior.

While a person who’s obviously depressed, lacking energy and uninterested in regular activities may not even leave the house, someone with smiling depression may feel full of energy and be more likely to act on suicidal ideas.

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Smiling Depression Symptoms

Depression can involve a range of symptoms that affect both your mental well-being and certain aspects of your physical health. 

You may be suffering from depression if you experience several or all of the symptoms below on a daily or near-daily basis for a period of at least two weeks:

  • A pessimistic, hopeless outlook on life

  • Feeling like you’re guilty, helpless or worthless

  • Persistent sad, empty or anxious feelings

  • Reduced interest in your hobbies and pastimes

  • Difficulty focusing and remembering things

  • Finding it more difficult than normal to make decisions

  • Slowed physical movement and/or speech

  • Increased irritability and a shorter fuse

  • Difficulty staying still throughout the day

  • Changes in your appetite, eating habits and weight

  • Feelings of tiredness and lack of energy

  • Difficulty falling asleep or staying asleep

  • Waking up early in the morning or oversleeping

  • Aches, pains, cramps and other physical symptoms

  • Thoughts of death, suicide plans or attempts at death by suicide

What Causes Smiling Depression?

Depression is highly common, with an estimated 8.4 percent of all US adults affected by at least one depressive episode in the year prior to 2020.

Despite this, experts still aren’t aware of precisely what causes depressive disorders — including smiling depression — to develop. 

Right now, research suggests that a variety of genetic, psychological and environmental factors are all involved in the development of depression. These may include your family and personal history of mental illness, your physical health and your use of certain types of medication.

Certain life events, such as sudden, unexpected changes and environments that cause chronic stress, are also believed to contribute to the development of depression.

As for smiling depression specifically, there’s no single reason why people often appear happy and content with life while feeling depressed. Experts believe the act of hiding depression from others may be related to:

  • Feelings of guilt and/or shame. Research shows that people with depression tend to engage in self-blame, including through emotions such as guilt and shame. If you feel depressed, you may blame yourself and feel as if it’s caused by a personal failing.
    These emotions could result in you making efforts to hide your depression from others due to a sense that you’re responsible, or that it’s unfair to expose them to issues that you view as your own fault.

  • Embarrassment about feeling depressed. Depression can potentially affect anyone, and it isn’t a sign of weakness or failure. However, some people view depression as a negative aspect of their life and hide it from others out of embarrassment.
    You may feel embarrassed about depression if you view it as a temporary problem that you expect to pass on its own.

  • Concerns about being judged by others. Many people affected by mental disorders such as depression are affected by public stigma. If you’re affected by depression, you may worry about the impact that it could have on the way you’re perceived by others.
    For example, it’s common to feel concerned about depression affecting your authority in the workplace or respect among your peers.

  • A need to appear perfect in front of others. Sometimes, admitting that you’re affected by a mental illness can take a toll on your self-esteem, especially if you pride yourself on being a high-performer or having a “perfect” life.
    This may result in you taking steps to hide your depression from others, or to make your symptoms appear less severe than they really are. 

In general, experts believe that the façade of happiness involved in smiling depression is a form of defense mechanism. Many people with this form of depression may use it to protect their own true feelings and, in some cases, even remain unaware that they’re depressed.

How to Treat Smiling Depression

Like other forms of depression, smiling depression is treatable. However, many people affected by smiling depression fail to seek adequate help. One clinician reports that some people with this form of depression are even surprised to learn that they’re clinically depressed.

If you’ve recently started to develop depressive symptoms that think that you may have smiling depression, the best thing that you can do is to talk to a licensed mental health provider.

You can connect with a licensed provider by asking your primary care provider for a referral to a mental health specialist, or from home using our online psychiatry service.

In order to diagnose you with depression, your mental health provider may ask you about your symptoms, medical history and general life. It’s important to give detailed, complete information so that your mental health provider can reach an accurate diagnosis.

Although there’s no specific smiling depression test, your healthcare provider may ask you to fill in a depression test or self-assessment as part of the diagnostic process.

If you have clinical depression, your mental health provider may suggest taking part in therapy, using medication, making changes to your lifestyle or combining several forms of mental health treatment.

Psychotherapy

Psychotherapy, or talk therapy, involves talking to a mental health provider and learning how to deal with your thoughts, feelings and emotions. One common form of therapy for depression is cognitive behavioral therapy, or CBT.

We offer a private online therapy service, allowing you to connect with a profesional counselor and take part in therapy from the comfort of your own home. 

Medications for Depression

Depression is often treated with medications referred to as antidepressants, including selective serotonin reuptake inhibitors (SSRIs). These medications adjust the levels of natural chemicals in your brain that regulate your moods and feelings.

Your mental health provider may suggest using an antidepressant on its own or while you take part in therapy. 

If you’re prescribed an antidepressant, it’s important to use it exactly as directed by your mental health provider. You may need to use your antidepressant for several weeks before you’re able to feel any improvements in your moods, energy levels and other depression symptoms.

Our complete guide to depression medications lists common antidepressants and explains how they work in more detail. 

Lifestyle Changes

Sometimes, making small changes to your habits and day-to-day life can reduce the severity of your depression and help you to recover. Try to:

  • Get plenty of physical activity, even if it’s just a walk, bike ride or quick workout

  • Eat a balanced, healthy diet and avoid relying on food or alcohol to comfort you

  • Spend time with your friends and family, especially if you need someone to confide in

  • Get out of the house and avoid letting yourself become isolated from society

  • Focus on making consistent progress, not on feeling better within a few days

  • Stick with your therapy and medication plan, even if it doesn’t work straight away

  • Avoid making major life decisions until you’re feeling happy and mentally stable

Our guides to dealing with depression and practicing self-care share other tips and techniques that you can use in combination with therapy and medication to take control of your symptoms and make progress toward overcoming smiling depression. 

How to Recognize Smiling Depression in Others

Depression is far more common than many people think, and it’s possible that your loved ones or close friends could be affected. Use the techniques below to identify smiling depression and help your friends or family members seek help:

  • Pay attention if a loved one or close friend becomes withdrawn. Many people who are depressed may withdraw from friends and family even if they appear normal on other occasions.
    If a friend starts to become withdrawn or isolated, consider reaching out to ask if they’re feeling okay.

  • Let them know that depression isn’t shameful. Depression is very common, and it’s an issue that can affect people of all ages and backgrounds. Despite this, many people feel ashamed about their mental health issues and try to hide them from others.
    If you’re worried that a close friend or family member is hiding their depression, let them know that it’s nothing to be ashamed about. They may feel more comfortable opening up once they know that you’re not going to make fun of them or say something hurtful.

  • Offer to help them reach out to a mental health professional. For some people with depression, asking for help can be difficult. If a friend or family member shows signs of depression, consider asking them if they’d like you to seek help for them.
    Simple things such as escorting them to their primary care provider’s office or showing them how to seek help can make a big difference for a depressed person and get them on the road toward recovery.

  • Understand the warning signs of suicide. People who are suicidal might start to talk about wanting to die or being a burden. They may abruptly change their behavior, such as by using drugs or alcohol excessively, taking severe risks or saying goodbye.
    The National Institute of Mental Health maintains a more detailed list of suicide warning signs. If you notice any of these signs in a friend or loved one, try to provide help. If the situation is urgent, call emergency services to ensure they receive immediate care. 

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The Final Word on Smiling Depression

While most of us associate depression with an obvious depressed mood, low energy levels and other clearly visible symptoms, not all people with depression display these issues. 

In fact, a large number of people affected by major depression wear a metaphorical depression mask that hides their negative thoughts, feelings and other symptoms from the public. 

If you have smiling depression, it’s important to seek help. With the right combination of therapy, medication and healthy habits, it’s absolutely possible to overcome smiling depression and feel just as good on the inside as you appear on the outside. 

If you’d like to get started treating smiling depression, you can connect with a licensed provider using our online mental health services.

You can also learn more simple but effective techniques for dealing with depression, stress and anxiety issues using our free online mental health resources and content

7 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

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  2. Depression. (2018, February). Retrieved from https://www.nimh.nih.gov/health/topics/depression
  3. Major Depression. (2022, January). Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression
  4. Pulcu, E., Zanh, R. & Elliott, R. (2013, June 3). The role of self-blaming moral emotions in major depression and their impact on social-economical decision making. Frontiers in Psychology. 4, 310. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23750148/
  5. Corrigan, P.W. & Watson, A.C. (2002, February). Understanding the impact of stigma on people with mental illness. World Psychiatry. 1 (1), 16-20. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/
  6. The Secret Pain of "Smiling" Depression. (2014, November 12). Retrieved from https://www.psychologytoday.com/us/blog/the-guest-room/201411/the-secret-pain-smiling-depression
  7. Warning Signs of Suicide. (n.d.). Retrieved from https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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