Smiling depression refers to individuals who, despite appearing outwardly fine, experience all their depressive symptoms internally. They may seem happy and functional, but they still need professional treatment to manage their depression. This often includes therapy and/or medication, along with strategies like shifting focus away from negativity and getting support from family and friends, which can help alleviate symptoms.
What makes smiling depression particularly dangerous is its hidden nature. Since the severity of the emotional pain is not visible to others, it can delay the recognition and support these individuals need. This delay can increase the risk of severe depressive episodes or suicidal thoughts, making it crucial to understand and address smiling depression.
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What Is Smiling Depression?
Smiling depression is a term used to describe individuals who appear happy and content on the outside while secretly experiencing symptoms of depression on the inside. These people keep up a normal and positive front, managing their daily responsibilities at work, school, and in social situations. However, behind their smiles and cheerful attitude, they’re often struggling with feelings of hopelessness, fatigue, and a lack of interest in things they used to enjoy.
When someone with smiling depression is asked about their personal life or feelings, they usually give superficial answers, only revealing the truth to a select few.1, 2 The hidden nature of smiling depression creates constant tension as they worry about being found out. By the end of the day, they often feel exhausted from trying to keep up appearances while hiding their depression. To keep their depression hidden, they might isolate themselves, avoid social interactions, and frequently make plans only to cancel them later with weak excuses.
Smiling Depression Symptoms
Smiling depression is not an official diagnosis and may be caused by different types of depression.3 Therefore, symptoms of smiling depression can vary depending on the underlying type of depression and the individual.
Typical signs and symptoms of smiling depression include:2, 3
- Depressed mood or high levels of irritability
- Lower interest and less pleasure in usual activities
- Significant and unintentional changes in diet or depression-induced weight gain
- Sleeping much more or much less than usual
- Feeling slowed down or sped up during the day
- Low energy, feelings of fatigue, and depression-induced brain fog
- Feeling worthless or guilty even when the situation does not call for it
- Decreased ability to think clearly, make decisions, and concentrate
- Frequent thoughts about death and dying
These symptoms would largely — if not entirely — be hidden in public. To an outsider, a person with smiling depression might appear to be:
- Confident and collected
- Social and outgoing
- Highly productive and successful
- Optimistic and cheerful
- Engaged and attentive
A person experiencing depression who puts on a facade and smiles may feel:
- Like they will be judged or seen as weak for having depression
- Like no one will be able to understand what they’re going through
- Like talking about their depression will be a burden on their loved ones
- Like they should be able to willpower their way out of feeling depressed
- Overwhelmed by the effort to maintain their facade
- Like they are isolated and disconnected despite being surrounded by people
- Afraid of their true feelings being exposed and misunderstood
Why Do People Hide Their Depression?
People often hide their depression because they’re afraid of being judged or seen as weak. They worry it might affect their relationships and how others see them at work or home. Some feel they need to keep up appearances, thinking that showing their true feelings might lead to rejection or people not understanding what they’re going through.
Reasons a person might hide their depression behind a smile include:
- Lack of validation: A big reason someone might develop smiling depression is when their friends and family don’t validate their experience with depression. If people don’t believe them, downplay their feelings, or push them to “just be happy,” it can lead to the person hiding their true emotions. They might start pretending to be okay to please others or manage how others see them.
- Social media pressure: The pressure to portray a perfect life on social media can exacerbate smiling depression. Comparing oneself to others’ highlight reels can make a person feel worse about their own struggles.
- Fear of judgment and stigma: Someone may hide their depression behind a smile because of fear of judgment and mental health stigma. This fear often results in masking their true feelings to avoid criticism and maintain their perceived image. This can be especially true for men with depression, who may feel societal pressure to appear strong and unemotional.
- Desire to appear strong: Some individuals feel the need to project an image of resilience and capability and are afraid that showing vulnerability will make them look weak. These individuals strive to maintain control and uphold the facade of strength, even when they’re struggling inside.
- Fear of being a burden: Feeling like a burden can lead some with depression to pretend everything is fine, worrying that sharing their feelings will add stress to others’ lives. This can create a cycle where they feel even more isolated and unsupported, reinforcing their depression.
- People-pleasing: People-pleasers often hide their depression to avoid disappointing or upsetting those around them. They prioritize others’ comfort over their own, fearing that showing their true feelings might make them seem less likable or dependable.
- Denial: Denial about depression can stem from a belief that acknowledging their feelings makes them real or from a fear of confronting one’s own vulnerabilities. Maintaining a cheerful exterior can allow someone who is in denial about their depression to avoid dealing with the painful reality of their own mental health struggles.
- Perfectionism: Individuals with perfectionism often fear that showing any sign of struggle, including depression, will be seen as a flaw. Perfectionists might feel immense pressure to appear in control at all times, leading them to suppress their true feelings and put on a happy facade.
- Fear of consequences: People might hide their depression behind a smile because they worry about the potential repercussions of revealing their struggles. Fear of consequences can include concerns about losing one’s job, damaging relationships, or being seen as unreliable.
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The Danger of Smiling Depression
Smiling depression is particularly dangerous because it often goes unnoticed, allowing the condition to worsen over time. The facade a person maintains can prevent them from receiving the support and treatment they need, as friends, family, and even healthcare professionals may not recognize the severity of their condition.
The effort of maintaining a happy exterior while battling depression can lead to more severe depressive episodes. It can also increase the risk of suicidal thoughts and behaviors, as the person may think that they are alone in their struggles and ending their life is the only escape. Unlike those with typical depression, who may lack the motivation or energy, people with smiling depression might follow through with suicidal acts.1
If you are struggling with suicidal thoughts, help is available. Call or text 988 to speak to someone at the Suicide and Crisis Lifeline and get support at any hour of the day. If you’re worried that you or a loved one may harm themself, you should call 9-1-1 or contact a mental health professional immediately.
Depression Is Treatable with Therapy
Find a compassionate and supportive therapist. BetterHelp has over 30,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $65 per week. Take a free online assessment and get matched with the right therapist for you.
How to Manage Smiling Depression
Living with smiling depression requires finding practical coping skills to manage symptoms of depression. Some people might need to adjust their current coping methods, like improving their sleep routine, incorporating regular exercise, or practicing mindfulness techniques. Others could benefit from beginning therapy to learn new strategies, such as cognitive-behavioral techniques, developing a support network, or finding effective ways to manage stress. Either way, having the right skills can make a huge difference in managing the condition.
Here are thirteen helpful strategies for coping with smiling depression:
- Acknowledge and accept your experience: Denying your experience can prolong your struggle with smiling depression and prevent effective coping. Recognizing and accepting that you are dealing with smiling depression validates your feelings and allows you to take a step towards helping and to seek appropriate help and support.
- Speak to a therapist or counselor: Seeking professional help is essential for managing smiling depression. Therapists can provide you with coping skills for your depressive symptoms, helping you navigate your emotions and develop healthier thought patterns.
- Establish a healthy work-life balance: A healthy work-life balance can help manage smiling depression by reducing stress and preventing burnout. Make time for relaxation and leisure alongside your work commitments to maintain your mental health.
- Avoid isolating yourself: Make an effort to connect with others regularly, even if it’s just a brief interaction. Human connection is vital for emotional support and overall health.
- Build a support system: Friends, family, and support groups can provide emotional comfort and practical help when needed. Don’t be afraid to ask for help with your depression.
- Practice self-care: Self-care for depression is essential. Activities like regular movement, proper nutrition and hydration, and adequate sleep can boost your mood and energy levels.
- Set realistic goals: Avoid overwhelming yourself with unrealistic expectations. Set achievable goals that give you a sense of purpose and accomplishment.
- Limit or omit the use of alcohol and other drugs: Substance use can exacerbate depressive symptoms and interfere with your treatment. Drugs and alcohol make depression worse. Reducing or eliminating these substances can improve your physical and mental health.
- Practice self-compassion: Embrace self-love and self-compassion by gently acknowledging your negative self-talk without judgement and redirecting your focus to more nurturing and positive thoughts and affirmations. Using bottom-up techniques like deep breathing, grounding exercises, or spending time in nature, can help calm your nervous system and create space for more compassionate self-talk.
- Schedule enjoyable activities: Engaging in activities that you find enjoyable and fulfilling can help lift your mood. Whether it’s a hobby, spending time with loved ones, or exploring new interests, scheduling these activities can provide relief and joy.
- Practice mindfulness: Mindfulness techniques can help you stay present and reduce the impact of negative thoughts. Try mindfulness exercises for depression, including through free mindfulness apps, to guide you in developing this practice.
- Celebrate small wins: Positive reinforcement can help you stay focused on your progress, boost your self-esteem, and provide motivation. Celebrate your achievements, no matter how minor they seem.
- Engage in creative expression: Creative activities like writing, painting, or playing music can be therapeutic and help you process emotions. These outlets can provide a sense of accomplishment and joy, aiding in managing smiling depression.
Depression Worksheets
When to Seek Professional Support
People with smiling depression often have a hard time recognizing just how intense or pervasive their symptoms have become because it means breaking through the facade they’ve built. But if you start noticing that your depression is interfering with your daily life, seeking professional support is really important. Remember, reaching out for help is a sign of strength and a crucial step toward feeling better and improving your overall well-being.
A local therapist directory is a great way to find a therapist in your area who specializes in treating depression. There are also many online therapy services, such as Talkspace or BetterHelp, that can match you with a qualified therapist who provides therapy from the comfort of your home.
If you want to consider medication, a primary care physician, psychiatrist, or psychiatric nurse practitioner can recommend suitable pharmaceutical options. Online psychiatry services like Brightside Health also provide emergency care for individuals who are experiencing severe depression symptoms or suicidal ideation.
Smiling Depression Treatment
Smiling depression is often a long-term and pervasive depression, and treatment for depression often involves a combination of therapy, medication, and lifestyle changes. By working with a mental health team and openly communicating your experiences, you can effectively manage symptoms and improve your overall well-being.
Therapy for Smiling Depression
Therapy provides a person with a safe space to let go of the happy facade and express their true emotions without judgment. Therapists can help them identify negative thought patterns that keep them down and teach them coping skills for depression to manage difficult feelings. Additionally, therapy can also address the underlying causes of one’s depression, allowing a person to heal completely.
Effective types of therapy for depression include:4
- Cognitive behavioral therapy (CBT): CBT tackles smiling depression by challenging negative thought patterns that fuel the facade of happiness. CBT for depression helps identify and reframe these thoughts, allowing the person to see their situation more realistically. This reduces the guilt and self-blame often associated with smiling depression and allows for a more balanced emotional state.
- Dialectical behavior therapy (DBT): DBT for depression can be a powerful tool for smiling depression because it equips individuals with skills to manage emotions effectively. By learning mindfulness and distress tolerance, they can navigate the pressure to appear happy while addressing the underlying sadness. This empowers them to express authentic feelings in healthy ways.
- Interpersonal therapy (IPT): IPT is a short-term treatment for adults with depression. It encourages the person to restructure their communication styles to create happier and healthier relationships. This approach is particularly effective for smiling depression, as it helps individuals address the underlying relational issues that may contribute to their hidden distress, allowing them to express their true feelings more openly and improve their emotional well-being.
Medication for Smiling Depression
There are many options for medication to treat depression, and as pharmaceuticals advance, individuals can benefit from antidepressant medications that are safer and more effective than those from previous generations. Common medications fall into several categories, such as SSRIs or SNRIs, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs).5
No matter the prescribed medication, people should practice patience and flexibility when observing the results. Some medications may take four to six weeks to fully produce benefits, and some side effects may become too intrusive to ignore.
Support Groups for Smiling Depression
Support groups can be uniquely helpful for individuals struggling with smiling depression by providing a safe and understanding environment to share their experiences. Connecting with others who face similar challenges can reduce feelings of isolation and offer practical advice and emotional support. These groups encourage open discussions, helping members to validate their feelings and develop coping strategies for smiling depression together.a
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How to Help a Loved One With Smiling Depression
If you think your loved one is exhibiting signs of depression, it’s important to reach out and offer support. Remember, someone with smiling depression is attempting to hide their depression from others and may not react well to being asked if they are depressed. When talking to them, express your concern out of love and remind them that you will listen without judgment. If they are open to it, you can suggest treatment options and even offer to attend the first few appointments and ensure they have reliable transportation to and from their sessions.
In My Experience
“What you’re dealing with is unique to you, but you’re not alone. If you or someone you love is struggling with smiling depression, there is hope. There are many interventions available to help support you, and working with a therapist is a great way to come up with a plan to move forward. There is always hope to look forward to.”
Frequently Asked Questions
Can Depressed People Be Happy?
Yes, individuals with depression can experience moments of happiness. While depression often brings persistent sadness, individuals can still find joy in specific events, activities, or relationships. These happy moments don’t negate the presence of depression but highlight the complex nature of human emotions. Being able to embrace these positive experiences can actually be an important part of managing and coping with depression.
Smiling Depression Vs. High-Functioning Depression
People may also refer to smiling depression as high-functioning depression, though someone who is “high functioning” may still display outward symptoms of depression while maintaining the ability to complete their daily tasks. It’s important to note that neither is a clinical term of a formal depressive disorder.
Smiling Depression Infographics
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Nami. (2024, February 7). What you need to know about “Smiling Depression.” NAMI. https://www.nami.org/advocate/what-you-need-to-know-about-smiling-depression/
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Suicide. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/suicide
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Vahia V. N. (2013). Diagnostic and statistical manual of mental disorders 5: A quick glance. Indian journal of psychiatry, 55(3), 220–223. https://doi.org/10.4103/0019-5545.117131
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Karrouri, R., Hammani, Z., Benjelloun, R., & Otheman, Y. (2021). Major depressive disorder: Validated treatments and future challenges. World journal of clinical cases, 9(31), 9350–9367. https://doi.org/10.12998/wjcc.v9.i31.9350
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Depression (major depressive disorder) – Diagnosis and treatment – Mayo Clinic. (2022, October 14). https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013
We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.
Author: Eric Patterson, LCPC (No Change)
Reviewer: Trishanna Sookdeo, MD, MPH, FAAFP (No Change)
Primary Changes: Revised sections titled “Smiling Depression Symptoms,” “Why Do People Hide Their Depression?” “How to Manage Smiling Depression,” “Smiling Depression Treatment,” and “Can Depressed People Be Happy?” New content written by Amanda Stretcher, MA, LPC-S, and medically reviewed by Kristen Fuller, MD. Fact-checked and edited for improved readability and clarity.
Author: Eric Patterson, LCPC (No Change)
Reviewer: Trishanna Sookdeo, MD, MPH, FAAFP (No Change)
Primary Changes: Added sections titled “What Is Depression?” and “How Is Smiling Depression Diagnosed?” New material written by Silvi Saxena, MBA, MSW, LSW, CCTP, OSW-C, and medically reviewed by Dena Westphalen, PharmD. Fact-checked and edited for improved readability and clarity.
Author: Eric Patterson, LCPC (No Change)
Reviewer: Trishanna Sookdeo, MD, MPH, FAAFP (No Change)
Primary Changes: Added sections titled “Suicide Prevention” and “Why Do People Hide Their Depression?” New material written by Silvi Saxena, MBA, MSW, LSW, CCTP, OSW-C, and medically reviewed by Dena Westphalen, PharmD. Fact-checked and edited for improved readability and clarity.
Author: Eric Patterson, LCPC
Reviewer: Trishanna Sookdeo, MD, MPH, FAAFP
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