Smiling depression describes someone who lacks outward signs of depression, experiencing all their symptoms internally. They may appear fine, but they still need professional treatments to manage their depression. Treatment often involves therapy and/or medication, but tactics like shifting focus away from negativity and getting support from family and friends can also help alleviate symptoms.
What Is Depression?
Depression is a mental health condition in which someone can experience a variety of symptoms such as drastic changes in sleep, low mood, and a tendency to withdraw from people and places they once enjoyed. People with depression often feel a very low mood and have no interest in their hobbies. They also can let their day-to-day activities go, such as not paying bills, cleaning their living space or taking care of themselves personally.
The most common conception of depression is of someone tearfully laying on their couch unable to muster the motivation to fulfill their duties at work and home. However, depression comes in many forms, with “smiling depression” being a nonclinical term used to describe one variation.
What Is Smiling Depression?
Smiling depression is a term used to describe a form of depression that does not match the common views of the disorder. Instead, the person could appear happy, motivated, and energetic. Smiling depression is not an official diagnosis, and may be caused by many different types of depression, most commonly major depressive disorder (MDD).1
Someone with smiling depression may experience intense tension throughout the day as they worry about someone uncovering their true status. Then, when they come home, they can feel extreme exhaustion, since they had to perform at an expected level while keeping their depression secret.
To keep their secret, the person may isolate and spend limited time around others. They may make plans only to not show or make a poor excuse later. When asked about their personal life or feelings, the person with smiling depression may provide only superficial answers to most people. Only a select few will know the truth about the impact of smiling depression.2,3
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 Symptoms
Smiling depression is not an official diagnosis, but many people with smiling depression will experience the effects commonly tied to depressive disorders. Moods, thoughts, energy levels, and behaviors will all suffer during smiling depression.
Typical signs and symptoms of smiling depression include:1,3
- Depressed mood or high levels of irritability
- Lower interest and less pleasure in usual activities
- Significant and unintentional changes in diet or weight gain
- Sleeping much more or much less than usual
- Feeling slowed down or sped up during the day
- Low energy and feelings of fatigue
- 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
Like with other depressive disorders, not all depression symptoms have to be present at all times. As long as five or more symptoms are identified most of the day, nearly every day, the person will meet the criteria for a depressive disorder.
Risk Factors For Smiling Depression
A significant risk factor for typical depression transitioning to smiling depression is when friends and family do not effectively validate the individual’s experience and fail to accept their condition. This pattern may result in the person concealing their authentic feelings to please others or regulate others’ opinions and perceptions of the person.
The Danger of Smiling Depression
With smiling depression, the disconnection between someone’s feelings and outward presentation will confuse the person, their loved ones, and even their treatment providers. Without an accurate understanding of the person’s condition, symptoms could worsen with time.
When symptoms increase, some people with smiling depression may exhibit suicidal ideation. People with typical depression may lack the motivation or energy to follow through with suicide, while people with smiling depression may complete the act.2
Preventing suicide involves talking about suicide and discussing tough feelings. Talking about the ways in which someone may consider acting on their suicidal ideations and what access to means to complete suicide is also important. If someone is talking about harming themselves or taking their own life, it’s important to consider the depth to which they’ve thought about this and if they have the means, a plan, and a timeframe. Reducing this access and contemplation while being present in the moment with their feelings and supporting them through this time is critical.
Coming up with a plan for safety and having resources to use for when someone is alone is also important, so share any supportive avenues you can think of and come up with some together. Talking to this person’s loved ones and considering accessing additional support is important to do as well.
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.
Why Do People Hide Their Depression?
Reasons a person might hide their depression behind a smile include:
- Fear of being a burden: they don’t want to create work for others in any way so they pretend everything is OK
- Embarrassment: they feel like their depression is silly and they should get over it, so they minimize their own experience
- Denial: they don’t believe that anything is actually going on with their mood or feelings, so they continue to discount their own feelings
- Don’t want to appear weak: they don’t want to seem like they are unable to handle hard feelings and deny that feeling sad is different than depressed
- Perfectionism: someone with perfectionism doesn’t want to admit that they are imperfect, and acknowledging that they’re depressed would mean that they are imperfect
5 Ways to Manage Symptoms of Smiling Depression
Living with smiling depression requires finding effective coping skills to manage symptoms. Some people will need to revise their current coping skills to be more appropriate, and others will need the expert guidance of a professional to learn new skills. Either way, these skills can make an enormous impact on the condition.
Here are five helpful strategies for coping with smiling depression:
- Find a support system: whether from friends and family or support groups for people with depression, expanding your support system can add a sense of fellowship and understanding that you cannot get on your own
- Care for your physical health: depression is a mental health concern, but since the mental and physical influence each other, taking steps to improve your physical health will benefit your mental health as well
- Avoid negative inputs: consuming too much caffeine, drinking too much alcohol, or using drugs may offer short-term relief from depression, but they tend to only exacerbate the issue
- Change your self-talk: negative self-talk can fuel depression, so you should work to identify and change the problematic messages
- Try a new hobby: shifting your routine to include learning or pursuing something new can give you an energy boost and give you something to look forward to
How Is Smiling Depression Diagnosed?
Smiling depression is typically diagnosed by a psychiatrist and supported by a therapist. Due to the paradoxical way smiling depression works, it can be hard to identify, but understanding high functioning depression is critical. It can be found that those with smiling depression may be more functional, engaged, on top of their work, however are at greater risk for suicidal ideation.
Smiling Depression Treatments
Therapy, medication, and certain lifestyle changes are all useful options for how to treat depression. By working with a team of experienced mental health professionals, smiling depression symptoms can be addressed and alleviated quickly in many situations.
Depression therapy is a safe and effective way to address the unwanted effects of smiling depression. Today, many therapists offer online therapy, which makes scheduling time for therapy sessions much more convenient and greatly expands your options for therapists. Many therapy options exist but not all will be equal in their ability to treat symptoms, so anyone interested in psychotherapy should thoroughly explore their choices.
Therapies most effective for depression include:6
- CBT: by investigating a person’s thoughts, feelings, and behaviors and offering alternatives, CBT for depression can successfully treat numerous physical and mental health issues
- DBT: with a focus on communication skills, distress tolerance, mindfulness, and emotional regulation, dialectical behavioral therapy (DBT) helps a person with depression navigate their world
- IPT: interpersonal therapy (IPT) is a short-term treatment for adults with depression, IPT encourages the person to restructure their communication styles to create happier and healthier relationships
Some therapists will explicitly use just one type of therapy while others will blend and integrate pieces to create one cohesive treatment style. When therapy is successful, symptoms can improve rapidly. Options like CBT and IPT can create significant changes in 12 sessions, with some people making a complete recovery from smiling depression. Other people will need more time and treatment to achieve their desired level of progress.6
There are lots of options when it comes to medication for depression, and as drugs advance, a person can receive wonderful benefits from antidepressant medications that are safer and more effective than generations of the past. A person can receive prescriptions from various prescribers including psychiatrists, nurse practitioners, and primary care physicians.
Some of the most common medications fall into several categories, including SSRIs and SNRIs, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs).5 No matter the prescribed medication, people should practice patience and flexibility when it comes to observing the results. Some medications will take four to six weeks to produce benefits fully, and some side effects will become too intrusive to ignore. Talk to your prescribing doctor to learn more about how antidepressants make you feel.
Throughout the medication process, it is essential that the person maintains open contact and communication with their prescriber.
How to Get Help For Smiling Depression
It may seem daunting, but getting help for smiling depression is simple for people who are willing to admit their need for treatment. Sometimes, people with smiling depression really struggle to acknowledge how intense or pervasive their symptoms have become because it involves breaking through the facade they’ve worked to create.
Ways to seek out treatment for smiling depression include:
- Speak to your doctor or another healthcare provider
- Contact your insurance company by calling the number on the back of the card to receive a list of providers
- Present to the nearest mental health provider to inquire about an intake
- Speak with someone who has been in mental health treatment before about their experience
- Call a national mental health hotline for available providers in the area
- Phone the county assistance office for information about mental health care
Whatever the method, a person should consider what form of treatment they desire. A therapist will offer psychotherapy but not medication. Finding & choosing an online therapist using an online therapist directory is easy. A psychiatrist, PCP, or nurse practitioner will offer medication but usually not therapy. Often people work with a treatment team composed of a therapist and prescriber for more comprehensive care.
How to Help a Loved One
Knowing how to get help for a friend or loved one with depression may be uncomfortable, but the process is so important. Whenever you’re talking to someone with depression, be sure your loved one knows your motivations for helping. Let them know that you love and support them, and you only want what’s in their best interest.
You can help them by suggesting treatment and having a few recommendations for where they could go and how treatment works. From there, offer to attend the first few appointments with them if they want you to, and make sure they always have transportation to and from sessions.
Beginning treatment can be awkward for the both of you, so be sure to communicate openly and honestly along the way. Never suggest mental health treatment during periods of conflict or use it as a threat.
Final Thoughts on Smiling Depression
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.