Smiling depression is a term doctors use to describe when a person masks their depression behind a smile. Someone with smiling depression looks happy on the outside when, in reality, they may be struggling with feelings of internal hopelessness and sadness.
As they can hide their depression so well, people with smiling depression often fail to get the treatment they desperately need.
People who live with this type of untreated depression may be at a higher risk of hurting themselves and of death by suicide.
Although it may be difficult to recognize, doctors can treat smiling depression with medications and other behavioral therapies.
Keep reading to learn more about what smiling depression is, how it compares with other types of depression, and how doctors treat it.
Smiling depression is not a medical diagnosis. Instead, it is a term mental health professionals use to describe people with a depressive disorder who hide their symptoms from others.
People with smiling depression can carry on with most day-to-day activities, yet they are privately struggling with a serious mood disorder.
Depression is not the same as the blues or occasional feelings of sadness. With normal sadness, there is usually a reason behind it, and it lasts for a short while before going away.
With depression, often the sadness does not lift for long periods, making a person feel there is no possible relief to their feelings of gloom and despair. Depression is an all-consuming and ongoing state that can significantly impact a person’s ability to function.
Depression is a common mood disorder. Globally, the World Health Organization estimate that there are more than 264 million people of all ages with depression.
People may try to hide their depression behind a smile for several reasons. These may include:
- they worry what others will think
- they do not want to burden others
- they fear job loss
- they think the depression will go if they pretend to be happy
- they may not realize they are depressed
- they do not know how to get help
Although there are many different forms of depression, hiding depression behind a smile can occur with any of the following mood disorders:
Major depressive disorder
Major depressive disorder is a persistent feeling of sadness, a loss of interest in things that normally bring pleasure, along with other specific symptoms. Symptoms must be present daily for at least 2 weeks.
This type of depression consists of both manic (high), depressive (low) episodes with periods of normal mood in between.
Substance or medication induced depressive disorder
With this type of mood disorder, the symptoms of depression start soon after someone takes or stops taking a recreational substance or prescribed medication.
Depressive disorder due to an underlying medical condition
Seasonal affective disorder
Seasonal affective disorder, or SAD, is also known as major depressive disorder with seasonal pattern. It is depression that occurs only during the winter months when there is less natural sunlight.
Persistent depressive disorder
Sometimes called dysthymia or mild depression, people with persistent depressive disorder have episodes of major depression, as well as milder symptoms that last for at least 2 years.
Despite their outward smile and pretension to be happy, people with smiling depression are still experiencing typical symptoms of depression.
Symptoms tend to develop gradually over days or weeks and can vary greatly from person to person. These symptoms may include:
- depressed mood
- fatigue, lack of energy, or exhaustion
- bouts of irritability or mood swings
- anxiety or tendency to worry
- recurrent thoughts of death or suicidal ideation or intent
- feelings of worthlessness, guilt, or hopelessness
- obsessive ruminations or intrusive thoughts
- loss of interest in pleasurable activities
- changes in appetite or weight
- avoidance of social interactions or events
- difficulty with concentration or making decisions
- sleep problems
Those suffering from classic forms of depression might have suicidal thoughts but not the energy to act on them.
However, as people with smiling depression are still able to go to work and look as if they are keeping it together, they may have the energy to plan and end their life by suicide.
Doctors treat smiling depression similarly to any other depressive disorder. Treatment varies, depending on the severity of symptoms and often involves a combination of the treatment options, as follows:
There are several classesof prescription medication available to treat depression. It can take a few weeks before the medication starts to work. A person with depression should be followed closely by a doctor during this time period.
Psychotherapy, also known as talk therapy, is a treatment technique that mental health professionals use to help a person understand their thoughts and feelings in order to learn healthy coping skills.
There are different types of psychotherapy, including cognitive, psychodynamic, group, interpersonal, and family therapy.
Chronic stress exposure or the inability to manage stress can contribute to the development of depression.
Learning and practicing stress management techniques and lifestyle measures can help a person manage depressive symptoms.
Eating a wide variety of nutritious foods, including colorful fruits and vegetables and healthful fats, may help lessen some depressive symptoms.
Exercise can help to prevent depression, as well as treat the symptoms. Even if a person with depression does not have the energy to do much more than short walks, some physical activity is better than none.
Bright light therapy using a light box may help treat seasonal affective disorder as well as nonseasonal depression.
Electroconvulsive therapy is a safe, controlled procedure for treating certain types of depressive disorders that have not responded to other treatments.
There are many things people can do to help someone who is experiencing smiling depression.
The first thing is to encourage the person with smiling depression or any other type of depression to see a doctor, mental health professional, or other healthcare providers. Other ways to help include:
- going with the person to a medical appointment or helping arrange their transport
- offering nonjudgmental acceptance, support, and encouragement
- never downplaying comments about suicide, but instead helping contact a treatment provider if they are feeling suicidal
- bringing a meal, offering childcare services, helping clean their house, or keeping them company
- watching for changes in behavior or routines.
If someone with smiling depression or any depression cancels plans or does not answer their phone, it is important to reach out to them.
It is helpful to let a person with smiling depression know that they are not alone, and reminding them that with treatment and time, they will get better.
Depression is a serious health risk that can have potentially devastating consequences for the individual who has it and their loved ones.
Depression may not always be obvious. The United States Preventive Services Task Force (USPSTF), and the American Academy of Family Physicians, recommend screening for depression in adults. The USPSTF also recommend the same for anyone 12 years of age or older.
People with any symptoms of depression should consult with a doctor to determine what treatment may help.
Depression can lead to death by suicide in some cases. Any individual who expresses suicidal thoughts or plans should not be left alone.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.
Smiling depression is not a medical diagnosis, rather it is a term people use to describe those who mask their symptoms of depression behind a smile.
Depression is a common and treatable mood disorder that can affect people of all ages and walks of life, but sometimes, it can be hard to identify.
If a person suspects they might have smiling depression, they should reach out to their healthcare provider or other trusted individual.
Asking for support is the best thing a person can do to diagnose and treat smiling depression.