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Smiling Depression: What You Need to Know

• Symptoms
• Risk factors
• Diagnosis
• Treatments
• Outlook

What is smiling depression?

Usually, depression is associated with sadness, lethargy, and despair — someone who can’t make it out of bed. Though someone experiencing depression can undoubtedly feel these things, how depression presents itself can vary from person to person.
“Smiling depression” is a term for someone living with depression on the inside while appearing perfectly happy or content on the outside. Their public life is usually one that’s “put together,” maybe even what some would call normal or perfect.
Smiling depression isn’t recognized as a condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) but would likely be diagnosed as major depressive disorder with atypical features.
Keep reading to learn more about the features of smiling depression and how you can learn to recognize it in someone else.

What are the symptoms of smiling depression?

Someone experiencing smiling depression would — from the outside —appear happy or content to others. On the inside however, they would be experiencing the distressful symptoms of depression.
Depression affects everyone differently and has a variety of symptoms, the most distinguished being deep, prolonged sadness. Other classic symptoms include:

• changes in appetite, weight, and sleeping
• fatigue or lethargy
• feelings of hopelessness, lack of self-esteem, and low self-worth
• loss of interest or pleasure in doing things that were once enjoyed

Someone with smiling depression may experience some or all of the above, but in public, these symptoms would be mostly — if not completely — absent. To someone looking from the outside, a person with smiling depression might look like:

• an active, high-functioning individual
• someone holding down a steady job, with a healthy family and social life
• a person appearing to be cheerful, optimistic, and generally happy

If you’re experiencing depression yet continue to smile and put on a façade, you may feel:

• like showing signs of depression would be a sign of weakness
• like you would burden anyone by expressing your true feelings
• that you don’t have depression at all, because you’re “fine”
• that others have it worse, so what do you have to complain about?
• that the world would be better off without you

A typical depressive symptom is having incredibly low energy and finding it hard to even make it out of bed in the morning. In smiling depression, energy levels may not be affected (except when a person is alone).
Because of this, the risk of suicide may be higher. People with major depression sometimes feel suicidal but many don’t have the energy to act on these thoughts. But someone with smiling depression might have the energy and motivation to follow through.

Suicide prevention

• If you think someone is at immediate risk of self-harm or hurting another person:
• •  Call 911 or your local emergency number.
• •  Stay with the person until help arrives.
• •  Remove any guns, knives, medications, or other things that may cause harm.
• •  Listen, but don’t judge, argue, threaten, or yell.
• If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Who’s at risk for smiling depression?

Some risk factors may include:

Big life changes

As with other types of depression, smiling depression can be triggered by a situation — like a failing relationship or loss of a job. It can also be experienced as a constant state.

Judgment

Culturally, people may deal with and experience depression differently, including feeling more somatic (physical) symptoms than emotional ones. Researchers believe these differences may have to do with internally versus externally oriented thinking: if your thinking is externally oriented, you may not focus on your inner emotional state but instead may experience more physical symptoms.
In some cultures or families, higher levels of stigma may also have an impact. For example, expressing emotions may be seen as “asking for attention” or as showing weakness or laziness.
If someone tells you to “Just get over it”or that “You’re not trying hard enough” to feel better, you’re less likely in the future to express these emotions.
This can be especially true for men under scrutiny for their masculinity — who may have been subjected to old thinking like, “real men” don’t cry. Men are far less likely than women to seek help for mental health problems.
Someone who feels they would be judged for their depressive symptoms would be more likely to put on a façade and keep it to themselves.

Social media

In an age where as many as 69 percent of the U.S. population is using social media, we can be sucked into an alternate reality where everyone’s lives are going so well. But are they really going that well?
Many people may not be willing or able to post pictures when they’re at their worst, instead opting to share only their good moments with the world. This can create a void of realness that gives smiling depression more room to grow.

Expectations

We all sometimes have unrealistic expectations of ourselves to be better or stronger. We’re also affected by outside expectations — from coworkers, parents, siblings, children, or friends.
Whether you have unrealistic expectations for yourself or the expectations are from others, you may be more likely to want to hide your feelings if they don’t seem to serve those expectations. Someone with perfectionism might be even more at risk, due to the impossibly high standards they hold themselves to.

How is smiling depression diagnosed?

According to a paper from the World Health Organization (WHO), smiling depression presents with antithetical (conflicting) symptoms to those of classic depression. This may complicate the process of diagnosis.
Other difficulties with diagnosing smiling depression is that many people may not even know they’re depressed or they don’t seek help.
If you think you have depression, it’s important to seek treatment as soon as possible.
To be diagnosed, you’ll have to visit a medical professional. Your doctor will ask you some questions about your symptoms and any big life changes that have occurred.
They may also refer you to a mental health professional, such as a psychiatrist, if you would benefit from medications, or a psychologist or other mental health professional who performs psychotherapy (talk therapy).
To be diagnosed with major depressive disorder, you must have experienced a depressive episode lasting longer than two weeks, most of the day, nearly every day. These symptoms affect how you feel, think, and handle daily activities, such as sleeping, eating, and working.