Medically reviewed by: Elizabeth Keohan, LCSW-C, MSW

Reviewed On: February 3, 2023

Symptoms of depression aren’t always obvious. Some people can mask the signs, appearing happy, fulfilled, and smiling, even when their depression is severe. This is known as “smiling depression,” and despite seeming like this could be a positive coping technique, it can be harmful. 

Smiling depression often results in unnoticed symptoms, making it harder to get the help and support people with depression need. Keep reading to learn more about smiling depression and why paying attention to this often-unnoticed type of depression is essential.

What Is Smiling Depression?

Depression can present in many ways. For people with smiling depression, it’s possible to conceal their depression symptoms and put on a happy face. On the outside, they might look content or even cheerful. On the inside, they’re dealing with feelings of sadness or worthlessness. 

People with smiling depression tend to be high-functioning, but this doesn’t mean they’re not struggling with severe depression. Far from it, in most cases. Most people with smiling depression make a tremendous effort to hide their classic symptoms from everyone around them. Unfortunately, the stress and effort it takes to hide depression can take a toll — in many cases, it even makes symptoms more severe. 

“Smiling depression reminds me of the old saying, “you can’t judge a book by its cover” — just because someone looks happy on the outside doesn’t mean they’re not masking deep pain and suffering. Oftentimes someone may be struggling with depression, yet they’re able to go to work, make social plans, and appear to be doing OK because they aren’t able to let others know what’s actually going on. This experience can be very isolating — do not hesitate to reach out for support. You don’t have to struggle with these symptoms alone.”

Talkspace therapist Jill E. Daino, LCSW-R

Symptoms of Smiling Depression

It can be hard to tell when someone is masking their potentially severe depression. Yet even when typical symptoms of depression aren’t blatant and obvious, there are warning signs that can be indicators. These symptoms might include the following:

  • Weight changes: Depression has been linked to emotional eating and can also cause a loss of appetite. Sudden, unexplained weight loss or weight gain can both be indicators of depression.   
  • Decreased interest in activities: A common symptom of depression is anhedonia, which is the inability to feel pleasure or joy. Even if someone with smiling depression can put on a happy face to get through their days, they may lose interest in the activities they once enjoyed. 
  • Sleep disturbances: Insomnia, excessive sleep, and other sleep disturbances are associated with depression. Changes in sleep habits can signify depression and put people at increased risk for depressive symptoms. 
  • Difficulty concentrating: People with depression often experience what’s known as brain fog or have trouble focusing. Someone with smiling depression may struggle to complete tasks or stay engaged during conversations. 

What Causes Smiling Depression? 

According to the National Institute of Mental Health, more than 19.4 million adults had a major depressive episode in 2019. Unfortunately, despite being such a common mental health condition, many people feel pressured to hide symptoms of depression or depressive thoughts. 

In our society, we face incredible pressure to be productive and successful. Things are slowly changing as work-life balance and self-care become more prevalent. However, for many there’s still an intense expectation of perfection. This pressure can result in depression or smiling depression as we seek to fulfill our expectations. 

Some additional significant causes of smiling depression include:

Mental health stigma

Fortunately, studies show that the stigma around mental health issues is decreasing. However, there are still prejudices and misconceptions about clinical depression and other mental health conditions. Due to this stigma, many worry about how they’ll be perceived if others discover they’re struggling and depressed.  

Some might worry about being judged by family members. Others may be concerned about employers holding their condition against them, or they fear peer or social judgment. As a result, it can be common to believe it’s safer to hide their depression rather than be open about it. 

Mistrust of doctors and other mental health professionals

Someone who’s had troubling or unhealthy experiences with doctors or mental health care providers might be understandably reluctant to seek depression treatment. Negative interactions can cause some people to feel it’s better to hide their symptoms rather than seek help. 

In addition, many people have misconceptions about mental health care. They worry that they’ll be pressured to take medication or that medication will change who they are.

Shame and embarrassment 

Guilt and shame are strongly correlated with depression. It’s common for people to blame themselves for their condition. They might mask with smiling depression to avoid feeling embarrassed about their symptoms or prevent others from seeing them as weak.  

Unrealistic standards

Some people hold themselves to impossibly high standards. For example, those prone to perfectionism might feel pressured to present themselves in the best possible light, even if they struggle with mental health symptoms. They may even convince themselves that they’re not depressed by pretending everything’s fine. 

Fear of being a burden 

It’s not uncommon to worry about burdening others, especially for a people-pleaser or someone who struggles with low self-esteem. Unfortunately, this fear can make some people feel they must keep their depression symptoms private. They might think if they can hide behind a smile, their friends and family won’t have anything to worry about. 

“While there are many reasons that contribute to smiling depression, cultural backgrounds, worries that you’ll be perceived as weak, or that you’re burdening others, etc., it’s important to remember that depression can be treated and you don’t have to suffer with these symptoms. Depression, even smiling depression, when you’ve been putting on a “brave face” for the world, can be debilitating, but with treatment and support systems, you can improve.”

Talkspace therapist Jill E. Daino, LCSW-R

Treatment for Smiling Depression

Smiling depression isn’t always easy to notice, but once it’s known, it is treatable. Treatment for smiling depression is very similar to treatment for major depressive disorder. Depression medication, therapy, and positive lifestyle changes can all work together to improve depressive symptoms. 

The biggest obstacle facing people with smiling depression can be a reluctance to seek treatment and learn how to treat depression. Some people with this condition may not be aware that they’re depressed. If you suspect a friend or family member is struggling with smiling depression, encourage them to seek help. 

How to Help Someone with Smiling Depression

If someone in your life has smiling depression, don’t hesitate to speak up. Let them know you’re worried about them and that they can come to you for support. Talk to them about mental health resources they can take advantage of. 

Not everyone with smiling depression will display obvious symptoms. Thus, we must try to normalize talking about depression (and other mental health issues). Consider sharing your own mental health struggles. When you speak about your mental health, the people around you tend to feel more comfortable sharing their feelings. Here are a few other ways how to help someone with depression:

  • Offer rides to appointments
  • Be there to listen
  • Offer to go to appointments with them
  • Find community resources
  • Be there for emotional support

Get Professional Help for Smiling Depression with Talkspace

How can you help someone who’s dealing with depressive symptoms? Whether you want to support a loved one or it’s you who is looking for guidance from a professional, you can get the help you need at Talkspace. 

Talkspace makes it easy for people with depression to find a therapist and start treatment. Our online therapy platform means you can begin therapy for depression from the convenience of your own home. If you or a loved one is hiding symptoms of depression, check out Talkspace today. Help is available for smiling depression — you just need to take the first step. Read more about the benefits of online therapy to see how our resources can help you or someone you know learn how to deal with depression.