What Is Smiling Depression?
You won’t find smiling depression listed in the official diagnostic manual for mental disorders. But some mental health professionals use this term to describe people who are depressed but look and act happy.
If you have smiling depression, you feel low inside but tell others that you feel fine. You look fine, too. You might power through your daily activities as usual. Another term sometimes used for this is "high-functioning depression." When you don't look or act depressed, your family and others may not realize you need help. Even you may not realize that your inner struggles are signs of depression.
Who Is Most at Risk For Smiling Depression?
Since smiling depression isn't an official diagnosis, there's not a lot of research on who it affects.
But mental health professionals say they sometimes see the signs in people:
- From cultures with a high stigma surrounding mental illness
- With a mild to moderate form of depression that lasts years, called persistent depressive disorder
- With outwardly typical lives, including jobs, romantic relationships, and educational achievements
- Who may be perfectionists or harbor especially strong fears of appearing weak or out of control
Depression, in general, can affect people of any age and gender. But it's more common in:
- Women
- People in the LGBTQI+ community
- People with a personal or family history of depression
- People going through major negative life changes, trauma, or stress
- Those with serious medical conditions such as diabetes, cancer, heart disease, chronic pain, or Parkinson’s disease
Smiling Depression Symptoms
If you have smiling depression, you may have the usual internal signs of depression, but you hide them from others. These could include:
- Persistent sadness
- Anxiety
- Feeling empty
- Feeling hopeless or pessimistic
- Feeling irritable, frustrated, or restless
- Feeling guilty, worthless, or helpless
- Losing interest or pleasure in hobbies and other activities
- Fatigue, lack of energy, or feeling slowed down
- Trouble concentrating, remembering, or making decisions
- Trouble sleeping, waking too early in the morning, or oversleeping
- Changes in appetite
- Losing or gaining weight unintentionally
- Physical aches or pains, headaches, cramps, or digestive problems without a clear cause
- Thoughts of death or suicide
You don't have to have all these symptoms to be depressed. But if you have some of the symptoms that last at least 2 weeks and interfere with your life — even if no one else notices — you might have depression.
Some people with depression withdraw from friends and family members and are unable to keep up with their responsibilities at home and work. But if you have smiling or high-functioning depression, you keep up appearances in a way that hides your condition. You might seem to have your usual energy around other people — even if you collapse when you're alone.
Complications of Smiling Depression
If you are depressed and hiding it, the people around you may not realize you need help. That might delay you from getting treatment to improve your life. If your underlying problem is persistent depressive disorder — chronic mild to moderate depression — you face a higher risk of a major depressive episode.
Untreated depression may increase your risk for:
- Weight problems
- Pain
- Physical illness
- Alcohol or drug misuse
- Self-harm, such as cutting
Also, when you're depressed, you think more negatively about yourself and the world. That can increase your risk of suicide.
If you're having suicidal thoughts, it's important to get help right away. If you have a doctor or mental health provider, call them. If you are in the U.S., reach out to a counselor by calling or texting 988 for the 988 Suicide & Crisis Lifeline, available 24 hours a day, 7 days a week.
Diagnosing Smiling Depression
If you think you are depressed, your first step might be to consult your primary care doctor. They'll ask about your concerns and run some tests to rule out treatable physical causes, such as a thyroid disorder. They may refer you to a mental health professional, such as a psychiatrist or psychologist, for further tests and conversations.
A full workup might include:
- A physical exam
- Lab tests, such as blood work
- Questionnaires to give your doctors more information about your thoughts, feelings, and behaviors
If you do have signs of depression, you'll get a diagnosis based on the official Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. It doesn't include smiling depression or high-functioning depression. Instead, your diagnosis might be major depressive disorder, persistent depressive disorder (chronic depression), bipolar disorder, or something else.
Your doctors may also describe your depression in other ways. For example, some people who seem to be smiling through depression could have "mixed" depression or "atypical" depression. People with mixed depression can be manic, which means they have high energy and talk a lot. People with atypical depression can be temporarily cheered by positive events, unlike most depressed people.
Smiling depression test
There's no specific test for smiling depression since it's not an official diagnosis. But the information you share with your doctors, including your answers to depression screening questionnaires, can help show whether you are depressed and the kind of depression you have.
You might find self-tests for depression or even smiling depression online, but you shouldn't diagnose yourself. It's best to use such tests only as clues and to follow up on any concerns with your doctors.
To get an accurate diagnosis and the right kind of help, you'll need to be honest with your doctors about your symptoms.
Smiling Depression Treatment
Smiling depression, like other forms of depression, is treatable. The main treatments for depression are medications and talk therapy, also called psychotherapy. They can be used alone or in combination. The best choices for you may depend on the severity of your symptoms, your overall health, and your preferences.
Medications for depression
The most commonly prescribed medications are selective serotonin reuptake inhibitors (SSRIs). They generally have fewer side effects than the alternatives. But several other types of drugs are available if needed.
Sometimes, you'll need to try several medications or combinations to find the right one.
Talk therapy for depression
Mental health professionals offer several different types of psychotherapy, such as cognitive behavioral therapy and interpersonal therapy.
In addition to treating your depression symptoms, talk therapy can help you find new ways to deal with problems and adjust to difficult events.
Self-help for depression
In addition to medication, talk therapy, or both, there are things you can do to feel better. They include:
- Getting more physically active — such as walking 30 minutes a day
- Sticking to regular sleep and wake-up times
- Eating regular, healthy meals
- Talking with people you trust about your feelings
- Avoiding alcohol and drugs not prescribed for you
How to Help Someone With Smiling Depression
Depression symptoms can vary from person to person. And, in the case of smiling depression, it can be hard to know for sure what's going on.
What to look for
Someone with smiling depression is hiding their mental pain behind a happy face. But you still might notice changes such as:
- Sleeping too much or too little
- Shifts in appetite or weight
- Unexplained physical problems such as headaches or backaches
- Problems with concentration, memory, or making decisions
- Not responding as usual to phone calls, texts, or other outreach
How to help
If you do suspect that someone you care about is depressed and is covering it up with a happy face, here are some things to try:
Talk to the person. Tell them why you are worried.
Explain that depression is a treatable health problem. Some people see depression as a shameful personal failure.
Suggest a doctor's visit. It's important to find out what's going on and get treatment if needed.
Offer continued support. Let them know you're there to listen, take them to doctors' appointments, or offer other support.
Takeaways
If you have smiling depression, you can feel as low and suffer as much as anyone else with depression. But you hide your pain behind a smile. You may mask your depression in other ways as well, making it harder for both you and others to realize you need help. But treatment is available, and it can help.
Smiling Depression FAQs
Why am I smiling when I'm not happy?
Smiling when you're not happy can be a sign of smiling depression. But there are other possible reasons. For example, you might be smiling to seem more likable, even if you're not depressed. In some situations, you might smile to be polite or to show someone you approve of their behavior.
Is smiling a coping mechanism?
Some research suggests that even putting on a fake smile can make you feel happier. Other studies find no such effect. But scientists have also observed that many people smile or laugh while grieving or dealing with other difficult situations. So smiling may sometimes be a coping mechanism.
What is smile anxiety?
Smile anxiety is a term some dentists use for worrying about the appearance of your teeth so much that you don't like to smile.
