What does depression look like?

If you picture a depressed person as someone who can’t stop crying, who is exhausted, who doesn’t want to socialize, or who has stopped taking care of their health or appearance, you may be right. However, depression can also look like an A student, a social butterfly, or a consummate professional. The most pulled-together, on-top-of-everything, energetic gregarious person you know could be suffering from depression.

How is it possible that someone could be depressed without showing any symptoms? This is what is called “smiling depression.”

You could also think of it as high-functioning depression. People who have smiling depression do experience symptoms, but they mask or internalize the symptoms so that they’re not obvious to others. Take a look at some statements that people who have smiling depression will understand.

Why Is It Called Smiling Depression?

“Smiling depression” isn’t a diagnosis that you’d find in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A more clinical phrase would be something like “depressive disorder with atypical features”. What it means is that the patient has depression, but doesn’t exhibit the usual outward symptoms of the condition.

A person with smiling depression can appear to be very happy and very high-functioning. 

While they may experience many of the commonly-known signs of depressions, such as changes in their sleeping or eating habits, fatigue, feelings of hopelessness, or loss of interest in activities they previously enjoyed, they don’t show evidence of these symptoms for the casual observer to see, and they may not talk about them, even to friends or loved ones. It’s possible for a person with smiling depression to not even realize themselves that they are depressed.

You can think of smiling depression as similar to someone putting a smiling mask over a sad face, but it’s important to realize that they’re probably not purposely hiding their feelings. People who have smiling depression may be afraid that showing outward signs of their depression would be perceived as weakness or would cause a burden on the people they care about. They may feel that others have worse problems, so they don’t have the right to complain about their own. Or they may simply have convinced themselves that they’re fine and don’t need any help.

What Causes Smiling Depression?

Depression is a complex condition with a number of possible causes, and often there is more than one cause at play in an individual person’s case. Depression has a genetic component and is related to the composition of chemicals in your brain. Certain medical conditions or medications can contribute to depression, as can substance abuse. Environmental factors are at play as well. Depression can be triggered by certain life events, like experiencing violence or other trauma, losing a loved one, or even a major change, like moving or graduating.

All the same factors that go into causing regular depression can also be involved in causing smiling depression. However, there are a few other things that make smiling depression more likely. A tendency toward perfectionism is one example. People who are especially driven to be high achievers who succeed seemingly single-handedly may be especially prone to hiding their depression from the world, or even suppressing it strongly enough that they don’t realize it themselves.

People who are held to a high standard by others can also be at special risk for smiling depression. Adolescents often feel great pressure to make good grades, maintain jobs, participate in extracurricular activities, and keep up an active social life. Some teenagers feel pressure to get into highly competitive colleges, and may worry that they won’t succeed in life if they don’t meet very high standards. Internet culture may also put pressure on teenagers, as they feel compelled to present themselves publicly in the best light at all times.

What Are the Dangers?

Depression leaves sufferers feeling worthless, hopeless, and isolated, which greatly impacts their quality of life in a negative way. Depression can also adversely affect physical health, as it’s associated with things like unhealthy weight gain or weight loss, poor sleeping habits, and destructive habits like smoking or alcohol and drug use, among other things.

It’s also important to keep in mind that depression can lead to self-harm or suicide. This is where smiling depression becomes particularly dangerous. People who suffer from smiling depression may be at particular risk for suicide attempts. There are a few reasons why. For one thing, because the signs and symptoms of depression may not be apparent to outsiders – or even to the sufferer themselves – they may not be as likely to seek help before the problem gets out of control.

In cases where a person dies by suicide, it’s not uncommon for friends or family members to express shock and surprise. When someone appears happy, healthy, and high-achieving, it can be hard to imagine that they may be considering suicide.

People suffering from smiling depression may also simply have more energy and motivation to plan and carry out a suicide attempt. Depression can sap a person’s energy reserves, sometimes leaving them without the will to get out of bed. As disabling as this can be, it could be a protective factor against suicide in some cases. Planning and carrying out a suicide takes more energy, which means that depressed people who experience surges of energy, such as people with smiling depression who continue to function at high levels, are more at risk of initiating a suicide attempt.

What To Do If You Think Your Teen May Be Depressed

Because the symptoms of depression are masked in smiling depression, sometimes even from the sufferer themselves, it can be difficult to know if your teen is struggling. However, close observation and frequent checking in can reveal subtle signs of depression.

It’s important to initiate conversations with your teen about how they’re feeling. Let them know that you’re there to listen and that you won’t judge them or be disappointed in them for expressing themselves honestly. Evaluate your own expectations for your teen and make sure that those expectations are reasonable – don’t hold them to impossible standards, and make sure that they know it’s OK to fall short sometimes. If your teen expresses feelings of depression or displays worrying signs of depression, intervention from a trained therapist can help.

1. “I Don’t Want to Upset Anyone Else”

People with smiling depression may feel responsible for other people’s feelings as well as their own. For example, a teen with smiling depression may not want their parents to feel worried or their friends to feel burdened or bored by their problems. Keeping up the smiling façade doesn’t do anything to alleviate the depression, but it does seem to keep others around them happy.

Very often, people with smiling depression are also people who are perfectionists, people who take on heavy responsibilities, and people who are held to high standards, either by themselves or by someone else. They may fear disappointing others, failing to live up to their own standards, or being seen as weak, disappointing, or unreliable. These fears cause them to hide the signs of depression that other people are likely to recognize. However, they still experience distressing symptoms like anxiety, loss of appetite, sadness, fatigue, fear, insomnia, or intrusive thoughts. They just don’t show or talk about them.

2. “I Want to Feel as Happy as I Look”

Smiling depression could be an attempt at a “fake it till you make it” approach to depression. That is, the person may believe that by smiling, laughing, and going about their day-to-day life as if everything were OK, they can eventually force themselves to feel OK.

“Fake it till you make it” can be an effective strategy in certain situations. In therapy, this is sometimes referred to as acting “as if”. For example, if you want to be more confident, you can act as if you were more confident by doing what a confident person would do in a given situation – say, introducing yourself to a stranger at a party or boldly talking up your accomplishments and skills in a job interview. And in those scenarios, acting as if often works. Acting as if you’re happy when you’re feeling a little down or having a bad day can also work – smile enough and you may eventually boost your own mood.

However, there are also times when acting as if, or faking it, doesn’t work at all. For pervasive, long-lasting depression, it takes more than just acting happy to actually bring on feelings of happiness. Faking it also tends not to work when the person is doing it more for other people than for themselves. Acting happy just to please the people around you or make them more comfortable can actually be quite isolating, and that feeling of isolation may make depression worse, not better.

3. “I Don’t Know If My Smiling Depression Is Real”

Smiling depression could be a deliberate attempt by the depressed person to hide their true feelings, but it can also be unintentional. Sometimes, people with smiling depression don’t know why they keep smiling, and they may not trust their own feelings. They may not even recognize that they are depressed.

Because someone with smiling depression often seems well-adjusted, happy, and content, they also often receive complimentary feedback on these characteristics. Being told that they’re “so cheery!” or “so successful!” or “so motivated!” when they don’t feel cheerful, successful, or motivated can be confusing. They may view themselves as negative, worthless, or lazy for not feeling like they live up to the appearance they’re presenting to others instead of realizing that it’s depression that’s responsible for the disconnect between the way they appear and the way they feel. This can lead to doubling down on keeping up appearances rather than reaching out for help.

4. “I Want to Tell People How I Feel, but I Can’t”

Hiding or masking a serious problem like depression is like building an invisible wall between the depressed person and the people around them. The longer it goes on, the higher and more impenetrable the wall becomes. A person with smiling depression may recognize that they need support, but feel unable to get the words out when they have the chance to.

A person who has smiling depression may feel like they will have to explain their outwardly happy behavior if they confess to feeling depressed, and they may not feel up to the task – or necessarily even understand it themselves well enough to explain it. The longer they go on presenting a smiling face to the world while inwardly suffering from depression, the harder it may feel to explain.

If a person with smiling depression does attempt to speak out about it and is met with skepticism and unhelpful comments like, “you don’t seem depressed,” they may withdraw even further, feeling that they won’t be believed or understood. They might doubt their own feelings. They may feel unable to press the issue further or seek out someone else to talk to.

Learn How to Recognize the Signs of Smiling Depression

Smiling depression is deceptive. While people with smiling depression may look like they’re going through their lives successfully, they’re still experiencing all of the negative effects of depression. Smiling depression can lead to other health problems, it can lead to self-harming behaviors, and it can also lead to suicide. Compared to other forms of depression, which tend to leave sufferers without much energy, smiling depression may put sufferers at greater risk of suicide because they’re less likely to receive help and support and because they have the energy to act on suicidal thoughts. Recognizing subtle signs of smiling depression can help ensure that the person with depression gets the help they need.

Related Articles:

Could Your Teen Be Struggling with Smiling Depression?

Atypical Depression: Causes, Signs, and Treatment

Teen Depression and School Performance