The Secret Pain of "Smiling" Depression

By Rita Labeaune, Psy.D.

How many people do you imagine look happy, but struggle with depressive thoughts on a daily basis? Typically depressed people are depicted as being bedridden and incapable of functioning. What may or may not be surprising is, according to the National Institute of Mental Health, that approximately 10 percent of the United States population is suffering from depression, which is 10 times more than those suffering from bipolar disorder (1 percent) and schizophrenia (1 percent).

Not everyone experiences depression in the same way. Some might not even realize that they are depressed, especially if they seem like they're managing their day-to-day life. It doesn’t seem possible that someone can be smiling, chipper, functioning, and at the same time depressed.

In my practice, those who are most surprised to realize they're experiencing some form of depression are those suffering from “smiling depression.” Most people haven’t even heard of the term. The definition of smiling depression is: appearing happy to others, literally smiling, while internally suffering from depressive symptoms. Smiling depression often goes undetected. Those suffering from it often discount their own feelings and brush them aside. They might not even be aware of their depression or want to acknowledge their symptoms due to a fear of being considered “weak.”

The hallmark of smiling depression is sadness. The smile and external façade is a defense mechanism, an attempt to hide their true feelings. A person could be experiencing sadness about a failed relationship, career challenges, or lacking what they view as a true purpose in life. The sadness might also manifest as a constant overall feeling that “something just isn’t right.”

Other common symptoms of smiling depression are feelings of anxiety, fear, anger, fatigue, irritability, hopelessness, and despair. Those suffering from this and other forms of depression may also experience problems sleeping, a lack of enjoyment in pleasurable activities, and a loss of libido. Everybody’s experience is different. It’s possible to feel just one or many of these symptoms.

Another way to think about smiling depression is to see it as wearing a mask. People suffering from smiling depression may offer no hint of their problem to the outside world. They often maintain a full-time job, run a family household, participate in sports, and have a fairly active social life. With their mask on, everything looks great, even at times perfect. However, underneath the mask, they are suffering from sadness, panic attacks, low self-esteem, insomnia, and, in some cases, suicidal thoughts.

Suicide can be a particular threat for individuals suffering from smiling depression. Typically, people suffering from classic, severe depression might have suicidal thoughts, but not the energy to act on their feelings. However, those suffering from smiling depression have the energetic ability to plan and follow through. This is why smiling depression can be more dangerous than a classic form of severe depression.

If you or anyone you know might be suffering from smiling depression, the good news is that help is available. This is one of the most treatable mental health problems. Whether through counseling or psychotherapy, it is possible to successfully navigate out of this state of mind and be freed from the sadness. Your loved one or close friend whom you suspect is suffering from smiling depression may deny it and might even have a negative reaction when you first broach the subject. This is normal. Often people aren’t aware of smiling depression, and the word “depression” might sound too extreme. Keep in mind they may view getting help as a sign of weakness or something only needed by the severely disturbed.

Aside from counseling or psychotherapy, those suffering can start by opening up to those around them. Choosing one close family member, friend, or confidant, and making it a practice to discuss feelings and concerns can help alleviate symptoms. It's important not to be concerned about being a burden. Sometimes we forget that those around us are happy to support us in the same way we would them. Opening up and sharing feelings is a key element in coping with depressive thoughts.

As long as you continue to deny or avoid what makes you feel empty, it will be near impossible to fix the problem. When depressive thoughts and feelings aren’t addressed, they typically build up and become worse. What matters most is to reach out.

Rita Labeaune, Psy.D., is a clinical psychologist with a private practice in Beverly Hills. She treats adults dealing with smiling depression and other forms of depression, anxiety, and mood disorders.