Aug 21st 2023
Smiling depression occurs when people are depressed yet have few or none of the tell-tale signs of depression, at least outwardly. Inside, however, the pain of depression runs deep. Though smiling depression is a non-clinical term and is not in the DSM-5, it is considered a form of major depressive disorder with atypical features.
Smiling depression is like a mask or a facade. On the outside, someone with smiling depression appears to be happy and completely content. Moreover, this facade isn’t just for others - many people with smiling depression don’t realize they are depressed.
However, lingering under the surface are the typical symptoms of depression, like feelings of inadequacy, hopelessness, despair, and worthlessness. In many cases, people with smiling depression have struggled with depression, anxiety, or both, but maintain the mask of happiness out of fear of being judged by others.
So, even if a person is aware of their depressive symptoms, they maintain a picture of normalcy and continue with their day-to-day lives as though nothing is wrong. The ability to conduct the business of everyday life lends itself to another non-clinical term used to describe smiling depression - high-functioning depression.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines the criteria for a major depressive episode. These criteria, which describe common symptoms of depression, are paraphrased as follows:
In addition to these core depression symptoms, there are other smiling depression symptoms of which to be aware.
For example, the DSM-5 notes that major depression with atypical features involves milder symptoms overall. This goes back to the earlier point that some people with smiling depression don’t even realize they’re depressed.
Additionally, atypical depression must include mood reactivity and at least two of the following:
These symptoms may be difficult to identify, if not wholly absent, when a person is with others. However, the symptoms might manifest when a person is by themselves.
Furthermore, low-grade symptoms - negative thinking, self-criticism, irritability, and aches or pains associated with atypical depression - might be written off as regular ups and downs or as part of another psychological or physiological ailment.
Smiling depression symptoms may be caused by multiple factors, just like any other mental health issue. The cause may include a combination of genetic predisposition for depression, environmental factors (e.g., extreme stress, grief, etc.), and psychosocial factors (e.g., persistent interpersonal rejection).
Likewise, biology plays a part in smiling depression. For example, people with depression have abnormal levels of serotonin, norepinephrine, and dopamine in the brain. Likewise, GABA, glutamate, and glycine are believed to be involved in the development of depression as well.
In addition, multiple risk factors increase the chances of someone developing depression. These include:
As noted earlier, the DSM-5 offers specific criteria for diagnosing major depression with atypical features, the subtype under which smiling depression falls. Refer to the earlier section on symptoms to review those criteria again.
Remember, though, that smiling depression is not a diagnostic term, nor is high-functioning depression. Instead, these are colloquial terms used to describe this type of depression. Remember as well that smiling depression symptoms can be difficult for people to recognize, both as someone with the disorder and as a mental health professional attempting to make a diagnosis.
To aid in a smiling depression diagnosis, a mental health professional might use assessments like the Beck Depression Inventory, Hamilton Depression Rating Scale, or Geriatric Depression Scale. Clinicians might also rely on observations (their own or those from people familiar with the patient’s circumstances) to assist in making a diagnosis.
Other methods of diagnosis typically involve ruling something else out. For example, a physician might conduct a physical examination and order blood work to rule out the patient’s depressive symptoms resulting from a physical issue.
Like any depression, some risks are inherent to smiling depression, particularly suicide. Where people with more common types of depression might lack the energy to even get out of bed, people with atypical depression usually don’t have this issue. Furthermore, they might have enough energy and focus to make a plan for their death and carry it out. People with smiling depression may also be may also be at a higher risk of suicide due to the lack of warning signs that the individual is even struggling with depressive symptoms, which would make intervention less likely.
Additionally, studies show that depression is associated with a higher risk of:
Though a hallmark feature of smiling depression and other forms of depression is a feeling of hopelessness, there is hope it can be treated. In fact, there are many ways to treat this condition and do so with very high efficacy.
Self-help strategies like the following can help you identify how you feel, assess your mental health, and make positive strides toward better mental health:
Of course, if your symptoms are too much for you to bear on your own, it’s important to contact your physician or mental health provider for assistance. In many cases, the treatment for smiling depression includes a combination of therapeutic interventions and medication.
Some of the most common treatments and medications for depression include:
MentalHealth.com is a patient-first technology company driven by its mission to make optimal mental health attainable for everyone. With a focus on expanding care access, empowering choice, and enhancing care quality, the company delivers innovative solutions that support individuals throughout their mental health journey.
Our Medical Affairs Team is a dedicated group of medical professionals with diverse and extensive clinical experience who actively contribute to the development of our content, products, and services. They meticulously evaluate and review all medical content before publication to ensure it is medically accurate and aligned with current discussions and research developments in mental health. For further information, please visit our Editorial Policy.