The hidden risks of smiling depression

Logic tells us that if a person has a good sense of humour and is always smiling, they must be happy, right? Not necessarily, or at least not in every case. Things are not always what they seem or, as the saying goes, sometimes “the real struggle is hidden beneath the surface.” 

An Invisible Form of Depression 

Smiling depression is a type of depression that, although it does not appear as a recognised diagnosis in official psychopathology manuals, refers to a reality that is much more common than it may seem and therefore needs to be made visible in order to be properly addressed. 

The symptoms of smiling depression can be the same as those of standard clinical depression, but it has one characteristic that makes it unique: the person withdraws into themselves. Although they may be experiencing enormous suffering internally, they create a wall between themselves and the outside world, becoming isolated and appearing to others as a happy person or someone without any obvious problems. 

Two Coexisting Sides 

The emotional self-isolation experienced by someone suffering from smiling depression means that only one side of them is visible externally, the happy side, while an important internal and hidden side is overlooked. Yet it is within this hidden side that much of their daily experience takes place and where they often find themselves completely alone. Let us look at these two sides in more detail. 

External Side 

• They appear as though everything is going well and that there are no problems in sight. Sometimes they may exaggerate their sense of wellbeing. 
• They are always in a good mood and make jokes. 
• They actively seek the company of others as an attempt to normalise their internal state, but sometimes this becomes impossible to maintain and they withdraw. 
• They fulfil their responsibilities as they always have. 
• They take care of their appearance and place importance on how they look. 
• They hide their pain and internal conflicts from those close to them (family and friends), although they may occasionally disclose aspects of their distress to complete strangers in situations where they will not meet again. 
• They do not usually attend psychotherapy, but they may seek information about mental health through blogs, forums, self-help books and similar resources. 
• They try to stay busy at all times. Stopping means thinking and re-evaluating their internal situation. 
• They experience outbursts of anger for no apparent reason. This is the way they allow themselves to express their internal distress. 

Hidden Side 

• Sadness for much of the day. 
• Lack of motivation or loss of interest in activities. 
• Loss of appetite or increased appetite. 
• Sleep disturbances. 
• Constant exhaustion and lack of energy. 
• Feelings of guilt, worthlessness or being deceptive (feeling that they are misleading the people they care about most). 
• Difficulties concentrating, solving problems or making decisions. 
• Recurring thoughts about death, sometimes fear of dying and sometimes suicidal thoughts, with or without a specific plan. 

Who Is More Likely to Experience It? 

It is not necessary to go through major difficulties or traumatic experiences to develop smiling depression. There may, in fact, be no “objective” reasons for suffering that would explain its development. However, the experience of reality is subjective and is lived in a completely unique way by each individual. 

This type of depression does tend to affect people who are more inclined towards introversion and/or who have high levels of self-demand. These are often people with significant responsibilities, whether professional, family-related or personal, who do not feel entitled to express what they truly feel because they fear the possible consequences of doing so. 

The Dangers of Remaining Silent 

Smiling depression is one of the most dangerous forms of depression and can have particularly serious consequences. Because the problem is not recognised, the person does not seek help, either from those close to them or from professionals, making it difficult to receive the support needed for treatment. As a result, the hidden side becomes increasingly severe and the possibility of recovery appears more distant. This makes the person particularly vulnerable to thoughts of suicide, which may be perceived as the only way to end their suffering. Many cases of completed suicide, where loved ones cannot understand or explain what happened and could not foresee it, are often cases of smiling depression. 

It is important not to confuse smiling depression with high-functioning depression, also known as dysthymia. In the latter, depression is also present and the person continues to function normally in daily life, but unlike smiling depression, it is not hidden. As a result, professional support and treatment can be accessed, making recovery possible. 

Mental Health Team, Teladoc Health 

You do not have to face emotional challenges alone. If you would like to speak with someone about your mental wellbeing, Global Health provides members access to mental health coaching, alongside telemedicine and Get Fit Program, at no additional cost through the Ecare portal and app.