Causes And Symptoms Of Smiling Depression

Updated December 21, 2022by BetterHelp Editorial Team

"Don't judge a book by its cover" is a phrase that might apply to someone who lives with depression. Someone may look like they're happy and functioning outside. Still, the reality is that these individuals could be facing difficult symptoms like low mood, feelings of worthlessness or hopelessness, irritability, fatigue, and trouble engaging in daily obligations or tasks. According to the National Institute of Mental Health, an estimated 8.4% of the U.S. population aged 18 and above experienced a major depressive episode in 2020 alone. The percentage for those aged 18-25 is even higher at 17%. If you think you may be one of those people, know you're not alone. Depression is considered very common, and the fact is that it can impact anyone.

Everyone experiences depression differently. Some people might not even realize they are experiencing depression, especially if they get through their daily lives with a smile. While it is not a clinical term, this effect is sometimes called "smiling depression."

To The Rest Of The World, You're Smiling. But On The Inside, You're Suffering.

Definition Of Smiling Depression

Smiling depression describes a state where you're living with symptoms of depression, but you can hide these feelings and signs, possibly even from yourself. For people enduring depression in this way, it can be challenging to get help because it's hard to break the facade of happiness and reveal what's going on inside. As such, one may discount their feelings. They may also fear that acknowledging their feelings makes them appear weak to others - or that it would make the feelings "more real" because they would have to address them and admit how they feel to themselves. Sometimes, thoughts like "It'll pass," "I have nothing to be sad about," "I have to be strong for other people," and so on may arise or play a role.

The best way to explain smiling depression is to think of a theater where the actors are all wearing masks. Those masks hide their problems from the outside world, but the reality behind the show might be very different. People experiencing smiling depression can have a family, hold a full-time job, and even have an active social life. Still, behind the mask, they may be experiencing significant sadness, panic attacks, and even suicidal* thoughts.

*please get in touch with the National Suicide Prevention Lifeline if you or someone you know is experiencing thoughts of suicide. To reach the National Suicide Prevention Lifeline, call 1-800-273-8255 or use their webchat option.

Essentially, the façade of happiness is a defense mechanism to hide their true thoughts and feelings. With depression as a whole - including depression that presents in this way - there could be an identifiable contributing factor, including a breakup, a job loss, or even the loss of a loved one. Or there may not be. Several things can increase the risk of depression, but regardless, it isn't something to ignore, and working through it is possible.

Causes Of Smiling Depression

Feeling worthless or hopeless and experiencing other negative thoughts is common among people with depression. One may face poor self-image, which can further feed into feelings of emptiness, emotional numbness, self-critical behavior, and high expectations that may be regularly unmet. As a result, these individuals may find themselves trying to do everything perfectly, which creates a need to control others and their surroundings. There is a link between perfectionism and depression, and it's often mediated by an individual's self-esteem or lack thereof.

Those who face perfectionism often have a higher risk of developing depression - perhaps because they set unrealistic expectations for themselves and others. However, this is only one potential risk and contributing factor. Other causes or contributing factors may include:

  • Physical illness.
  • Family history.
  • Personal history of other mental health conditions.

Bottled-up emotions (known as emotional repression or suppression) can also worsen or pose a risk for depression symptoms. Over time, negative feelings and thoughts can feed into each other, creating a loop in a person's head that pushes them further into sadness and low self-worth.

What To Do If You Have Smiling Depression

It can be challenging for those living with smiling depression to realize that what they're experiencing is indeed depression. Carrie Krawiec, a licensed marriage and family therapist, suggest that individuals with smiling depression can exemplify happy, put-together outward appearances while keeping their inner turmoil hidden from the world.

"These people would likely hide symptoms and true feelings from others, feeling more isolated, which would contribute to more worthlessness and hopelessness, and without adequate help could lead to suicide," says Krawiec.

*If you have been experiencing any suicidal thoughts, reach out for help immediately. You can reach the National Suicide Prevention Lifeline at 1-800-273-8255, 24 hours a day, seven days a week.

By learning to recognize the signs of depression, you can recognize when you need to seek a licensed therapist or other assistance to address feelings of sadness and worthlessness.

First, acknowledge that your feelings are valid. Your symptoms are not a sign of weakness; instead, they're a sign of emotional distress that must be addressed, and there is great strength in acknowledging and handling it. As part of this process, it's important to value yourself. That can be difficult if you're encountering self-esteem issues. Plus, when we feel bad, it can be easy to fall into a self-critical pattern that can further negatively impact our self-esteem.

Helping Those With Smiling Depression

If you have a friend who lives with depression, understand that healing is a process and that treating depression is about more than a particular mindset. You won't be able to tell them they're wrong for feeling the way they do (nor should you), and your friend will be unable to snap out of it. Instead, remind them of your love. Then, let them express how they're feeling without judgment. Let them know it's okay not to feel okay sometimes. 

If they are in the process of reaching out for help, support them as they take those steps. Visiting a therapist for the first time may not be easy for someone wearing this mask. Your support could be critical as they take the first steps toward addressing their feelings. Although social support plays a role that differs from professional help, it can be very beneficial and healing for individuals facing a wide range of concerns, including depression.

To The Rest Of The World, You're Smiling. But On The Inside, You're Suffering.

Having Compassion For Yourself

As you seek help, it may be advantageous to extend compassion to yourself. Recognize that this is not your fault and know that things can improve. Treat yourself as you would a friend. You may try an exercise such as writing a letter or email of encouragement to yourself in which you are sure to draw attention to the positive aspects of your personality while showing yourself compassion.

It can also help to look at things from an outside perspective. If a friend were facing a mental or physical health condition, you would likely have compassion for them and encourage them to seek treatment. Try to do the same for yourself.

That might not be easy because depression - and perfectionism, too, if that is indeed something you experience - often comes with unrealistic expectations about what we can or "should be able" to do. With honesty, you may be able to admit that everything is not okay. The next step is to take action. Treatment and support for depression may include a combination of practices or changes, which will differ from person to person. These may include but aren't limited to individual therapy, group therapy, peer support via a support group or other means, lifestyle changes, and potentially medication if you choose. Please consult a licensed medical professional for all guidance regarding treatment options and medication. Your journey is unique to you, and getting to a better place is not always linear. It's often not! It would be best if you had someone to reach out to when you need it.

Reaching out for help is a way to invest in yourself and your future. Invest in yourself through the good and the bad, and know that the tough times do not make you less than others but are opportunities for incredible learning and growth.

Therapy Can Help

If you are interested in speaking with a professional about feelings of depression or something else that's going on in your life, consider online therapy with BetterHelp. A therapist can help you understand your feelings and give you the tools to make significant changes to feel better. They can also assist you with life stress and anything else that may impact you. Therapy is something that anyone can benefit from or find value in. It is not something to be ashamed of, and you deserve to get the support you need.

Want to learn more? Read the counselor reviews below from people experiencing similar concerns who benefitted from the help of a BetterHelp mental health professional.

Counselor Reviews

"Heidi has been a great help. I'm so very thankful. I was having a hard time getting my thoughts in order and was at an all-time low with my depression because I didn't know where to go or what to do. Heidi's guidance helped me tremendously, and I am ever so grateful."

"Tamera is straightforward and supportive. She's not afraid of pointing out what to work on and immediately giving you the right. It is highly personalized just for your unique symptoms and situation! Tamera helped me manage my depression and anxiety, and I became more empowered to control my life. I feel a lot happier."


If you're living with - or think that you could be living with - smiling depression, please be compassionate with yourself. You're not alone, and things can get better. You can be on your way to a new life with a few simple steps, and your smile will finally be honest. Take the first step today.

Below are commonly asked questions on this topic:

What kind of depression is it when you smile?

The term "smiling depression" is sometimes used to refer to people who "smile through" their depressive symptoms. The type of depression can vary—e.g., major depressive disorder, seasonal affective disorder, etc.—but a consistent factor is a person who shows a smiling face and thus effectively hides (or attempts to hide) their depression from the world. 

Depression is a mental illness that needs treatment, and "smiling depression" poses just as much immediate risk. Moreover, the person may also engage in harmful practices—such as self-harm—that they manage to hide. People with smiling depression will generally benefit from treatment, including emotional support through talk therapy, medication, and even treatment facilities dedicated to depression. 

Do people smile when they are depressed?

Many people who are depressed will continue to smile. This may be because the depression is not so severe that they are constantly feeling down, or it may be because they want to hide the fact that they are depressed. This latter incidence is known as smiling depression, which is just as much a mental illness as other forms of depressive disorder. As such, it should be treated by licensed wellness professionals. 

Why do I smile when I'm sad?

They were smiling when sad isn't uncommon. It may be an attempt to cheer yourself up, or it may be to mask your sadness. Many people may have significant depression but try to smile their way through it. Mental disorders generally do not resolve all on their own, so it's essential for depression to be treated. People with smiling depression may have negative habits—such as substance abuse, self-harm, etc.—but they mask it (like a "high functioning alcoholic"). This doesn't make it any less severe, so smiling depression should be actively treated, whether that's through treatment facilities, talk therapy or family therapy, and medication.

Is there a disorder for smiling?

A disorder known as "Angelman syndrome" is a genetic disorder. People with Angelman syndrome will laugh and smile frequently and generally have "happy, excitable personalities," according to the Mayo Clinic. 

This is different from someone with smiling depression, who will generally smile and laugh not as a compulsion but to make it seem as if they aren't depressed. It's essential to get treatment, as smiling depression may lead to significant depression and other mental health problems. They may also cope with substance abuse or other unhealthy activities that they do in private.

Why do I smile in serious situations?

Some people smile and laugh in challenging situations out of nervousness or anxiety. For example, some people laugh when they are in uncomfortable situations where deep emotions are being shown. This may be upsetting to the emotional ones present, e.g., at a funeral or wake. This can also be a tendency of a manic phase, though many people have this impulse. It's a way that they involuntarily cope with an awkward or otherwise uncomfortable situation that makes them nervous or anxious. 

Why do I keep smiling for no reason?

People generally smile for a reason. You may think it's "for no reason," but there may be a reason underlying it. For example, people who are falling in love often walk around smiling. Some people are sad but force themselves to smile to cheer themselves up or cover up their sadness (or both). 

Is smiling a coping mechanism?

Smiling can be a coping mechanism for people who are depressed. Smiling depression may lead to significant issues, such as substance abuse or other mental health problems, as it's simply an attempt to mask the depression from others. Many peer-reviewed studies show the risks of untreated depression, so treatment is paramount. 

What is the smiling death?

The "smiling death" is a phenomenon of crushing injuries when people may smile as a result of less pain when crushing pressure is released but then fall victim to the sudden change of pressure (known as reperfusion syndrome).

What should people with smiling depression do?

It's essential to get help for smiling depression, which is when someone attempts to smile through the pain of depression. It affects all sorts of people, whether doctors, lawyers, college students, mechanics, etc. People with smiling depression must seek treatment, as they may have a severe form of depression, such as major depressive disorder (one of many forms of depression outlined in the Diagnostic and Statistical Manual of Mental Disorders). Offering emotional support is an invaluable service that you can do for people with smiling depression. Another helpful approach can be to manage settings, e.g., avoiding sad or uncomfortable situations, though this isn't always possible. You can also try learning from others who have relevant experience with smiling depression; this way, you can securely process your feelings with someone who can relate empathetically. 

In any case, if you have thoughts of harming yourself or others, it's essential to call a local emergency number or one offered by a national alliance, such as the National Alliance on Mental Illness hotline: 800-950-6264.

What do you call a person who hides their pain behind a smile?

Someone who hides their pain behind a smile may have what's known as smiling depression. This can be just as severe as any other form of depression, but they attempt to cover it up. 

You Don’t Have To Face Depression Alone. Our Experienced Counselors Can Help.

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