Symptoms Of Smiling Depression: What To Know

Medically reviewed by Laura Angers Maddox, NCC, LPC
Updated July 10, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
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The phrase “Don't judge a book by its cover” can be aptly applied to people who live with a certain form of depression. Individuals experiencing smiling depression, also commonly known as high-functioning depression often appear happy and well-adjusted on the outside, even though they may be facing difficult symptoms like low mood, feelings of hopelessness, irritability, fatigue, and lack of motivation.

Smiling depression, though not a clinical term, is a common phenomenon characterized by outward expressions of happiness or mental wellness and concurrent internal struggles with depressive symptoms.

This is often an especially challenging way to experience a depressive disorder, so it can help to understand why smiling depression happens and how it manifests. Below, we’re going to provide an overview of this type of depression, including its causes, symptoms, and treatment methods that may improve mental health.

Getty/Xavier Lorenzo
You don't have to smile through depression

Definition of smiling depression

According to the National Institute of Mental Health, an estimated 8.4% of the US population aged 18 and above experienced a major depressive episode in 2020. Given this high level of prevalence, even among individuals with drastically different personalities, it makes sense that people can express feelings related to depression in varied ways. While many people living with depression exhibit noticeable symptoms, such as withdrawal or irritability, others do not show clear signs that they are struggling. Instead, they may project positivity and optimism, which is why they are said to experience “smiling depression”. 

Smiling depression describes a state in which individuals experience symptoms of depression, but hide these feelings and avoid expressing the typical signs of depression expressions of sadness, fatigue, or lack of interest, possibly even from themselves. People with this may be repressing their emotions, avoiding appearing weak, or trying not to worry others. Some may be so high functioning that they are unaware that they are experiencing depression.

For people experiencing major depressive disorder in this way, it can be challenging to break the facade of happiness and reveal what they’re feeling inside. Additionally, it can be harder for other people to read that the individual is living with depressive symptoms. 

Causes of smiling depression

Smiling depression—and major depressive disorders as a whole—can be the result of several causes. There could be an identifiable contributing factor, such as the loss of a loved one, physical illness, a breakup, or a comorbid mental health condition such as bipolar disorder; or there could be no discernible cause. 

Repression is a common factor in this type of functioning depression. Repression is a defense mechanism that can lead an individual to bottle up their emotions instead of expressing them. While they do this, their disposition may seem positive and content; but repressed feelings often resurface in unexpected and negative ways. 

It is also thought to be caused by the desire to appear—both to oneself and others—high achieving and well-adjusted. Medically reviewed sources have shown a link between perfectionism and depression, and it's often mediated by an individual's self-esteem. A person who sets unrealistic expectations for themselves may not know how to cope with negative feelings, causing them to ignore depression symptoms or express them in maladaptive ways that may result in other health conditions. 

Effects of social media

Social media may be a common influence on the development of smiling depression. Many people want to appear positive and cheerful in order to fit in with peers or influencers who portray that lifestyle online every day. This can create unrealistic expectations that may lead to complicated feelings if they aren’t attained. 

Some people may 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. There is a stigma that is sometimes attached to mental health challenges. This can make some people feel as though a disorder like depression is a flaw that they will be judged for experiencing. If you’re living with it, it’s important to remember that it is a common mental illness that anyone can experience, and you’re not alone.   

Signs and symptoms

The symptoms of smiling depression typically mirror those of common disorders that feature depressive episodes (e.g., major depressive disorder, bipolar disorder), with the exception of certain behaviors. While many individuals with depression exhibit low mood through a lack of energy, withdrawal, or irritability, people with smiling depression may present with a happy, energetic persona. Even though they are experiencing symptoms internally, these individuals hide their true feelings. People with smiling depression may function at the expected level at work or in social settings, but then struggle to take care of themselves or get other things done at home. 

Common symptoms include:

  • Low mood

  • Feelings of hopelessness and worthlessness

  • Fatigue

  • Lack of motivation

  • Sleep disruptions

  • Weight fluctuations

  • Suicidal ideation or suicide attempts

Identifying if a happy person is depressed

It can be challenging for those living with it to realize that what they're experiencing is indeed a mental health disorder. Some individuals with this type of depression seem to embody happiness while keeping their inner struggles hidden from the world. If you think you may be living with it, ask yourself some questions. Do your internal feelings often conflict with the image you project? Do you have trouble expressing your emotions? Being honest about your feelings can help you better determine whether you’re experiencing it. 

If you think you are living with smiling depression, it can be important for you to acknowledge that your feelings are valid. Your symptoms are not a sign of weakness; in fact, there is strength in seeking help when you’re feeling down. Below, we’re covering strategies for coping with symptoms. 

Addressing this type of depression

Treatment for depression typically consists of psychotherapy, medication, or both. Therapy — even family -therapy can help individuals address their symptoms and better understand why they struggle to express their feelings outwardly. Medication can help with symptom reduction and lead to improved overall treatment outcomes. Commonly prescribed antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs). Always consult with a healthcare professional before starting or stopping any medication.  

Practice being compassionate

As you seek help, it can 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 draw attention to the positive aspects of your personality while showing yourself compassion. That might not be easy because depression often comes with unrealistic expectations about what we can or "should be able" to do; but acknowledging your emotions is often the first step toward processing them and moving forward. 

You don't have to smile through depression

Supporting loved ones living with it

If you have a loved one who lives with this type of depression, you can offer them support by giving them the opportunity to express how they're feeling and letting them know that it's OK to not feel OK sometimes. Many people with it are concerned about judgment from others; so, knowing that they will be accepted regardless of their mental health condition can be vital. 

Navigating depression with online therapy

The results of an increasingly large body of research point to online therapy as an effective form of treatment for symptoms of depression. In one broad-based review, researchers concluded that online therapy led to significant improvements in depression symptoms among participants from the 40 included studies. The review also notes the versatility of online therapy platforms, stating that a “range of different interventions, communication types and support types exist”. 

If you think you may be living with this type of depression or a similar mental health challenge, online therapy can be a flexible, effective form of care. With an online therapy platform like BetterHelp, you can work with a therapist remotely, which may be helpful if depression makes leaving home difficult. Online therapy is also an affordable option and you can cancel anytime. A licensed mental health professional can help you express feelings in a healthy way. Continue reading for reviews of BetterHelp therapists from people who have sought help for similar concerns.

Therapist 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.”


Smiling depression can be difficult to identify and navigate because it can lead others to believe you’re feeling healthy and content, even if this isn’t the case. If you’re struggling to express your emotions regarding depression, know that you're not alone. Connecting with a licensed therapist online can be the first step toward improved symptoms and mental wellness.
Depression is treatable, and you're not alone
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