Causes And Symptoms Of Smiling Depression

By William Drake|Updated April 8, 2022
CheckedMedically Reviewed By Wendy Boring-Bray, DBH, LPC

"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, but 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 the year of 2020 alone. For those aged 18-25, the percentage is even higher at 17%.  If you think you may be one of those people, know that 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 that they are experiencing depression, especially if they're getting through their daily lives with a smile. While it is by no means a clinical term, this effect is sometimes referred to as "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 in which you're living with symptoms of depression, but you're able to hide these feelings and signs, possibly even to yourself. For people enduring depression in this way, it can be difficult to get help because it's hard to break the facade of happiness and reveal what's really 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” in the sense that they would have to address them and admit the way 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 mask 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 contact 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 here.

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. There are a number of things that can increase the risk of depression, but regardless, it isn’t something to ignore and working through it is absolutely possible.

Causes Of Smiling Depression

Feeling worthless or hopeless and experiencing other negative thoughts is common among people who live 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/or 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 difficult for those living with smiling depression to realize that what they’re experiencing is indeed depression. Carrie Krawiec, a licensed marriage and family therapist, suggests 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 and 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, 7 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 both in acknowledging this distress and in addressing 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 not be able to simply 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 ok to not feel ok sometimes. Listen actively, acknowledge what they're sharing, and offer to be there as a listening ear in the future.

If they are in the process of reaching out for help, support them as they take those steps. For someone wearing this mask, visiting a therapist for the first time may not be easy. 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 look into getting 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 take a look at things from an outside perspective. If a friend was facing a mental or physical health condition, it’s likely that you would have compassion for them, and you'd 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. For all guidance regarding treatment options and medication, please consult a licensed medical professional. Your journey is unique to you and getting to a better place is not always a linear process. In fact, it’s often not! It is important that you have 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, 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 how you're feeling and give you the tools to make big changes to feel better. They can also assist you with life stress and anything else that may impact you along the way. 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 give you the right tools immediately. 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. With a few simple steps, you can be on your way to a new life, and your smile will finally be real. Take the first step today.

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