SMILING DEPRESSION

The term “smiling depression” – appearing happy to others while internally suffering depressive
symptoms – has become increasingly popular. Articles on the topic have crept up in the popular
literature, and the number of Google searches for the condition has increased dramatically this
year. Some may question, however, whether this is actually a real, pathological condition.While
smiling depression is not a technical term that psychologists use, it is certainly possible to be
depressed and manage to successfully mask the symptoms. The closest technical term for this
condition is “atypical depression”. In fact, a significant proportion of people who experience a low
mood and a loss of pleasure in activities manage to hide their condition in this way. And these
people might be particularly vulnerable to suicide.

It can be very hard to spot people suffering from smiling depression. They may seem like they
don’t have a reason to be sad – they have a job, an apartment and maybe even children or a
partner. They smile when you greet them and can carry pleasant conversations. In short,
they put on a mask to the outside world while leading seemingly normal and active lives.

Inside, however, they feel hopeless and down, sometimes even having thoughts about ending it
all. The strength that they have to go on with their daily lives can make them especially
vulnerable to carrying out suicide plans. This is in contrast to other forms of depression, in which
people might have suicide ideation but not enough energy to act on their intentions.

Although people with smiling depression put on a “happy face” to the outside world, they can
experience a genuine lift in their mood as a result of positive occurrences in their lives. For
example, getting a text message from someone they’ve been craving to hear from or being
praised at work can make them feel better for a few moments before going back to feeling low.

Other symptoms of this condition include overeating, feeling a sense of heaviness in the arms
and legs and being easily hurt by criticism or rejection. People with smiling depression are also
more likely to feel depressed in the evening and feel the need to sleep longer than usual. With
other forms of depression, however, your mood might be worse in the morning and you might
feel the need for less sleep than you’re normally used to.

Smiling depression seems to be more common in people with certain temperaments. In

particular, it is linked to being more prone to anticipate failure, having a hard time getting
over embarrassing or humiliating situations and tending to ruminate or excessively think
about negative situations that have taken place.

Women’s Health magazine captured the essence of smiling depression – the façade – when it
asked women to share pictures from their social media and then to recaption them on
Instagram with how they really felt in the moment they were taking the picture. Here
are some of their posts .

Burden and treatment

It is difficult to determine exactly what causes smiling depression, but low mood can
stem from a number of things, such as work problems, relationship breakdown and feeling as
if your life doesn’t have purpose and meaning.

It is very common. About one in ten people are depressed, and between 15% and 40% of
these people suffer from the atypical form that resembles smiling depression. Such
depression often starts early in life and can last a long time.If you suffer from smiling
depression it is therefore particularly important to get help. Sadly, though, people suffering
from this condition usually don’t, because they might not think that they have a problem in
the first place – this is particularly the case if they appear to be carrying on with their tasks
and daily routines as before. They may also feel guilty and rationalise that they don’t have
anything to be sad about. So they don’t tell anybody about their problems and end up feeling
ashamed of their feelings.

So how can you break this cycle? A starting point is knowing that this condition actually
exists and that it’s serious. Only when we stop rationalising away our problems because we
think they’re not serious enough can we start making an actual difference. For some, this
insight may be enough to turn things around, because it puts them on a path to seeking help
and breaking free from the shackles of depression that have been holding them back.
Exercise and meditation can help. Credit: Pixabay

Meditation and physical activity have also been shown to have tremendous mental health
benefits. In fact, a study done by Rutgers University in the US showed that people who had
done meditation and physical activity twice a week experienced a drop of almost 40% in their
depression levels only eight weeks into the study. Cognitive behavioural therapy, learning to
change your thinking patterns and behaviour, is another option for those affected by this
condition. And finding meaning in life is of utmost importance. The Austrian
neurologist Viktor Frankl wrote that the cornerstone of good mental health is having purpose
in life. He said that we shouldn’t aim to be in a “tensionless state”, free of responsibility and
challenges, but rather we should be striving for something in life. We can find purpose by
taking the attention away from ourselves and placing it onto something else. So find a
worthwhile goal and try to make regular progress on it, even if it’s for a small amount each
day, because this can really have a positive impact.

We can also find purpose by caring for someone else. When we take the spotlight off of us
and start to think about someone else’s needs and wants, we begin to feel that our lives
matter. This can be achieved by volunteering, or taking care of a family member or even an
animal.

Feeling that our lives matter is ultimately what gives us purpose and meaning – and this can
make a significant difference for our mental health and well-being.

What is Smiling Depression?
Smiling depression involves appearing happy to others and smiling through the pain,
keeping the inner turmoil hidden. It’s a major depressive disorder with atypical
symptoms, and as a result, many don’t know they’re depressed or don’t seek help.
People with smiling depression are often partnered or married, employed and are
quite accomplished and educated. Their public, professional and social lives are not
struggling. Their façade is put together and accomplished.

But behind the mask and behind closed doors, their minds are filled with thoughts of
worthlessness, inadequacy and despair. They’ve usually struggled with depression
and/or debilitating anxiety for years and have had some experience with therapy or
medication. Many don’t disclose their depression due to fear of discrimination
from loved ones or employers. “Oftentimes, I am the only person in this
individual’s immediate circle who is aware of how he or she is feeling on the inside,”
said Dina Goldstein Silverman, Ph.D., a licensed psychologist and
assistant professor of psychiatry. 
Why is it dangerous?

According to Silverman, there’s a troubling connection between smiling depression

and suicide. In contrast with a patient who has little energy to even get out of bed,
chronically depressed patients who report a surge of energy might be more likely to
initiate a suicide attempt. Significant traumatic life changes—such as a recent job
loss or divorce—are often predictors of suicide attempts, particularly in men. In some
cases, having young children or being devoutly religious may serve as protective
factors. But many of us know exceptions to that.

One of the deaths that shocked my community the most was the suicide of a Sunday
school teacher and youth counselor. Active in our church and several nonprofits, he
mentored many and loved connecting people. Was he disheveled, withdrawn and a
downer to be around? Absolutely not. He was encouraging, thoughtful and went out
of his way to attend and organize events. Often in a suit and always put together, he
was who we aspired to be when we grew up. Did we ever ask him how he was
doing, if he was hurting or if he needed someone to listen to him for once? No. We
bought in to the façade and couldn’t see the pain hiding under the surface.

His life was one-of-a-kind, but unfortunately his story is not. Many who have felt the
impact of a friend’s suicide say the same thing: “I had no idea he was suffering. He
was the last person I would have expected to do this.”

How can we help?
Create awareness to de-stigmatize mental illness

Many people struggling with smiling depression are perfectionists, or they don’t want
to appear weak or out of control. The more we can shift the conversation to show
positive role models living with depression—those who advocate for the mix of
therapy, exercise, medication, sleep, diet—the less shame and stigma will be
associated with it.
Pay more attention to your loved ones (especially the warning signs)

If you have a friend who suddenly stops responding to phone calls or texts or
cancels plans, don’t hesitate to ask them what’s going on and if they’re feeling okay.
Let them know that they are heard and are not alone. Also, it’s vital to notice if a
loved one begins giving away possessions (often a symptom that someone is
considering suicide), or begins to isolate and withdraw.

“As a therapist, I try to encourage [my patients] to develop authentic social

relationships, so he or she can experience the relief of being heard, understood and
validated by friends and loved ones, and build genuine connections,” Silverman said.

If you think you might be depressed:

On the days when your brain seems to be fighting you for your life, remember
that you are enough, you are worthy, you are loved and you are not alone.

Find activities and pursuits that are meaningful to you and make you feel productive
and accomplished. Try your best to be present in these activities. Silverman says
that “mindfulness is the opposite of perfectionism in that it focuses on a balance
without judgment, and it’s an important set of skills that someone can learn in
therapy.”

Reach out to someone you trust and consider contacting a therapist. Let these
influential roles in your life help you to create a more positive state of mind. Rather
than become “submerged in a vortex of negative, self-defeating thoughts,” Silverman
encourages her patients to learn self-compassion. Above all, please don’t give up.
Please don’t let depression win. You are not alone.