Smiling depression is not a formal medical term. It is commonly used to describe having depression symptoms while making a great effort to disguise them or outwardly appearing as if you did not have the condition. You may appear cheerful on the outside and still have depression.
Depression is a formal mental health condition that responds well to professional support and self-care.
Symptoms of major depressive disorder (MDD), popularly called clinical depression, include:
loss of interest in activities you once enjoyed
low mood that includes hopelessness, emptiness, and sadness
changes in your sleep cycle
low energy and fatigue
feelings of worthlessness, guilt, and shame
changes in appetite and weight
trouble concentrating
changes in mobility, like moving faster or slower than usual
thoughts of suicide or suicide attempts
Not everyone experiences the same symptoms. To receive a diagnosis, at least five of the nine symptoms above must be present for 2 weeks or longer. Sadness isn’t a prerequisite for a depression diagnosis.
Some people meet the criteria for depression but may appear cheerful or content on the outside.
Is smiling depression a formal diagnosis?
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Smiling depression is a colloquial term for depression that’s hard for others to identify. It’s still depression and involves most of the criteria for this diagnosis.
The diagnosis of these conditions might come with the specifier “atypical features.” These are additional symptoms or symptoms that present differently from what they usually do. The specifier helps add clarity or more detail to an individual’s experience with depression. It helps guide their management plan.
Atypical features in depression may involve significant mood reactivity. This refers to experiencing and expressing a positive emotional reaction to actual or perceived good news or positive events. On the outside, this looks like cheerfulness or high mood.
People with smiling depression may be more likely to have mood reactivity, which often qualifies them for a diagnosis of atypical depression.
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With atypical depression, you experience some of the symptoms of a formal depression diagnosis in addition to atypical features. “Atypical” refers to how common or frequent these features are in the population.
Atypical features may involve significant mood reactivity and at least two of the following:
pronounced weight gain
increase in appetite
hypersomnia (sleeping more than 9 hours per day)
leaden paralysis (feeling like your limbs are heavy)
interpersonal rejection sensitivity (intense fear of rejection) that results in social or functional impairment
Since “smiling depression” is not a formal diagnosis, a mental health professional might not use that term if they believe you have atypical depression.
Smiling depression vs. high functioning depression
Neither high functioning depression nor smiling depression are formal diagnoses. Therefore it’s difficult to compare the two, as neither one has formal criteria.
All formal depression diagnoses share some common features. One is the presence of emotional and mental changes that affect a person’s ability to function. Therefore, even if a person appears to be “high functioning” or “cheerful,” they may not be doing as well as they would be without depression.
Others may perceive a person with smiling depression as being “high functioning.” Depression doesn’t take away from your individuality or personality, and everyone experiences depression differently.
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Treatment options depend on your specific diagnosis. For example, if you have features of smiling depression as part of bipolar II disorder, a healthcare professional may recommend a treatment plan that differs from what they’d recommend for someone with MDD with atypical features.
Psychotherapy, also called talk therapy, is an effective tool to manage depression.
Cognitive behavioral therapy (CBT) helps people reassess the thoughts that may affect their mood and develop techniques for problem-solving and positive self-talk.
Medication may be another important part of depression treatment.
If you call 911, you can ask the operator for someone trained in mental health support.
Summary
Smiling depression is a colloquial term for when someone lives with depression, but it’s hard to tell from the outside. The person might not show any outward signs of distress, but they experience some of the symptoms of a depressive disorder.
Sometimes smiling depression is atypical depression, where someone becomes happy in response to good news or events, or anticipated positive events, but also has symptoms like hopelessness, increased appetite, and excessive sleep.
Medication, psychotherapy, and self-care are all potential treatments for depression. The condition often responds well to intervention, so reaching out for help can be the first step to getting better.
