What You Need to Know About 'Smiling Depression'

“How are you? Really?” This is my mom’s standard line of questioning any time I dye my hair darker. In her mind, darker hair equals darker mood. She’s on to something, but in my case, she has it backwards. She shouldn’t worry that I’ve “moved over to the dark side” when I, well, move over to the dark side. What’s really cause for concern is when I dye my hair blonde.

I’m best at hiding my depression when I’m blonde.

When I’m brunette, I feel authentic. I literally let a little more of my darker side show.

When I’m blonde, I’m a fraud. Trying too hard. I’m bubbly, social and easy to get along with. It’s an artificial light, in every sense. When I’m blonde, I’m the face of smiling depression.

What is smiling depression?

It’s 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. Those who do would prefer to keep their struggle private.

People with smiling depression are often partnered or married, employed and are quite accomplished and educated. They’ve usually struggled with depression and/or debilitating anxiety for years and have had some experience with therapy or medication. Many who know they are depressed don’t disclose it due to fear of discrimination from loved ones or employers. Their public, professional and social lives are not suffering. 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.

The image many of us have of depression is inaccurate and incomplete.

“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 are suicidal and 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 the exceptions to that statement.

One of the deaths that rocked my community the hardest 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 just under the surface.

His life was one-of-a-kind, but unfortunately his story is not. Many who’ve felt the impact of a friend’s suicide say the same thing: “I just 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. Pay more attention to ourselves and our loved ones. Ask the hard questions. Specifically, notice if a loved one begins giving away possessions (often a symptom that someone is considering suicide), or begins to isolate and withdraw.

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 OK. Or offer a low-key activity you can do together where they know they can be heard and are not alone.

If you’re a physician, notice the co-morbidity rates for patients suffering from asthma, obesity, diabetes or cardiovascular disease, and include a screening for depression and anxiety. And be prepared to make appropriate referrals to psychologists and psychiatrists.

Many people suffering from 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 with depression – those who advocate for the tailored mix of therapy, exercise, medication, sleep, diet – the less shame will be associated with the depression.

“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 and know that you are enough, you are worthy, you are loved and you are not alone.

Find the activities and pursuits that are meaningful and make you feel productive and fruitful. Reach out to someone you trust, consider contacting a therapist and let both help you flip the script running through your mind.

Rather than become “submerged in a vortex of negative, self-defeating thoughts,” Silverman encourages her patients to learn self-compassion and be present and fully engaged.  “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.”

Above all, please don’t give up. Please don’t let depression win. You are not alone.

“Those who have a ‘why’ to live, can bear with almost any ‘how.’”  — Viktor E. Frankl, “Man’s Search for Meaning”

If you or someone you know needs help, see our suicide prevention resources.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.

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