Many times after a suicide friends and family may say that they saw no warning signs before the self-inflicted death. There is a type of depression that has been categorized recently as “smiling depression”. This is not a clinical term, but rather a term that describes someone that is suffering from depression, but outwardly may be smiling, functional, and “normal” to coworkers, friends, family, and sometimes even healthcare providers. When someone is suffering from smiling depression, their depressive symptoms are masked and go completely undetected by others. Instead, the depressive symptoms are suffered inwardly. When depression is masked by smiles, there can be an increased risk of suicidality or suicide.

Living Behind the Mask

Those who are suffering from the so-called smiling depression often try to pretend that everything is okay. On the surface, they go to work or school and interact seemingly normally with those around them. Sometimes, this is a personal choice, other times it may be a learned or cultural trait to always smile and be positive, no matter what is really going on inside. Some of these people also drink or use substances to mask their pain, but display improved moods when under the influence.

Smiling depression can be the loneliest type of depression because no one has any idea what is going on behind the mask. It can also be one of the most exhausting types of depression because holding in that pain and suffering all day takes a lot of emotional effort. With the loneliness and lack of perceived support, it is easy to see how dangerous masking signs of depression can be.

Diagnoses that Lurk Behind the Smile

Smiling depression can feature any of the classic symptoms of depression, or only a few. True depression is diagnosed when there are five or more symptoms experienced most days for at least two weeks. This diagnosis can be elusive even for trained professionals because most of their diagnosis is based on the information they receive from the patient. If a patient is telling them that everything is okay, it can be very difficult to know otherwise.

There are other diagnoses that can be overlooked or mistaken for smiling depression. Certain types of bipolar disorder have mixed features which feature elevated mood and increased energy, despite being in the middle of a depressed episode. There are also types of depression with atypical features in which depression continues, despite improved mood due to external factors. Diagnoses can also be inaccurate when substance use is involved. Making mental health diagnoses can be particularly difficult because most of the information is coming from the place which is affected.

Masking Suicidal Thoughts

Suicide rates in certain age groups have doubled or even more in recent years. These deaths are preventable. Yet people experiencing suicidality rarely talk about how they are feeling. Stigma about treatment for depression or fears of repercussions about hospitalizations or diagnoses may keep people from being honest about what is going on inside when they are experiencing thoughts of ending their lives. Worse still, the conscious awareness of the severity or frequency of suicidal thoughts may not come until it is too late. This is a particular danger for someone who is hiding their depression from themselves or others.

No Symptoms? Or Symptoms Overlooked?

There is another possibility for smiling depression, which is that most people are not aware of the symptoms of depression or don’t want to face a mental health diagnosis in someone they love. They overlook the changes in weight or sleep, increase in substance use, or just seeming “off”, particularly when the person affected does not complain about the symptoms. In hindsight, many family members and friends of those who have passed by suicide may be able to string telltale symptoms of depression together that they missed. But with suicide, hindsight is always too late.

How to See Behind the Smile

Watching for symptoms requires knowledge about depression and awareness of mood and other obvious signs. Particularly if there is a loved one who is at risk for or has been previously diagnosed with any type of depression, it is important to be vigilant for changes in moods, behaviors, or habits. An increase in substance use or abuse can always be a red flag for something happening behind the smile. Maintaining good relationships with loved ones is also important so that they will have someone to trust and confide in if needed. Smiling depression can be one of the most dangerous forms of depression, but if stigma is decreased and awareness is increased, lives can be improved or even saved.

Although smiling depression is not an actual clinical diagnosis, it is a good description of those whose depression is hidden behind seemingly normal functioning and behaviors. Although there are various diagnoses that can lead to this phenomenon, the risk of suicide is increased because of the intense loneliness and isolation of symptoms. Some of the problems could be a lack of awareness about the symptoms of depression, or perhaps having symptoms masked by drug or alcohol use. When there is substance abuse and depression, Rancho Milagro Recovery is the perfect place to turn to for help. Our beautiful natural setting helps you to heal from addiction and depression simultaneously. Call (951) 526-4582 for more information about our family-owned Southern California ranch. The various forms of insurance we accept can help make it easier for you to get the help you need. Let us help you match the emotions on the inside with your expressions on the outside.

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