The Dangers of “Smiling Depression”

The Dangers of “Smiling Depression”


When you think of depression, you probably imagine someone moping, tucked under the covers all day, unable to muster the energy to get out of bed. For some people with the condition, however, there are none of these telltale signs. Instead, although they may feel lethargic, worthless, and sad on the inside, they appear perfectly happy on the outside. They skillfully mask their feelings and power through their days, appearing so cheerful that some people refer to this condition as “smiling depression.”

Although it isn’t recognized as a clinical diagnosis, smiling depression is real, and it affects more people than you might think. Consider the number of celebrity suicides of people who were too embarrassed or ashamed to ask for help (from Ernest Hemingway, Judy Garland, and Junior Seau to Robin Williams, Mindy McCready, and Anthony Bourdain). On the outside, they seemed like they had everything; on the inside, they were suffering.

You may be suffering too.

Hiding the Hurt

People who hide their feelings may experience all the typical symptoms of depression, including:

  • Persistent negative moods and sadness
  • Loss of interest in pleasurable activities
  • Fatigue
  • Feelings of hopelessness
  • Difficulty concentrating
  • Irritability
  • Excessive crying
  • Trouble sleeping
  • Loss of libido
  • Thoughts of death or suicide

For someone with smiling depression, however, they tend to “fake” happiness, forcing themselves to appear optimistic. Outwardly, they look like the picture of success. They often perform well on the job, work out on a regular basis, take good care of the family, and still find time for an active social life. Everything looks completely normal, but it’s all a façade. Even though they may be laughing with friends or coworkers, they actually feel empty and disconnected inside.

Reasons Why People Hide Depression

There are many reasons why you might keep depressive symptoms private. For example, you may:

  • Think mental illness is a character flaw or personal weakness
  • Be ashamed of your feelings
  • Want to avoid being a burden on friends and family
  • Be in denial about your symptoms
  • Fear discrimination in the workplace
  • Want to avoid being labeled a complainer
  • Have already unsuccessfully tried antidepressants and think you’re out of treatment options

Whatever is motivating you to internalize your feelings, be aware that keeping it all bottled up has consequences.

The Hidden Danger of Smiling Depression

People with depression are prone to thoughts about death and suicide. In typical depression, people generally lack the energy to act on their suicidal thoughts. Those with smiling depression, however, tend to have the energy required to plan and act on such thoughts. For this reason, someone who is hiding their depression from the world could be at greater risk of attempting suicide. On top of this, because they are keeping their pain inside, they are less likely to reach out to friends or family for support or to seek help. This compounds depression and adds to the risk.

Finding Hope, Seeking Help

If you’re experiencing symptoms of depression but hiding it from everyone (including yourself), understand that there is hope and there is help. Follow these 3 steps to put yourself on the path to healing.

1. Start by choosing someone you trust with whom you can share your feelings. Opening up about your inner pain may help you cope with some of your symptoms.

2. The next critical step is seeking a diagnosis. Finding a practitioner who understands that mental health conditions are based on the biology of the brain and who utilizes functional brain imaging can help you see that your problems aren’t a sign of psychological weakness but rather a biological and treatable problem.

3. Getting the right treatment plan depends on the type of depression you have. Brain imaging studies have identified 7 different types of depression, and treatment needs to be tailored to your type. In addition, the most effective treatment plans go beyond antidepressants and can include diet and exercise recommendations, nutritional supplements, strategies to eliminate negative thinking patterns (killing the ANTs, or automatic negative thoughts), psychotherapy, and more.

Don’t let smiling depression keep you down. You deserve to feel as happy on the inside as you look on the outside.

At Amen Clinics, we use brain SPECT imaging, as well as an all-encompassing 4-circle approach that looks at biological, psychological, social, and spiritual elements to diagnose and treat depression symptoms. By using the least toxic, most effective personalized solutions, we have helped thousands of people overcome symptoms of depression. To learn more or to schedule your comprehensive evaluation, please visit us online or call 888-288-9834.



  1. I don’t get it. Please excuse my skepticism in advance. Other than enriching the drug industry and leaving the users of the myriad of antidepressants etc, with so many very dangerous side effects, worsening depression and yes even suicide (the thing trying to be prevented in the first place), how does the suggestion of taking these kind of actions improve the quality of life for people who experience depression? I’ve had others tell me the doctor blamed them when a medication didn’t work. Wow! That is pretty insane. That as well as the labeling of the individual by medical providers as well as others who access the system, which negatively prejudices others against those so labeled. The amount of effort put into marketing these dangerous medications is very confusing. Providers are gleeful every time they can convince a patient to start using them.

    “Finding a practitioner who understands that mental health conditions are based on the biology of the brain and who utilizes functional brain imaging can help you see that your problems aren’t a sign of psychological weakness but rather a biological and treatable problem.” I guess this may be the key, but how can the typical person figure out which provider(s) actually meet this requirement? The adage you don’t know what you don’t know really applies here.

    Comment by Craig — October 16, 2019 @ 2:34 AM

  2. I took my 16 year old son to Amen clinic in July 2018. He displayed symptoms of “smiling depression” but we did not recognize it at the time nor were we informed of it. After his brain scans we were told to have him take certain supplements to help with areas of depression and impulsivity but I left with a false confidence that there wasn’t any grave concern . My son committed suicide that January and left our family and our community devastated. I pray that other families get help from a mental health practice that actually discusses the real dangers of this type of depression and the urgency for intervention. We also found the excess amount of supplements can be upsetting to the stomach so compliance over time was a problem. I wish I had known to make sure you get to a doctor for a medicine if this is the case … I just don’t want it to happen to anyone else’s beloved son or daughter

    Comment by Stacey Dewey — October 16, 2019 @ 2:42 AM

  3. They don’t do brain imaging in Australia, or work out what’s wrong with you.
    They just dictate to you what’s wrong with you without asking any questions.
    They didn’t even catscan me when I got brain damage.
    They won’t even treat my m.p.d….

    Maybe its just me….
    Maybe its everyone…..

    Comment by kylus — October 16, 2019 @ 2:54 AM

  4. which brain imaging are you talking about/ which t ype of meds are you recomending

    Comment by michael weber — October 16, 2019 @ 6:11 AM

  5. What do you recommend for medicine. I thought meds are not good for you.

    Comment by Nadia — October 16, 2019 @ 7:14 AM

  6. I’ve never heard the term smiling depression before but I totally get it and I can see how the famous people who have committed suicide could fit in this category. One of the biggest issues is the cost of the proposed screening and treatment described above – it is not affordable to 90% of the population. Who has $3000 – $5000 laying around for a brain scan – then need another $200+ per month for supplements – and this is not government approved treatment/therapy so it’s not covered by insurance so pull out that fat wallet and hope the treatment works for you.
    I have tried a dozen antidepressants with all negative results, often making me worse than before I started. I don’t think I am the exception to the rule and I wish pharmaceutical companies would get their act together and find treatments that work and are available to everyone (ketamine looks promising and can anyone make an approved/covered CBD product?).
    I appreciate the article and enjoy hearing Dr Amen speak but I just don’t see this info as being helpful to those most in need. As a whole, we need to find affordable mental health treatment for those who are suffering. Our population is screaming for help. Who is going to help those in desperate need before it’s too late for the next son, daughter, father or mother?

    Comment by Notsmiling — October 16, 2019 @ 7:38 AM

  7. There is research currently being done with psilocybin under guided psychiatry that is having profoundly positive results with few treatment sessions for depression. You might want to find a psychiatrist that practices integrative medicine to discuss that option.

    Comment by Diane — October 16, 2019 @ 8:40 AM

  8. programs or meds dont work if you dont try

    Comment by pam — October 16, 2019 @ 2:41 PM

  9. I would like to comment on your list of famous people who have committed suicide. How do you determine, without examination, why these people killed themselves, which also answers questions about imaging of the brain, and getting a good doctor.
    I’m want to point out Robin Williams as an example of the need to know what is wrong before knowing what treatment is appropriate. Most people either thought Robin was depressed, or depressed because he had been diagnosed with Parkinson’s disease. First of all, in Parkinson’s disease depression is a symptom of the disease, not because of having it; sometimes it can be the first symptom, in fact. Second of all, Williams did not have “just” depression, and in fact, he did not have Parkinson’s. Autopsy should he had Lewy Body Dementia, and probably did not understand the significance of what he was doing when he hung himself. My point is, if a person doesn’t seek out proper help, proper treatment cannot be applied. There ARE many reasons for depression, many of them quite complicated. Patients and their families have the right and the need to know what is wrong, how a prescribed treatment is supposed to work, what to look for if it’s not working and what to do, and just how serious a diagnosis either is, or could be. They also have the right and need to know what kind of treatments that are available, and those who treat have the responsibility to give all available information to the patient and/or family involved.

    Comment by Teresa Baker — October 17, 2019 @ 1:06 AM

  10. Dr Amen and his team have been pioneers in this walks of life, that are still a bit difficult to understand….
    I have all symptoms of Smiling Depression, but I don’t have it, yet I know too much about each single item the the article points out. I have learned over the years on how to split my Mental health issues, from my medical issues that arise from nerve head injury..they both intersect, but are not the same, and while I deal successfully with the mental health issues, it’s very hard to even document what I feel, because historically mental health therapists and psychiatrists are ill equipped to understand, let alone diagnose correctly the root causes of the symptoms. Because the Insurance industry and Big RX are rigged with each other in politicians pockets, the US capitalist economy is a prime vehicle for mass miss-diagnoses , and mass over-medication… People like Dr Amen should be in the boards of leading US healthcare institutions, because he knows that the models , used currently are very much outdated. One day as I was researching and coming to this conclusion about what was happening to me, I heard his TED talk, and immediately as he was started to talk I knew that he is a seeker of higher knowledge, not a believer of some baloney sandwich was fed to him in med school. Unfortunately, the industry is rigged as I noted, and dr Amen is just a tiny drop in the bucket , when we compare national numbers, and really, the Gov should fine Big RX and Insurance lunatics to pay him and people like him, to lead a lab with scientists and researchers and the latest and greatest, such having free access access to NIH. I can tell you by my own experience, that depressive symptoms can come either form mental Health issue alone, and also from blunt force or strong jolt to the head, which can impair the axon fibers and subsequently the synapses between brain cells.. prickly issue , that combined with genetic mutations and chemical unbalances that are surely beyond one’s control , can be fatal.. Some medications are useful , and many types of natural food and mindful exercises are crucial to healing back to recover to whatever is possible, but these techniques are not profitable, and so insurances don’t want to pay for them, because it would defeat the purpose of paying high insurance premiums. yes, capitalism has many great things, and as many great problems…Many countries and cultures are way ahead the USA in some mental healthcare areas, and that’s a fact.

    Comment by Joao Vieira — October 17, 2019 @ 9:59 AM

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