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Depression isn’t always obvious. In fact, some people go to great lengths to hide the symptoms of depression from the people around them — concealing the problem so well that they themselves may scarcely recognize it.

This is why hidden depression is sometimes called “smiling” depression. Someone with hidden depression may seem content, happy, and productive. Their work life and relationships, from all outward appearances, seem fine.

But inwardly, in quiet spaces that aren’t easily shared, depression symptoms are affecting their thoughts, feelings, and physical health. And those symptoms aren’t going away.

Becoming aware of how depression symptoms vary is important. Undiagnosed and untreated depression can get better if people get help. Learn more about how it’s diagnosed and treated.

One reason it can be hard to recognize hidden depression is that symptoms vary so widely from person to person. You may already be familiar with the better-known symptoms of depression:

  • sadness that persists longer than 2 weeks
  • frequent crying
  • a big drop in self-esteem
  • losing interest in things that were once important

But other symptoms may be harder to recognize as depression, including symptoms like these:

  • physical pain or gastrointestinal problems not linked to another health condition
  • fatigue or lack of energy
  • changes in sleep patterns
  • weight gain, weight loss, or changes in appetite
  • changes in substance use
  • irritability, grumpiness, or extra-sensitivity
  • feelings of hopelessness or worthlessness
  • problems with attention, concentration, or memory
  • loss of interest in sex

One way to determine whether someone has depression is to look at how long someone has had symptoms. Generally, symptoms that don’t go away within 2 weeks should probably be discussed with a trusted healthcare professional.

Here’s more perspective on high functioning depression.

It’s important to watch for any changes in behavior. When people have depression, they may begin to act differently than they used to act, even if they’re not acting sad or listless.

One or two changes on their own don’t necessarily signal that someone is hiding depression, but several that occur around the same time may be cause for concern.

When someone is experiencing symptoms of depression but not talking about it, attentive people around them might notice these kinds of changes:

Personality differences

Changes in personality may be a sign of hidden depression. Someone living with hidden depression might, for example, become quieter if they were once outgoing, or more pessimistic when they used to have confidence about the future.

Losing or gaining significant amounts of weight

Suddenly changing their eating habits — showing no interest in eating or eating in response to emotional situations may be a sign of hidden depression.

Changes in substance use

Changes in drinking or substance use patterns that interfere with your everyday life may be a sign of hidden depression.

Changes in sleeping habits

Sleeping much later each day or for longer than usual, or staying awake at unusual hours, can all be signs of depression.

Becoming more serious

If someone is living with hidden depression, they may begin initiating or having conversations that are deeper, darker, or more philosophical than usual.

Differences in social interactions

Signs of depression may include someone becoming the “life of the party” in ways that don’t seem genuine. They might also start withdrawing from social activities, giving frequent excuses for why they aren’t engaging with friends and family as much can be signs of depression.

Productivity differences

Either devoting a lot of extra time to work or seeing a decline in performance can both indicate depression.

Abandoning hobbies or causes that once mattered

An individual with hidden depression may give up on things that were once very important to them, or they may start participating in half-hearted ways.

Negative self-talk

A person may say negative things in a joking manner to deflect attention away from their underlying pain. There may be an increase in risk-taking behaviors, especially in adolescents. This may be an attempt to counteract numbness or inflict self-harm.

Anyone can hide depression symptoms, especially if they feel there’s something to lose in talking about it. But some groups of people may be more likely than others to conceal depression or be unaware that depression is affecting them.

Research shows that depression can be hidden, underdiagnosed, and under-treated in these groups of people:

  • older adults
  • children and teens
  • men
  • people with chronic illnesses
  • people recovering from traumatic experiences
  • people from marginalized or underserved communities

People often feel that they have very good reasons to keep depression symptoms private. Maybe they’ve experienced negative consequences from disclosing depression symptoms in the past. Maybe they aren’t aware of the health risks untreated depression can pose.

The list below captures some of the reasons people hide what they’re feeling.

“It came on so gradually, I hardly noticed.”

For some people, the symptoms of depression increase over time. They may not even realize how much depression is affecting them until someone close to them calls attention to the problem.

“I don’t trust doctors.”

In some communities, historical and present-day racism, colonialism, and discrimination make it hard for people to be open with medical professionals about what they’re experiencing.

People may have been misdiagnosed or mistreated by medical professionals who didn’t recognize their symptoms or regard them with respect. Their encounters with medical professionals may have left them feeling disempowered, overlooked, or stereotyped.

“I am afraid of what will happen if I talk about a mental health struggle.”

Some people don’t disclose depression symptoms because there can be harmful repercussions if they do. For example, one 2020 study found that mothers were afraid to say they were depressed because they didn’t want child protective services to take away their children.

In some places, mental health conditions can lead to encounters with law enforcement, which can be dangerous and frightening. Mistrust of systems can make people feel the need to hide their symptoms.

“I don’t want to be a burden.”

People sometimes feel a sense of guilt when they seek treatment or ask for help. This may be especially true for teens and older adults who don’t want to worry their families and friends.

This concern can also impact people with chronic illnesses who don’t want to add something to the list of medical conditions they’re discussing with a physician.

“I’m embarrassed to talk about it.”

Public health campaigns have improved how people see mood disorders like anxiety and depression. But attitudes toward mental health still vary from place to place. In some families, communities, and cultures, a stigma is still attached to depression.

People may misunderstand the condition, thinking it’s caused by a flaw or weakness of character. This can keep people from talking about symptoms and seeking treatment.

“I don’t want to take medications.”

Some people are concerned about taking antidepressants and other medications because of the risk of side effects. But while antidepressant medications are commonly prescribed treatments in the United States, not everyone living with depression has them as part of their treatment plan — and that’s OK!

About 19 percent of people in the United States sought treatment for a mental health condition in 2019. Just under 16 percent were prescribed medication to treat the condition, and just under 10 percent opted for psychotherapy or counseling, either on its own or in combination with medication.

Many people find that psychotherapy and changes to their diet, exercise, thinking patterns, and sleep habits are effective treatments, especially if symptoms are mild or moderate.

It can be hard to know how to help someone who seems to be dealing with depression. Here are some options to consider:

  • You can ask questions that show you care and open an opportunity to talk.
  • Listen without judging or giving too much advice.
  • Avoid clichés and cheery pep talks, which might not be helpful.
  • Offer to take walks together.
  • Make arrangements for low-pressure social activities, considering the other person’s interests.

Being cautious about disclosing a health condition is a matter of personal judgment and choice. Not every family member, friend, or workplace is safe and supportive, so protecting private health information can be a wise decision for some people depending on their situation.

But it is important to consider seeking treatment if you’re experiencing depression symptoms, especially if your symptoms are affecting your health, education, job, or quality of life.

One 2017 study suggested that the longer depression remains undiagnosed and untreated, the worse symptoms become and the harder they are to treat.

Untreated depression increases the risk of suicide. Researchers at the National Institutes of Mental Health point out that untreated depression can also raise your risk of developing illnesses, including:

  • cardiovascular disease
  • diabetes
  • stroke
  • osteoporosis
  • Alzheimer’s disease

Hidden depression is treatable. When people get help, symptoms often get better, although it can take some time for the effects to be noticeable. The most common and effective depression treatments are medications, psychotherapy, or a combination of the two.

In cases where therapy and medication haven’t fully relieved severe symptoms, brain-stimulating treatments may be an additional option.

It’s also possible to improve some depression symptoms with exercise, improvements to sleep, and a diet that limits sugary, processed foods (such as the Mediterranean diet).

People with depression sometimes hide their symptoms from the people around them. They may not recognize that what they’re dealing with is depression, or they may be putting on a happy face to disguise how they feel inside.

Maybe they’re concerned about what others might think of them, or they’re worried about the consequences of seeking treatment for a mental health condition. They may not fully trust healthcare professionals, co-workers, friends, and family members to be supportive.

It’s important to recognize the symptoms of depression and get treatment so things don’t get worse. Untreated depression can lead to other health problems over time.

If you or someone you know is working hard to camouflage depression symptoms, know that good help is available. With treatment, depression can be managed, and a better quality of life can be restored.