The mask of ‘smiling depression’

The following article by Olivia Remes discusses ‘smiling depression’. In clinical practice this term would not be used diagnostically, however I do think that it is a helpful way of describing a certain depressive coping style.

‘Smiling depression’: it’s possible to be depressed while appearing happy – here’s why that’s particularly dangerous

Putting on a mask doesn’t make depression any easier.
Alyssa L. Miller/Flickr, CC BY-SA

Olivia Remes, University of Cambridge

The term “smiling depression” – appearing happy to others while internally suffering depressive symptoms – has become increasingly popular. Articles on the topic have crept up in the popular literature, and the number of Google searches for the condition has increased dramatically this year. Some may question, however, whether this is actually a real, pathological condition.

While smiling depression is not a technical term that psychologists use, it is certainly possible to be depressed and manage to successfully mask the symptoms. The closest technical term for this condition is “atypical depression”. In fact, a significant proportion of people who experience a low mood and a loss of pleasure in activities manage to hide their condition in this way. And these people might be particularly vulnerable to suicide.

It can be very hard to spot people suffering from smiling depression. They may seem like they don’t have a reason to be sad – they have a job, an apartment and maybe even children or a partner. They smile when you greet them and can carry pleasant conversations. In short, they put on a mask to the outside world while leading seemingly normal and active lives.

Inside, however, they feel hopeless and down, sometimes even having thoughts about ending it all. The strength that they have to go on with their daily lives can make them especially vulnerable to carrying out suicide plans. This is in contrast to other forms of depression, in which people might have suicide ideation but not enough energy to act on their intentions.

Although people with smiling depression put on a “happy face” to the outside world, they can experience a genuine lift in their mood as a result of positive occurrences in their lives. For example, getting a text message from someone they’ve been craving to hear from or being praised at work can make them feel better for a few moments before going back to feeling low.

People with smiling depression can feel better temporarily.
4 PM production/Shutterstock

Other symptoms of this condition include overeating, feeling a sense of heaviness in the arms and legs and being easily hurt by criticism or rejection. People with smiling depression are also more likely to feel depressed in the evening and feel the need to sleep longer than usual. With other forms of depression, however, your mood might be worse in the morning and you might feel the need for less sleep than you’re normally used to.

Smiling depression seems to be more common in people with certain temperaments. In particular, it is linked to being more prone to anticipate failure, having a hard time getting over embarrassing or humiliating situations and tending to ruminate or excessively think about negative situations that have taken place.

Women’s Health magazine captured the essence of smiling depression – the façade – when it asked women to share pictures from their social media and then to recaption them on Instagram with how they really felt in the moment they were taking the picture. Here are some of their posts.

Burden and treatment

It is difficult to determine exactly what causes smiling depression, but low mood can stem from a number of things, such as work problems, relationship breakdown and feeling as if your life doesn’t have purpose and meaning.

It is very common. About one in ten people are depressed, and
between 15% and 40% of these people suffer from the atypical form that resembles smiling depression. Such depression often starts early in life and can last a long time.

If you suffer from smiling depression it is therefore particularly important to get help. Sadly, though, people suffering from this condition usually don’t, because they might not think that they have a problem in the first place – this is particularly the case if they appear to be carrying on with their tasks and daily routines as before. They may also feel guilty and rationalise that they don’t have anything to be sad about. So they don’t tell anybody about their problems and end up feeling ashamed of their feelings.

So how can you break this cycle? A starting point is knowing that this condition actually exists and that it’s serious. Only when we stop rationalising away our problems because we think they’re not serious enough can we start making an actual difference. For some, this insight may be enough to turn things around, because it puts them on a path to seeking help and breaking free from the shackles of depression that have been holding them back.

Exercise and meditation can help.
Yuganov Konstantin/Shutterstock

Meditation and physical activity have also been shown to have tremendous mental health benefits. In fact, a study done by Rutgers University in the US showed that people who had done meditation and physical activity twice a week experienced a drop of almost 40% in their depression levels only eight weeks into the study. Cognitive behavioural therapy, learning to change your thinking patterns and behaviour, is another option for those affected by this condition.

And finding meaning in life is of utmost importance. The Austrian neurologist Viktor Frankl wrote that the cornerstone of good mental health is having purpose in life. He said that we shouldn’t aim to be in a “tensionless state”, free of responsibility and challenges, but rather we should be striving for something in life. We can find purpose by taking the attention away from ourselves and placing it onto something else. So find a worthwhile goal and try to make regular progress on it, even if it’s for a small amount each day, because this can really have a positive impact.

We can also find purpose by caring for someone else. When we take the spotlight off of us and start to think about someone else’s needs and wants, we begin to feel that our lives matter. This can be achieved by volunteering, or taking care of a family member or even an animal.

Feeling that our lives matter is ultimately what gives us purpose and meaning – and this can make a significant difference for our mental health and well-being.


In the UK, Samaritans can be contacted on 116 123 or by email – jo@samaritans.org. Other similar international helplines can be found here.The Conversation

Olivia Remes, PhD Candidate, University of Cambridge

This article is republished from The Conversation under a Creative Commons license. Read the original article.

I’m worried, what should I do?

What should I do if I’m struggling, worried, or trapped in behaviours I don’t know how to get out of?

Physical and mental health should be considered equally, and we are, I believe, getting much better at understanding this. But it can be difficult to know when and how to seek help, particularly if the problem doesn’t seem to be an obvious medical condition.


Ideally your GP should be your first port of call as there are some difficulties which show emotional symptoms but can have an underlying medical cause that needs treating (e.g., thyroid and menopausal issues). But it can be hard to know what to say and how to talk about feelings.

It used to be the case that your GP would mainly offer medication, but there is much better access to psychological therapy now. There can be a waiting list unfortunately but if you are offered help from your local NHS service do put yourself on the waiting list. In the meantime, there are lots of self-help resources out there (books, websites and apps), as well as private psychological therapists. Nowadays therapy sessions can be carried out by telephone, or online video as well as face to face so there are options out there if you want to see someone privately. Therapy doesn’t have to mean endless weekly sessions either. You may just need a short course to get you back on track again.

What’s wrong?

You could start by saying that you don’t feel good, and then say how things used to be for you before you felt like this. Are there any thoughts that you have been having that feel overly negative, or worries that keep going around in your mind and making you feel anxious? Are you having flashes of distressing images – of something that has happened or something you fear might happen? Intrusive thoughts are common, especially when we are worried or anxious so please don’t feel that you will be judged for having them. Or maybe you are feeling that you just don’t have the motivation that you used to have, or you feel a bit lost or caught in patterns that you can’t seem to get out of.

Try using this quick table to jot down how you feel, it can help to see it written down, and it gives you a format to give to a GP or to the therapist that you see.

When we feel bad, our thoughts match what we feel. This isn’t helpful when it makes us think and believe that things will never get better. They will, and they can. I know it is hard but give therapy a try. Do it for you. You do deserve better. You don’t have to travel, although being in a different physical environment can make you see things from a different perspective, which can sometimes be helpful.

The Physical and the Psychological – inextricably linked!

The problem of Tinnitus

Tinnitus is a condition that can affect mental health, sometimes in quite severe ways. It’s hard to ignore and there’s no current cure for the condition. Therapy can help people to manage their symptoms and the associated frustration and depression that can result from this debilitating condition. Stress is thought to make tinnitus worse therefore if therapy can help you with stress then it can have an impact on the tinnitus also.

Here are some recent articles about tinnitus:

Help Musicians UK

Refinery 29 article about the film ‘A star is born’

The distress of tinnitus and its effect on musician Isobel Anderson

A Norwegian study of Tinnitus, Anxiety and Depression in rock musicians

Choosing a therapist

Who, What, How?

There are so many different types of therapists; counsellors, psychotherapists, psychologists, psychological therapists, addiction therapists, and of course psychiatrists who are not really therapists but medical doctors who specialise in psychiatric (mental health) disorders. It’s confusing but I’d like to guide you through this.

Who should I see?

It’s important that the therapist you see is governed by a professional body so that you can be sure they work to a code of practice and are professionally qualified. These are the main professional bodies and links to how to find therapists who are registered with them:-

British Psychological Society (BPS) – Governs Psychologists. To find a Chartered Psychologist who specialises in psychotherapy, look here.

British Association for Behavioural and Cognitive Psychotherapies (BABCP). The leading organisation for CBT in the UK and Ireland. The main Accrediting and Membership body for CBT Psychotherapists. To find a CBT Therapist look here.

British Association for Counselling and Psychotherapy (BACP). The Accrediting body for Counsellors and Psychotherapists. To find a Counsellor or Psychotherapist look here.

UK Council for Psychotherapy (UKCP). The main body for the regulation and accreditation of psychotherapists and psychotherapeutic counsellors. To find a psychotherapist look here.

EMDR Association UK and Ireland. The accrediting body for EMDR Therapists. To search for an EMDR Therapist look here.

National Counselling Society (NCS). Regulates and Accredits Counsellors in the UK. To find a counsellor look here.

A positive example of an open approach to mental health in the music industry

This discussion between Ellie Giles, who manages Bill Ryder-Jones, and Ryan Bassil gives a positive example of how to manage mental health in the music industry. Ellie is honest about her own limits and clear with her own self care so that she can be present when needed for her artist. She briefly discusses the mental health difficulties that her artist struggles with, and how she and the label manage this. The key points for me are:

  • Being kind to yourself, and to others
  • Look after yourself and put your self care first so that you can be more present for others
  • Know your limits and don’t be afraid to seek help
  • Keep clear boundaries – don’t be ‘on-call’ all the time

That’s how we’re going to move forward: be kind to yourself, then be kind to others.

Ellie Giles

Read the complete article here: How to Approach Mental Health as a Band or Artist Manager – Noisey