Depression is a mental health condition with specific diagnostic criteria and symptoms. Some people may use the term “smiling depression” to refer to depression without evident or noticeable symptoms, particularly low mood.

Depression usually occurs with observable symptoms like sadness, hopelessness, lethargy, or fatigue. But it doesn’t always look this way, and individual experiences of depression may fall anywhere along a wide spectrum. All these experiences are valid.

Smiling depression isn’t a formal clinical term or a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), a reference handbook used by most U.S. mental health professionals.

Symptoms of smiling depression fall under clinical depression, formally known as major depressive disorder (MDD).

If you have depression without noticeable symptoms — or with atypical ones — you may receive a formal diagnosis of MDD with atypical features. It means you experience symptoms of depression, but these manifest differently than in other depression cases. Some people may call this experience “smiling depression,” even though this is not a term accepted in the medical community.

People with “smiling depression” experience formal depression symptoms, but they may have developed skills to mask or hide them in front of other people. For example, they may feel sad and hopeless and yet appear cheerful and at peace on the outside.

Formal symptoms of depression include:

  • low mood, including sadness, hopelessness, emptiness, or flat affect
  • difficulty enjoying everyday activities or those that used to be pleasurable
  • fatigue and low energy
  • changes in appetite and body weight
  • changes in sleep patterns (sleeping more or fewer hours than usual)
  • feelings of worthlessness, guilt, and shame
  • changes in movement patterns (moving faster or slower than usual)
  • difficulty concentrating, making decisions, and using cognitive functions
  • thoughts of self-harm, death, or suicide

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

  • Call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
  • Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
  • Not in the United States? Find a helpline in your country with Befrienders Worldwide.
  • Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you’re not in the same household, stay on the phone with them until help arrives.

To reach a depression diagnosis, a mental health professional will try to establish that at least five of the above symptoms are persistent across various situations for most of the day, every day for 2 weeks or longer.

Other possible depression symptoms may include:

It’s possible to have depression without experiencing sadness, but it’s also possible that someone with low mood may not reflect it on the outside. This could result from someone believing that:

  • depression is a sign of weakness
  • they’d burden others by expressing how they truly feel
  • what they feel isn’t depression
  • others have it worse, so they shouldn’t complain or feel the way they do

Atypical depression may look and feel differently to each person. It’s also possible that symptoms shift from time to time. According to the DSM-5-TR, atypical features of depression include:

  • mood reactivity (changes in mood depending on the situation)
  • two or more of the following:
    • eating more than usual and gaining significant weight
    • sleeping more hours or more often than usual
    • having limb heaviness
    • experiencing persistent rejection sensitivity and interpersonal and occupational conflicts

Read more about major depressive disorder.

Depression can be managed, and relief is possible. Unmanaged depression often leads to more persistent and severe symptoms, but these respond to treatment in most cases.

Treatment for depression often depends on individual needs. In general, psychotherapy is the first line of treatment, and doctors may prescribe medications for more persistent or severe symptoms.

Evidence-based psychotherapy approaches for depression may include:

Medications for depression symptoms may include:

Doctors may prescribe other medications for specific cases, including atypical antidepressants and mood stabilizers.

Smiling depression isn’t a formal diagnosis. Instead, it’s a term that some people use to describe the experience of depression where symptoms may not be as noticeable or observable.

Some people may develop coping skills that involve masking or hiding some of their symptoms, like sadness or hopelessness. When that’s the case, a mental health professional may diagnose MDD with atypical features.