Why might depression be called a hidden illness

What It Is and How to Help

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.

The Dangers of Hidden Depression – Bridges to Recovery

In some people, symptoms of depression are very noticeable, but in others, there are no obvious symptoms on the outside. If you're struggling with hidden depression, you may be experiencing a lot of inner sadness, fatigue or lethargy while trying to appear in control of your life and emotions. You may even be attempting to hide symptoms of depression from yourself.

Depression is a mood disorder that is typically associated with extreme sadness and a despair that is so all-consuming that you can’t get out of bed or function in your day-to-day life. Symptoms of depression can vary quite a bit from one person to another. While some people are noticeably full of sadness and despair, in others symptoms may not be as obvious.

Some people live with depression on the inside, even though they appear cheerful and content on the outside. This is known as smiling depression or hidden depression. It’s also sometimes called walking depression, because those that have it can keep on walking, talking, and smiling in spite of their depression. If you have hidden depression, there’s a good chance that other people have no idea you are struggling with depressive symptoms.

Symptoms of Hidden Depression

If you have hidden depression, you make an effort to project an image of happiness even though inside you are experiencing a lot of sadness. You may attempt to brush aside your own feelings, or you may feel impatient with yourself for feeling them.

Symptoms of smiling depression include the most recognizable symptoms of depression such as:

  • fatigue
  • lethargy
  • Difficulty concentrating
  • Loss of interest in activities that once brought pleasure

What makes this form of depression distinctive is the fact that, in spite of experiencing these symptoms, you appear to be leading a very functional life. On the exterior you may be holding down a steady job, have a good family life, and seem to be cheerful and optimistic. There may not be anyone who knows you are depressed, except you.

Inner Struggles of Hidden Depression

When you have hidden depression, even though you seem to be functioning and coping, you are experiencing a lot of inner struggles. You may have thoughts similar to these:

  • It’s not acceptable to show signs of depression to others, because that would reveal character weakness.
  • You don’t want to bring down the people around you by telling them your true feelings and inner struggles.
  • There’s nothing seriously wrong in your life, so you shouldn’t be complaining.
  • Everyone around you would probably be better off without you.

Why Smiling Depression is Dangerous

The fact that you are able to lead a seemingly normal life may seem to be an advantage over a person who has clinical depression and is completely unable to function, but having high functioning depression can actually be dangerous. You may be denying your symptoms even to yourself, which means there’s a good chance you are not reaching out to your doctor or to loved ones for help.

Trying to ignore symptoms of smiling depression can lead to other problems. Some problems you may experience if you try to pretend nothing is wrong include:

  • Weight loss or gain from losing your appetite or turning to food for comfort
  • Misuse of alcohol or other substances
  • Physical pain or illness
  • Social isolation
  • Conflict in relationships
  • Self-destructive behavior such as cutting

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The Risk of Suicide

An even more serious problem is that hidden depression can lead to inner hopelessness and despair that can’t be communicated to anyone else. As your feelings of sadness and despair intensify, you may consider suicide.

The risk of suicide may be higher in hidden depression than it is in major depression. With major depression, you might feel suicidal but would probably not have the energy to act on these thoughts. With smiling depression, acting on suicidal urges is a real possibility.

Getting Help for Walking Depression

Opening up to the people around you is an important step toward overcoming hidden depression. Instead of trying to hide your uncomfortable feelings, reach out to a trusted family member or friend and begin to get in the habit of discussing your feelings. Those who love you are likely to want to be supportive, and sharing your feelings is an important part of coping with depressive thoughts and emotions.

Just because depressive symptoms are not completely incapacitating doesn’t mean that you shouldn’t get help. Working with a therapist can help you to identify the thought patterns and belief systems that are contributing to depressive feelings, as well as helping you to learn what tools you can use to improve your mood. These tools include meditation, physical exercise and learning mindfulness skills.

Another option is to go to a residential treatment center, where you can completely focus on getting help for hidden depression for a period of time. This allows you to participate in support groups and work with a therapist without the distractions and stresses of your day-to-day life. It’s a great way to get in touch with deep-rooted feelings in a safe environment.

Symptoms of hidden depression shouldn’t be ignored in the hopes they will go away. Depression, including high functioning depression, is a very treatable condition. With help, you can learn new skills for coping with your depression, and you will be able to smile on the outside as well as the inside.

  • We are here to listen compassionately.
  • Our free, confidential telephone consultation will help you find the best treatment program for you.
  • We can also guide you in approaching a loved one who needs treatment.

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causes, types, stages, symptoms, signs, diagnosis, treatment in women and men







Depression is a common mental disorder, the main features of which are a persistent decrease in mood, problems with memory and concentration, and minimal physical activity.

The causes of such a painful condition for a person in most cases are neuropsychic shock or chronic stress. Depression can be accompanied by severe illness, sudden changes in life. nine0003

Treatment is based on the use of psychotherapeutic techniques. In some cases, it is supplemented by taking medications.


Depending on the form, the disease is associated with external or internal factors. The causes of psychogenic reactive depression can be severe experiences, an acute psychotraumatic situation. Often, a violation develops after the loss of a loved one, loss of a job, divorce, relocation, injury.

Positively colored events, for example, finally gained wealth or popularity, can also cause upset. In this case, mental deviations are explained by the realization of a dream with the subsequent loss of the meaning of life, provided there are no other goals.

Neurotic depression is a consequence of chronic stress. In this state, it is usually not possible to establish a specific cause of experiences. A person finds it difficult to name any specific psycho-traumatic circumstance, sees his life as a whole as a series of losses and disappointments. nine0003

Depression in men often develops with regular use of alcoholic beverages, psychoactive substances.

Other risk factors for affective disorder in patients of either sex are:

  • very high or extremely low financial status;
  • impressionability, suspiciousness, poor resistance to stress;
  • low self-esteem, a tendency to self-flagellation;
  • pessimistic outlook on life; nine0036
  • high psycho-emotional stress in professional activities;
  • difficult childhood, psychotraumatic situations suffered at a young age;
  • divorce of parents or loss of one of them, upbringing in an incomplete family, orphanage;
  • the presence of mental or neurotic disorders, addictions among relatives;
  • loneliness, lack of support in the family and social environment;
  • economic and political instability in the country; nine0036
  • physiologically determined changes in the hormonal background - the process of puberty, the postpartum period, menopause.

Endogenous depressions develop as a result of neurochemical abnormalities due to genetic mutation or aging of the body. This group of disorders includes involutional melancholia and senile depression. This form of pathology also occurs in manic-depressive psychosis, characterized by a change in the phases of mania, depression and mental stability. nine0003

The likelihood of depression in women is higher in the postpartum and menopause periods, when there is a change in the level of sex hormones, which is stressful for the body. In a young mother, neuropsychic disorders can occur with complicated childbirth, problems with breastfeeding or the health of the baby, and the appearance of excess weight.

Diseases of various organs can also be accompanied by depression. They are divided into the following groups:

  1. Pathologies of the cardiovascular system - myocardial infarction, hypertension, circulatory failure, heart rhythm disturbances. nine0036
  2. Brain damage due to stroke, neuroinfection or head trauma.
  3. Endocrine disorders - diabetes mellitus, hyper- or hypofunction of the thyroid gland.
  4. Violation of the digestive system - cirrhosis of the liver, colitis.
  5. Rheumatic diseases with prolonged pain syndrome - rheumatism, systemic lesions of the connective tissue, arthritis.
  6. Oncological processes, especially malignant neoplasms. nine0036


Depending on the severity and nature of manifestations, depression is of the following types:

  • major or clinical;
  • postpartum;
  • atypical;
  • recurrent;
  • small;
  • dysthymia.

Latent or "masked" depression is characterized by the absence of signs of neuropsychiatric disorders and symptoms characteristic of somatic diseases. The following options are distinguished:

  • cardiology;
  • abdominal;
  • dermal.

Caused by an acute psycho-traumatic situation, reactive psychogenic depression proceeds in several stages:

  1. Denial. The psyche makes an attempt to isolate itself from the ongoing negative events, the patient stubbornly does not believe in what happened.
  2. Anger. Anger arises from a sense of injustice, and the search for the guilty begins.
  3. nine0035 Trade. A person tries to negotiate in order to avoid consequences. This indicates active attempts to find a way out of the situation.
  4. Depression. There is a feeling of loss of control over what is happening, a feeling of powerlessness and the impossibility of correcting anything. This is accompanied by a depressed mood, apathy, laziness, sadness, pessimistic judgments.
  5. Acceptance. After a real assessment of the situation and the prospects that have opened up, a person resigns himself to his fate and mentally prepares for the consequences. nine0036


The main manifestations of the disease are united under the name "depressive triad" and include:

  • a persistent decrease in mood, despair, melancholy, a sense of hopelessness for several weeks and even months;
  • slowing down of thinking, problems with memorizing and analyzing information, fixation on one's own experiences;
  • decreased motor activity, slowness, lethargy, prolonged stay in the same position. nine0036

The patient ceases to enjoy activities that previously brought positive emotions, becomes withdrawn and taciturn, can spend most of the day lying in bed or sitting, hunched over, bowing his head and resting his elbows on his knees. Feelings of guilt appear, self-esteem falls, suicidal thoughts arise. Fatigue is characteristic, the solution of simple everyday tasks requires great effort.

In some cases, depression may present with the following symptoms:

  • nocturnal insomnia, often associated with drowsiness during the day;
  • decreased appetite and weight loss;
  • increased heart rate;
  • constipation;
  • dilated pupils;
  • loss of sexual desire;
  • menstrual disorders;
  • intense pain in different parts of the body without objective causes;
  • aggressive behavior, attacks and accusations against other people; nine0036
  • dryness and flabbiness of the skin, the appearance of wrinkles;
  • increased hair loss, brittle nails.

With endogenous depression, the intensity of symptoms peaks in the morning, gradually weakening during the day, and the manifestations of psychogenic affective disorders increase in the evening. A feature of postnatal depression is a decrease in the mother's interest in the child, irritation from the need to take care of him.

Clinical depression is severe, including all of the triad and many additional symptoms. The small form is characterized by only a couple of signs of the disease that persist for two or more weeks. The atypical variant proceeds with increased appetite, drowsiness, emotional arousal, and anxiety. nine0003

Recurrent depression is characterized by a short duration of several days with a monthly recurrence. Seasonal affective disorder is associated with the change of seasons, the symptoms begin and end at about the same time interval. With dysthymia, the mood is steadily reduced for several years, but negative emotions and experiences do not reach the intensity characteristic of clinical depression.


The greatest danger is suicidal thoughts arising from the disease. They can provoke appropriate actions and lead to tragic consequences. With postpartum depression, a woman can harm not only herself, but also the child. In order to alleviate symptoms, the patient may resort to taking alcohol, drugs. nine0003


With somatogenic or latent forms of the disease, a person can seek help from a general practitioner, cardiologist, neurologist, gastroenterologist and other doctors. In the case of psychogenic affective disorder, self-referral to a psychologist is possible. It is important that these specialists promptly refer the patient to a psychotherapist who diagnoses depression. It detects the disease by questioning the patient, during which complaints and symptoms are clarified, possible causative factors. Based on the data received, the doctor will tell you how to get out of depression as soon as possible and draw up a treatment plan. nine0003

Special tests for depression are carried out to determine the severity of the process. They include standardized tasks designed and tested by experts. Thus, personal needs, character traits, emotional responses, intelligence levels, anxiety and stress are studied. The Beck Depression Scale with a test questionnaire is often used to identify and assess symptoms of the disease.


With a mild course of the disease, it is possible to undergo only a course of psychotherapy without the use of medications. Additionally, massage, hydrotherapy and exercise therapy may be recommended. Moderate and severe affective disorders also require medication. nine0003

The essence of drug therapy for depression is to take drugs that affect the production of biologically active substances that cause the transmission of a neurochemical impulse through the neurons of the limbic system of the brain. For this purpose, antidepressants are used. A large clinical form of the disease, as a rule, requires hospitalization. According to indications for severe depression, pills for insomnia and anxiety are also prescribed - sedatives, tranquilizers.

Psychogenic reactive disorders are successfully treated, and soon after the onset of the disease comes the way out of depression. The clinical picture of the somatogenic form of the disease depends on the severity of the organic pathology. Endogenous disorders are not amenable to psychotherapy, but medication can often achieve long-term remission. Neurotic depression is prone to a long, chronic course. nine0003

The author of the article:

Ivanova Natalya Vladimirovna


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