When most people try to picture a depressed person, they typically imagine someone who’s visibly sad — perhaps someone who cries a lot or has angry outbursts. But not everyone who’s depressed looks the part. Many people with depression appear to be thriving and highly productive. They might even look happy. But unbeknownst to the casual observer, these people are suffering from depression symptoms in private, such as deep sadness, low self-esteem, and loss of interest in things that were once important to them. This is what some people call “smiling depression“.

Now, “smiling depression” isn’t a clinical diagnosis, but it’s a very real problem. Left undiagnosed and untreated, depression symptoms can get worse, making them harder to treat. These symptoms could affect the person’s relationships, health, and quality of life. However, many people with smiling depression choose to hide their condition. Here’s why.

1. They’re in denial

One common misconception is that depressed people are unable to smile and laugh. And so some people with depression tell themselves that they’re perfectly fine, even when they’re not.

Some also find it hard to be vulnerable and open up about what they’re going through. They could even find it easier to pretend like everything’s fine than admit that they’re having mental health issues.

2. They’re afraid of treatment

Fear or distrust of medical professionals can make it hard for some people to look for professional help. They may be concerned about taking antidepressants and other medications. But although antidepressants can be helpful for some people, not everyone with depression is prescribed medication. For many, psychotherapy and changes to thinking patterns, sleep habits, diet, and exercise are effective treatments.

3. They’re don’t think they have the right to be depressed

Many people with depression experience a lot of guilt. Why? They may think that they shouldn’t be depressed because their life is good. Others have it worse, so why should they feel bad?

They could also feel that they did something wrong or they’re to blame for their depression. This leads them to feelings of guilt and shame, so they end up masking their depression.

4. They’re afraid of backlash

People hiding their depression could be doing so because they’re worried about how their mental health issues could affect their personal and professional lives. Someone could worry that they would be judged, ridiculed, or even abandoned by loved ones.

Others don’t disclose their depression symptoms because they fear that doing so would affect their chances of getting hired or stunt their career growth. (According to the Department of Labor and Employment’s Guidelines for the Implementation of Mental Health Workplace Policies and Programs in the Private Sector, employers are not allowed to discriminate against hiring and promoting workers with mental health issues, provided that they are able to perform at their job.)

5. They don’t want to appear weak

People who have taken painstaking measures to cultivate an image of strength and togetherness may find it difficult to admit to depression. They could fear that others would see this as a form of weakness, and that they’d be taken advantage of, so instead, they choose to put on a tough front.

There are also people with perfectionist tendencies who find it easier to pretend that they’re alright rather than admitting that their lives aren’t as perfect as it seems — even if it means compromising their mental health.

6. They think people won’t understand

Even though more and more people are talking about mental health, some people still believe that people won’t understand. They may think that they’re the only ones feeling the way that they do, and this isolation could cause them to brush their emotions under the rug.

7. They don’t want to be a burden

Many people with depression don’t want to burden others with their problems. This is most often the case for individuals who are more accustomed to taking care of others instead of having others take care of them. They’re not used to asking for help, so they decide to keep their struggles to themselves.

8. They don’t know they’re depressed

Some people don’t consciously hide their depression, but don’t recognize their symptoms and just how much depression is affecting them. This is especially true for people whose symptoms slowly increase over time.

What are the risks of hiding depression? How can you help?

Studies have found that the longer depression remains undiagnosed and untreated, the more severe symptoms can become and the harder they are to treat. Untreated depression can also increase the risk of suicide, as well as illnesses like cardiovascular disease, stroke, diabetes, osteoporosis, and dementia.

So what are the signs of depression that we should watch out for?

People with smiling depression may experience the better-known symptoms of depression, such as:

• deep, prolonged sadness
• angry outbursts
• feelings of hopelessness, lack of self-esteem, and low self-worth
• frequent thoughts of death, self-harm, and suicide
• anxiety and restlessness
• changes in sleep and appetite

But because many people with smiling depression mask their symptoms, recognizing the problem is trickier. Loved ones should look out for less obvious signs, such as changes in habits, fatigue, and a loss of interest in activities that they once enjoyed.

If you think a loved one has smiling depression, share your concerns. Tell them that their feelings are valid and offer emotional and practical support. Let them know that they can manage their depression and direct them to mental health services that could help. With the right treatment, they can restore or even improve their quality of life.

Here are some resources to help you get started: