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Smiling Depression: An Overview


teens smiling but actually depressed

When hearing the word depression, it intended to describe symptoms that typically present with clinical depression. Clinical depression is a mental health disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). An individual who suffers from clinical depression has a chemical imbalance in his or her brain, resulting in an inability to “bounce back” as quickly as others do when experiencing an emotional low. The World Health Organization (WHO) asserts that depression is “characterized by persistent sadness and a lack of interest or pleasure in previously rewarding or enjoyable activities,” resulting in significant impairment in one’s daily life. It is important to note that depression can manifest in many ways. Healthline explains that “smiling depression is a term for someone living with depression on the inside while appearing perfectly happy or content on the outside.” Smiling depression is not currently recognized as a standalone condition in the DSM-5 but could be diagnosed as major depressive disorder with atypical features

Signs and Symptoms

Teenagers that struggle with smiling depression will have varied symptoms and will be affected differently. Some examples of symptoms that could manifest in a young person struggling with smiling depression may include, but are not limited to the following, provided by Medical News Today:

  • Low self-esteem
  • Irritable
  • Crying spells
  • Feelings of sadness
  • Difficulty concentrating 
  • Changes in appetite
  • Loss of energy
  • Overly self-critical 
  • Loss of interest in previously enjoyed pastimes
  • Weight fluctuations
  • Difficulty sleeping

A young person with smiling depression will internally experience the above examples but will appear symptom free in public. While silently suffering, teenagers with smiling depression often hide behind a façade of inauthentic optimism and cheerfulness, and are typically viewed by others as active, high-functioning, successful individuals. 


Teenagers with smiling depression often appear perfectly healthy to others but are likely internally suffering from many of the same symptoms that accompany a diagnosable depressive disorder. Nowadays, there are countless treatment options available to help a teenager learn effective symptom management strategies and healthy coping mechanisms to navigate depression. Treatment plans for smiling depression often include psychotherapy and/ or medication. Each teenager is different and will respond distinctly to the varied treatment approaches available. Treatment plans for smiling depression could include a variety of therapeutic modalities such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), creative arts therapies, group therapy, family therapy and more. The symptoms of smiling depression can lessen with proper mental health treatment. In most cases integrating a combination of both psychotherapy and medication into one’s treatment plan yields the most successful long-term results.

For Information and Support

Seeking help is never easy, but you are not alone! If you or someone you know needs mental health treatment, we strongly encourage you to reach out for help as quickly as possible. It is not uncommon for many mental health difficulties to impact a person for the long term. The earlier you seek support, the sooner you and your loved ones can return to happy, healthy, and fulfilling lives.

Our admissions team is available to answer any general questions regarding mental health issues, treatment, and/or specific questions about the program at Pacific Teen Treatment and how we might be able to help your family. We can be reached by phone 24/7 at 800-531-5769. You can also contact us via email at

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