It is estimated that around 15  million Americans suffer from depression each year, but there may be more. A less commonly considered type of depression may be more prevalent than we’d like to admit – smiling depression.

What is Smiling Depression?

Smiling depression is when a facade of happiness is used to mask a deep underlying sadness, hopelessness, or unhappiness. These are often people who maintain an external personality of togetherness, success, and friendliness. They are often “type A” personality, who feel an almost visceral need for control, though the control they seek never seems to give them the sense of comfort, calmness, or stability they are really searching for. Smiling depression is a very real experience, though most people who fit this picture shy away from asking for help. The stress of maintaining an external image of “togetherness” may also help cover up feelings of hopelessness.

Self-image and Self-worth

The underlying belief in individuals suffering from smiling depression is that they “are not good enough.” A self-image of emptiness, emotional numbness, and unmet expectations are extremely common. Traditional symptoms of depression such as a lack of interest in pleasurable activities, weight loss/gain, sleep changes, fatigue, worry, guilt, loss of focus, and thoughts about death and dying all may occur at varying levels with smiling depression.

Therapy Couldn’t Hurt

It may be hard someone with smiling depression to admit that therapy could be of benefit, or even talk to friends and family about what they are going through. But if thoughts of death and dying, or a preoccupation with suicide is prevalent, counseling is certainly warranted. Learning to recognize and build awareness strategies could be very beneficial to these individuals.

Acknowledging the Existence

Acknowledging that the existence of this experience and manifestation of depression is important for friends and family being able to help. We all know individuals who are very successful, seemingly happy, and smile about everything. It’s important not to assume that just because someone is smiling that they are genuinely happy. A lack of relaxation activities, social time, and talk about pleasurable activities could all be signs that someone is missing something in their life. Talking with a therapist may be vitally crucial to that person enjoying life again.


Node Smith, associate editor for NDNR, is a fifth year naturopathic medical student at NUNM, where he has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine amongst the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend campout where naturopathic medicine and medical philosophy are experienced in nature. Three years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.

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