Key Takeaways
Masked depression may be difficult for others to detect. People with this form of depression are often high-functioning and skilled at concealing its symptoms.
Otherwise known as masked, hidden, or smiling depression, masked depression can be mistaken for a physical ailment. Misdiagnosis delays care and may cause symptoms to worsen.
Masked depression is often manageable through a combination of self-care, therapy, and medication.
Some signs of depression are easier to spot than others. For example, a person may seem unusually tired, irritable, or unmotivated. They might sleep more than usual, stop hanging out with friends, or face challenges with self-care. But other symptoms of depression may be harder to detect.
People can have an atypical form of depression known as masked depression or high-functioning depression. With this type of depression, a person might seem like they’re doing fine. To others, they may appear happy, successful, and driven. This is because people with masked depression are often very skilled at concealing their symptoms. Their difficulties might be undetectable to others — even when they’re experiencing challenges on the inside. Learning more about this form of depression can help you recognize it in yourself and others and know when to reach out for help.
Subtle signs of masked depression
The signs of masked depression might be undetectable to outside observers. But that doesn’t mean it’s any less difficult to live with. In addition to typical depressive symptoms like sleep disturbances and forgetfulness, people who mask their depression may be more vulnerable [1] to:
Chronic pain, gastrointestinal problems, and other physical complaints
Difficulty with focus and concentration
For example: Lately, you can’t seem to finish a task without getting sidetracked. Your long to-do list is stressing you out, and it’s becoming harder to concentrate at work. Despite being considered a “top performer,” your masked depression is impacting your ability to focus.
Sexual dysfunction, including loss of libido
For example: You and your wife have a great relationship. Like most couples, you’ve had your ups and downs, but you’ve always maintained a strong connection. However, over the past few months, you’ve lost interest in intimacy, and you’re not sure why. You learn that it’s depression, not a relationship issue, that’s affecting your libido.
Why people smile through depression
There are many reasons why someone may smile through their depression. But some of the most common include:
Stigma: People might believe they’ll be judged or appear weak if they acknowledge how they’re really feeling.
Caregiving: They might feel that they can’t slow down or prioritize their well-being because others are counting on them.
Culture: Someone might be part of a culture that doesn’t acknowledge the impact or existence of mental health concerns like depression.
Awareness: They might not be aware that they’re experiencing depression because they’re still functioning, often at a high level.
The problem with hidden depression
One of the biggest consequences of masking or smiling depression is that it prevents people from getting the help they need. Acknowledging your challenges is one of the most important (and difficult) parts of healing. But when depression is hidden or concealed, a person may continue to face challenges in silence.
In the case of masked depression, symptoms might not surface in the usual way. Unfortunately, this means that it often goes undiagnosed and may be mistaken for a physical ailment [2], leading to:
Serious physical and psychological consequences
Reduced professional and social functioning
Higher cost of diagnosis and treatment
Increased risk of suicide*
*If you or a loved one is experiencing suicidal thoughts or thoughts about harming themself or others, please call or text 988 on any phone for the Suicide & Crisis lifeline, contact a local crisis line, or head to the emergency room immediately. Any of these resources will ensure that the person in crisis receives support right away. For more information on getting help, go to 988lifeline.org
If experiencing a life-threatening emergency or you need immediate help, please call 911.
How to stop masking depression
No matter what form of depression you’re living with, know that you’re not alone and help is available. There are therapists and psychiatrists who can help you understand your masked depression and provide a safe space to process your experiences.Your healthcare providers can recommend evidence-based therapies [3] for depression along with medication, if needed. With their support, you can learn to authentically express your emotions so that you no longer feel pressured to “smile through the pain.”
In addition to seeking professional help, there are strategies you can use to manage masked depression. You may need to go through some trial and error to find what works for you. But here are a few ideas [4] to get you started:
Challenge your perfectionist tendencies. Some people who experience masked depression may feel like they can’t make mistakes or appear weak or out of control. If that rings true for you, consider where those messages are coming from. Try to cultivate a little compassion for yourself and remember that no one is perfect.
Lean on your support network. If you live with masked depression, you might be tempted to withdraw from friends and loved ones. You may worry about what others will think if they learn how much you’re having difficulties. However, isolation can make depression worse [5]. So try to spend time with people you trust, and talk to them about how you’re doing.
Practice mindfulness. Mindfulness is about slowing down to notice, without judgment, what’s happening in your mind, body, and environment. You can practice mindfulness by finding activities that bring you joy and being fully present while you’re doing them. This experience can provide a powerful mindset shift and help remind you that you’re worthy, capable, and lovable.
Clinician's take
A common sign of masked depression is irritability or getting frustrated very easily. Many people don’t realize that anger and short tempers can be depression in disguise — not just a bad mood. Professional support can help you work through these feelings.
Find care with Rula
Masked depression is a form of depression in which someone conceals or hides their symptoms. Deep down, they might be dealing with low mood, fatigue, hopelessness, sleep problems, and other classic depressive symptoms. But to outsiders, it might seem like nothing is wrong. People with masked depression tend to “smile through the pain” due to stigma, perfectionism, and other pressures.
Masked depression can make it difficult to reach out and ask for help. Fortunately, it’s typically manageable with the right support. Healing may involve a combination of therapy and medication (if needed). But self-care strategies like leaning on your support network, practicing mindfulness, and challenging perfectionism can also help.
At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best.
Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 21,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.
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Rula's editorial team is on a mission to make science-backed mental health insights accessible and practical for every person seeking to better understand or improve mental wellness.
Members of Rula’s clinical leadership team and other expert providers contribute to all published content, offering guidance on themes and insights based on their firsthand experience in the field. Every piece of content is thoroughly reviewed by a clinician before publishing.
