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What is Hidden Depression?

Author
Kris Mamuad

Content Warning: This blog contains information about suicide and suicidal ideation.

As we mark National Suicide Prevention Month this September, I’ve been thinking about the death of Stephen Boss, known to the world as tWitch. Last December, news broke that the beloved, always-smiling hip-hop dancer and Ellen DeGeneres Show DJ had taken his own life. This left many people confused and wondering: How could someone who seemed so happy take his own life?

There’s so much weight and emphasis on the word happy. ​​Happiness is a feeling, and feelings come and go. For some people, happiness may become an unhealthy coping mechanism used to mask their true feelings. They may look happy on the outside but really be struggling on the inside. The reality is that depression isn’t a one-dimensional condition.

What is Hidden Depression?

Hidden depression, which is conceptually related to "high-functioning depression", can manifest quietly, with people maintaining a seemingly normal exterior while knowingly or unknowingly dealing with depressive symptoms impacting their mental health. This affects people across all walks of life, from successful professionals to students and parents, who may appear to manage their daily responsibilities well despite their internal pain.

People often mask their depression for various reasons: fear of stigma or judgment, concern about impacts on their career or relationships, a desire to avoid burdening loved ones, or cultural expectations about mental health. Some may also have difficulty acknowledging their own depression, perhaps viewing their struggles as a personal weakness or believing they don't have the "right" to feel depressed when others may have more visible hardships. Recognizing hidden depression can be challenging precisely because those affected may become skilled at maintaining a facade of normalcy, even as they experience persistent feelings of emptiness, exhaustion, or hopelessness.

Depression Isn’t One-Dimensional

You often see depictions of what depression can look like: withdrawal from the world, constant feelings of sadness and worthlessness, outward irritability, and lack of motivation – but depression doesn’t look the same for everyone.

Some people cope with their internal feelings by showing a different side of themselves externally. This may look like an elevated mood, brushing off or minimizing their feelings, or not talking about their feelings openly. Sometimes known as “hidden depression” or “smiling depression,” a person may conceal symptoms of depression out of fear, shame, or distrust. I have worked with clients who struggled to express their real feelings because they didn’t want to burden loved ones — or felt someone else was worse off than them. Others created a “new normal” by increasing their threshold for distress, leading them to minimize their symptoms and mood.

Signs of Hidden Depression

It’s important to know some of the less common signs of depression. Below are some things to pay attention to in a loved one who may be masking their feelings and struggling with hidden depression struggles. They don’t necessarily indicate that someone is suicidal, but are potential signs that they could be suffering from hidden depression.

Emotional Responsiveness

Are their emotional responses matching their life situation?

For example, if your loved one has recently lost their job, are they emotionally responding to what is happening? Sometimes people will experience a life event like the loss of a job and want to pretend that everything is okay, but the loss of a job can take a massive toll on someone’s mental health and that lack of response can indicate a larger issue like hidden depression.

Ensuring your loved one is responding to what is happening in their life is critical. While their response may be different than your own, their acknowledgement of life events is important in order to process their emotions and grow.

Shifts in Routines and Behaviors

A shift in someone’s usual routine or behaviors can be a signal that they are dealing with hidden depression.

  • Changes in social behaviors, such as being repeatedly late when they usually are on time, canceling plans last minute, being slower to respond to messages, making excuses not to participate in social gatherings, or not enjoying activities that usually bring them joy.

  • Shifts in their appetite, such as overeating, lacking appetite, or sudden, unexplained weight loss or gain.

  • Difference in sleep patterns, such as waking up in the middle of the night, struggling to go back to sleep, having a hard time falling asleep at night, or sleeping in more than usual.

Brain Fog and Mental Blocks

Another symptom of hidden depression that we may not always think of is brain fog. It can present in a variety of ways: inability to focus on tasks, slower reactions, forgetfulness, and feelings of being mentally blocked. My clients have described days when they were unable to complete basic tasks, focused only on day-to-day “surviving.” Some couldn’t recall their mood from earlier in the week.

Writing is one proven way to slow down the production and repetitiveness of thoughts, allowing our mind to better organize and recall them. Clients have reported that journaling and meditation helped them increase their ability to focus, complete tasks, and remember their thoughts and feelings.

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How to Speak to a Loved One About Hidden Depression Signs

If you’ve noticed changes in your loved one’s behavior or routine, or if you’re becoming concerned about them, it’s a good idea to talk to them about it.

Opening Up the Conversation About Hidden Depression with a Loved One

Talking about depression and suicide can feel scary, but bringing it up can also provide a sense of relief. It’s a dangerous myth that talking about suicide will make someone suicidal; research consistently shows that is not true. It’s by opening up these conversations that we can work together to restore a better quality of life.

Really Check-In About Their Depression Signs/Symptoms

When talking to a loved one about suicide or their mental health in general, you might feel at a loss for what to say. It is important to provide a safe space to check-in, genuinely asking how someone is doing.

We often ask questions like, “How are you?” as small talk or a general greeting, rather than as a space to let someone share their thoughts and feelings. Instead of asking this out of politeness or habit, inquire in a way that creates space and shows that you genuinely want to know how the other person is doing. Consider using questions and phrases like:

  • How have you been feeling lately?
  • What's been on your mind recently?
  • How are you coping with everything going on in your life?
  • What are you feeling excited about these days?

It’s especially important to make this kind of space for your friends and loved ones who seem happy and strong, as they can sometimes be the most in need of a friendly, listening ear.

Actively Listen

Eliminate distractions such as checking your phone or having background noise. Note that you are there to listen, validate, and offer support as needed. Most times you don’t need to solve anything or provide solutions, but rather be present and non-judgmental.

Mere presence and undivided attention can help your loved one to be seen, felt, and heard as it is difficult for someone with hidden depression to really express their feelings. Validation and empathy can make a big difference, and by simply asking questions, we can make someone feel seen, heard, and supported.

Ensure You Have the Capacity

Be mindful that you also have the space to lend an ear and provide connection. Often we just jump into conversations when we don’t necessarily have the bandwidth to be fully checked-in.

It may seem contradictory to associate happiness with suicide but that’s because depictions of depression are often inaccurate. People who struggle with suicidal thoughts can still exude positivity and bring joy to those around them. We shouldn’t let this facade of happiness prevent us from going a layer deeper with our loved one and seeing the pain and struggles they may be facing internally with hidden depression.

How to Get Help If You Are Experiencing Hidden Depression

If you believe a loved one is struggling with depression, having them speak with someone trusted or working with a therapist is a great place to begin.

If you or someone you know is in crisis, here are resources for 24/7, free and confidential support, suicide prevention resources, and education around mental health illnesses.

Suicide & Crisis Lifeline

The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.

Call 988

The Trevor Project

The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people under 25.

Call 1-866-488-7386

Veterans Crisis Hotline

Connect with the Veterans Crisis Line to reach caring, qualified responders with the Department of Veterans Affairs. Many of them are Veterans themselves.

Call 800-273-8255 and press 1

Crisis Text Line

Text from anywhere in the USA to text with a trained Crisis Counselor. Every texter is connected with a Crisis Counselor, a real-life human being trained to bring texters from a hot moment to a cool calm through active listening and collaborative problem solving.

Text TALK to 741741 to text with a trained crisis counselor.

Full List of Suicide Prevention Resources provided by American Foundation for Suicide Prevention

Find resources for suicide prevention for your or someone you know.

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