When the topic of depression comes up, the picture that comes to mind is that of a weary soul laid down on the couch all day, tired and weak from doing nothing, overthinking, sorrowful, pessimistic and dispirited. But many people are not aware of another kind of depression that is gayly clothed. The kind of depression where nothing seems to be wrong with an individual externally while he or she is dying internally. This kind of depression is commonly known as smiling depression. It is also called high-functioning or hidden depression.
Contrary to the traditional or major depression well-known, smiling depression, as the name implies, puts on a facade that hinders correct diagnosis of the mental condition of an individual suffering from it. An individual suffering from smiling depression appears to be fine and successful, shows up at work and perform well, goes for social events and appears happy, whereas the opposite is true when they are alone. This hidden nature of smiling depression makes it even more difficult to treat.
In a recent interview on smiling depression, Mr. Anthony Ogbebor, a neuropsychiatric nurse, trained medical sociologist and head of Health Education and Drug Abuse Prevention (HEDAP) unit at neuropsychiatry hospital, Aro, Abeokuta, Ogun state, described smiling depression as an oxymoron- a case of having two different opposing experiences at the same time.
Meaning and Prevalence
Mr. Anthony Ogbebor described smiling depression as “a form of depression in which the sufferer appears to be happy, healthy and thriving on the outside, but suffering on the inside”. The depressed individual has a way of masking their depression behind a smile. Although smiling depression is not a clinical diagnosis, it is a term commonly used to describe a masked form of depression.
According to World Health Organization (WHO), an estimated 3.9% of the world population, approximately 280 million people in the world suffer from depression. An estimated 29.9 million cases of depression are recorded in Africa, with 7 million cases from Nigeria. Due to the fact that smiling depression is not a clinical diagnosis, Mr. Ogbebor stated that an estimated 15-40% of depressive disorder cases in Nigeria is smiling depression.
Symptoms of Smiling Depression
Like any other types of depression, the symptoms of smiling depression include:
- Loss of appetite which results in weight loss or increase in appetite that leads to weight gain
- Loss of interest in activities that seemed pleasurable in times past
- Feelings of guilt
- Loneliness
- Unworthiness and intrusive thoughts
Individuals suffering from smiling depression do their best to hide it from families, loved ones and coworkers for varying reasons which include: fear of rejection or being perceived as weak, perfectionism- individuals who are perfectionists don’t want to believe they are suffering from depression, fear of being stigmatized, thoughts of being a burden amongst other factors. All these factors make high-functioning depression a time bomb waiting to explode.
Risk Factors
A risk factor of smiling depression is that it is highly suicidal. People suffering from traditional depression are too weak and unmotivated to carry out the very act of depression even if the thoughts cross their mind, but since people with smiling depression are highly active, they can actually go ahead and commit suicide and this always comes as a shock to their loved ones who were not fully aware that they were passing through a period of darkness.
Contrary to the commonly known type of depression, smiling depression is dangerous, owing to the activeness of the sufferer. In the case of a student, he may be performing excellently academically, but may be depressed. His hidden condition may cause him to commit suicide without close associates being aware of his battle with depression.
Mr. Ogbebor spoke of the danger of smiling depression as sufferers of this mental condition find it hard to open up to loved ones or close associates. This increases the risk of them being suicidal. He further described smiling depression as a case of “smiling and suffering”. A common terminology used by Nigerians to describe a scenario whereby a person is passing through inner struggles while still putting up a strong demeanor.
The media is full of stories of individuals, especially celebrities, who suddenly commit suicide. They appear fine and glamourous outwardly, but in reality they are suffering from internal pain turmoil and anguish. These individuals are torn between meeting others’ expectations and seeking true joy. When the pressure builds up well enough, they break down under the burden of suicidal thoughts and bid the world farewell.
In regard to smiling depression being highly suicidal, Mr. Ogbebor shared the story of Cheslie Kryst, a former Miss USA beauty pageant winner, who jumped to her death from her apartment building in Midtown Manhattan, New York City, United States. Miss Kryst, who was crowned Miss USA in 2019, was also an attorney and a correspondent for the TV show Extra. Until after her death, close associates and loved ones, except for her mother, April Simpkins, didn’t know she battled depression and anxiety.
Ogbebor further made a noteworthy comment that smiling depression is mostly common among teenagers. This, he explained, is as a result of them being unable to handle pressures and life challenges at a very young age. They experience negative peer pressure, academic challenges, broken homes, identity crisis. They find it hard to express what they are going through to parents and guardians. They result to using hard drugs to cope with pressures. This can have long lasting negative effects on their mental health.
Another risk factor is that when sufferers open up about their condition, people don’t tend to believe them. The image they portray is that of a happy, successful and perfect person. This leaves no room for doubt that something might be actually wrong with them. It also a mental condition that is not clinically well-known and many other factors come into play when diagnosing smiling depression.
With the ubiquitousness of social media, high-functioning depression hides deeper below the surface of the sufferer’s personality. A lot of social media users make posts that depict their life as ideal, happy and perfect even when their lives are perfectly imperfect. This false portrayal on social media makes people with smiling depression think their lives are miserable when in reality, nobody has it all figured out.
Due to smiling depression not being a clinical diagnosis and a not well known mental health challenge, it is crucial for mental health practioners to create greater awareness. Mr. Ogbebor stated that smiling depression is not a well discussed topic among mental health practioners. He gave some of the ways through which awareness could be created. He emphasized the role of the media , both the new media (social media) and the traditional media (newspapers, radio and television), in ensuring people have the knowledge of smiling depression as a mental health issue.
He also mentioned the role of the community in collaboration with mental health experts. Experts can organize campaigns in communities to raise the awareness level. Churches, mosques and other religious organizations can as well organize mental health seminars for youths, so they could be aware of this condition.
How Sufferers Can Be Helped
How can individuals with smiling depression be helped?
It is essential to be sensitive enough, although not intrusive, to notice some subtle signs in people with smiling depression such as; drastic weight loss or gain, avoidance of public or social events with no convincing reasons, feelings of guilt for negative consequences they are not responsible for and seeing themselves as a burden.
Having recognized these symptoms, it is pertinent to get them to acknowledge their need for help and support from family, friends and treatment from mental health practioners like psychiatrists and therapists. Similar to other types of depression, medications like anti-depressants are used to treat a patient with smiling depression. Psychotherapy is one of the major ways to improve smiling depression. Stress management is also an important aspect of the treatment process. Nutrition and exercise are crucial to the overall recovery.
Electroconvulsive therapy (ECT) is a psychiatric procedure that uses a mild electrical current to create a seizure, with the goal of treating severe depression that has not responded to other treatments. This procedure is done while the patient is under general anesthesia.
However, this technology is not without side effects, which include, headache, temporary memory loss and nausea.
Smiling depression is not a death sentence. Families and loved ones of sufferers are not to be judgmental, rather, they should be supportive and understanding. The care and concern shown to sufferers help them go through the treatment process and recover fairly well.
