Signs of Hiding Depression Struggles and How to Help

The public is often shocked and saddened by the tragic suicides of famous people who, despite seeming to be living a charmed life, were struggling deeply. Recent examples include Food Network star Anne Burrell (July 2025), Stephen "tWitch" Boss, DJ for The Ellen DeGeneres Show (December 2022), and world-renowned chef and TV personality Anthony Bourdain, who died just three days after fashion designer Kate Spade (both in June 2018).

Approximately one in five American adults experiences a diagnosable mental health condition annually,¹ reflecting the widespread impact of mental illness across the U.S. In 2024 and 2025, over 18% of American adults received treatment for depression.² The actual number may be much higher, however, because of people suffering from hidden depression, unbeknownst to those around them. 

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What is hidden depression?

Hidden depression is known by different names. The term “masked depression” was coined over 60 years ago to describe individuals who experience internal depression symptoms like sadness and hopelessness without outwardly displaying them. One of the earliest references to masked depression appeared in a 1958 paper titled “Masked depression in middle-aged men” by Dr. V. A. Kral, published in the Canadian Medical Association Journal in 1958.³ However, Spanish psychiatrist Dr. Juan José López Ibor is credited with formally defining and popularizing the concept. His pioneering research on masked depression resulted in a landmark paper, “Masked Depression,” published in the British Journal of Psychiatry in 1972.⁴

More recently, the term “smiling depression” has emerged to describe individuals who, by outward appearances, seem to have everything going for them: they are smart, successful, and they seem happy and fine. “High-functioning depression” is another term sometimes used to describe hidden depression.⁵ People with hidden depression don’t exhibit noticeable symptoms; they appear happy while concealing inner struggles,^5,6 which may include deep emotional pain, exhaustion and a growing sense that things will never improve.

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Why people hide depression

There are many reasons why people hide their depression, including not realizing they are suffering from it.⁵ Cultural and societal stigma surrounding mental health and mental illness can cause people to deny and neglect conditions such as depression.⁷ In a 2009 article published in BMC Public Health, Barney et al. explain that the stigma surrounding depression, whether real or perceived, can significantly impact those who suffer from it, leading them to avoid seeking help due to anticipated negative reactions.⁸ 

People are afraid to disclose their depression because they fear being negatively labelled or ostracized. Furthermore, they may be reluctant to take antidepressants or other medications or get counselling for fear of negative repercussions professionally and personally. They may also feel guilty or ashamed to ask for help or seek treatment.

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Signs of hidden depression 

Behavioral changes can signal hidden depression. These changes may include personality changes, such as becoming quieter and more pessimistic or engaging in darker, more philosophical conversations; sudden changes in appetite, leading to weight loss or gain; persistent fatigue, severe tiredness or insomnia; increased alcohol consumption or substance abuse; withdrawal from social activities, or conversely, a display of exuberance that seems contrived; and changes in work habits, such as increased time spent at work or a decline in performance.^6,9 

In some cases, individuals may also express subtle signs of hopelessness, including statements suggesting that nothing will change, that they feel like a burden, or that the future feels bleak. It is critical to understand that a smile and pleasant external demeanor can be defense mechanisms. In a Psychology Today article, Dr. Rita Labeaune writes, “With their mask on, everything looks great, even at times perfect. However, underneath the mask, they are suffering from sadness, panic attacks, low self-esteem, insomnia, and, in some cases, suicidal thoughts. . . . Suicide can be a particular threat for individuals suffering from smiling depression. . . . those suffering from smiling depression have the energetic ability to plan and follow through.”¹⁰

How to support someone who may be struggling

You can support a loved one, friend or colleague you suspect may be hiding their depression by listening without judgment, asking caring questions and suggesting exercise-related activities like walks or social gatherings.¹¹ Maintaining regular contact is crucial so the person experiencing depression doesn’t feel isolated.¹¹ You can also encourage them to consult a physician to determine if medication or TMS therapy may help.⁶

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Why early recognition matters 

The longer depression goes undiagnosed and untreated, the more its symptoms can worsen and become resistant to treatment.¹² Untreated depression also elevates the risk of suicide and increases the likelihood of developing illnesses such as diabetes, stroke, cardiovascular disease, osteoporosis and Alzheimer's disease.¹²

Hidden depression can be especially dangerous because the suffering often remains unseen. People may continue working, socializing, and caring for others while quietly losing hope that things can improve. This internal struggle can create profound isolation, even when someone appears surrounded by support. 

Recognizing the signs and reaching out with compassion can make a difference. Depression is a medical condition affecting the brain and is one of the most common mental health conditions worldwide. With the right care, many people experience real improvement and recovery.

If you or someone you know is struggling with depression, please reach out to Salma Health or contact your doctor. Salma Health offers convenient options to connect you with the care you need: schedule a 15-minute Care Options Call, connect directly with our care team, or complete a comprehensive online intake. We meet you where you are and build a personalized care plan to suit your individual needs. Schedule your first appointment today and experience a higher standard of brain care—grounded in science, clarity, and continuity.

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_References

_{1. Mental Health America. Quick mental health facts and statistics. https://mhanational.org/quick-facts/}

_{2. Witters D. U.S. Depression Rates Remain Historically High. Gallup, September 9, 2025. .https://news.gallup.com/poll/694199/u.s.-depression-rate-remains-historically-high.aspx}

_{3. Kral VA. Masked depression in middle aged men. Can Med Assoc J. 1958 Jul 1;79(1):1–5. PMCID: PMC1830108}

_{4. López Ibor JJ. Masked Depressions. The British Journal of Psychiatry. 1972;120(556):245–258. https://doi.org/10.1192/bjp.120.556.245}

_{5. Gunnerson T and Painter K. Smiling Depression: What You Need to Know. August 2, 2024. https://www.webmd.com/depression/smiling-depression-overview}

_{6. Stanborough RJ. How to Recognize and Help Someone with Hidden Depression. Healthline. May 13, 2021. https://www.healthline.com/health/depression/hidden-depression}

_{7. Ahad AA, Sanchez-Gonzalez M, Junquera P. Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review. Cureus. 2023 May 26;15(5):e39549. doi: 10.7759/cureus.39549} 

_{8. Barney LJ, Griffiths KM, Christensen H, Jorm AF. Exploring the nature of stigmatising beliefs about depression and help-seeking: Implications for reducing stigma. BMJ Public Health. 2009 Feb 20;9:61. doi: 10.1186/1471-2458-9-61}

_{9. MedicalNewsToday. Recognizing the hidden signs of depression. November 6, 2023. https://www.medicalnewstoday.com/articles/325513}

_{10. Labeaune R. The Secret Pain of "Smiling" Depression. Psychology Today. November 12, 2014. https://www.psychologytoday.com/us/blog/the-guest-room/201411/the-secret-pain-of-smiling-depression}

_{11. National Health Service. How to help someone with depression. Reviewed: 18 August 2022. https://www.nhs.uk/mental-health/advice-for-life-situations-and-events/how-to-help-someone-with-depression/#:~:text=Let%20them%20know%20you%20care,and%20doing%20things%20they%20enjoy.}

_{12. National Institute of Mental Health. Understanding the Link Between Chronic Disease and Depression. Revised. 2024. https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health#:~:text=Medication%20used%20to%20treat%20a,due%20to%20symptoms%20like%20fatigue}