Chances are, someone you love is experiencing symptoms of depression — even if they don’t show it.

The World Health Organization (WHO) estimates that more than 264 million people have depression worldwide.

Hidden depression, also called “smiling depression” or “concealed depression,” is when someone works hard to conceal their symptoms and show the world that they’re A-OK. They may appear to be high functioning at work and in social situations, but behind closed doors they live with the classic symptoms of depression.

Some may hide their symptoms because they don’t want their loved ones to worry. Others may feel too embarrassed to ask for help or struggle with perfectionism. Some may also feel guilty or ashamed for struggling to begin with, which are both common emotions that go hand-in-hand with depression, according to research.

By getting familiar with the hidden signs of depression, you’ll be prepared to support your loved ones and help them seek additional resources.

Is your friend or family member talking about how tired they are lately or how they have no energy? Do they have bags under their eyes or show other signs of sleep disturbance?

Depression is known to interfere with restful sleep. Research shows that it can prevent people from falling asleep, staying asleep, or getting out of bed in the morning. It’s common for people with depression to sleep less — or even more — than usual.

Research shows that depression may cause a change in appetite, due in part to an influx of the stress hormone cortisol in the system. Some people may have less of a desire to eat, since food no longer tastes good, or they aren’t craving anything in particular.

For others, depression can manifest as craving foods that release feel-good neurotransmitters.

A meal high in sugar will nudge the brain to produce serotonin, also known as the “happiness hormone.” In the moment, it produces a pleasant sensation, but research now suggests that high-sugar diets could make overall depression worse, leading to a tricky cycle.

These dietary changes can all contribute to weight loss, weight gain, or fluctuations between the two. If you notice a sudden change in someone’s overall body composition, keep an eye out for additional symptoms of hidden depression.

Various research studies, including a 2020 review called “Low-hanging fruit for getting back on your feet,” have found that a diet that contains more fruit, vegetables, fatty fish, and whole grains — along with fewer sweets, processed foods, and fried foods — can help with depression.

Drinking alcohol triggers the release of endorphins, a natural stress and pain reliever. This neurotransmitter is responsible for the same lift in mood we feel while exercising, having sex, or enjoying a good laugh with friends.

Hitting the bar for happy hour is a socially acceptable way to cope with stress, which makes underlying depression more difficult to spot.

A common sign of hidden depression is that someone may turn to drinking more often or increasing the amount of alcohol they consume in one sitting.

In fact, studies suggest that alcohol use disorder is one of the most common co-occurring conditions alongside depression, more often impacting women than men.

In some cases, the bigger the smile, the bigger the depression it hides. “Toxic positivity” is a buzzword as of late — and for good reason. An overly positive attitude, a perfectly manicured highlight reel on Instagram, or appearing cheerful in public may be a mask to cover up what’s really going on.

If someone dismisses their own sadness or changes the subject, it could mean that they’re uncomfortable expressing how they truly feel or they’re in denial about their experience.

Listen for something that sounds like, “Yeah, I’ve been really down lately … but it’s okay, I’m fine. Really. How are you doing?”

If you suspect a friend or family member has hidden depression, spend more time with them. It’s difficult to hold up the mask of happiness all the time, and eventually little glimpses of their real feelings will poke through.

Research shows that people with depression use more “I,” “me,” and self-focused words because they are in an introspective state most of the time. In addition, they use what are called “absolutist” terms, like “always” and “never,” without a lot of gray area.

Depression also has a way of distorting thought patterns, which can lead to a different worldview. Findings indicate that those with depression have a more negative outlook. Listen for phrases with an air of pessimism, like “I can’t” or “I should.” You could also hear misplaced guilt, like “it’s all my fault.”

Someone you love may hint at suicide or bring up philosophical topics about the meaning of life, what it feels like to die, or the afterlife.

Those with hidden depression may struggle with a “vulnerability hangover.” That is, sharing about what’s really going on, only to later feel awkward, guilty, shameful, or generally unpleasant about letting someone get so close.

They may reveal dark thoughts and even call a therapist, only to back out of an appointment at the last minute and say, “Nevermind, I’m fine.”

You might notice “oversharing” on social media, which is sharing posts that contain lots of personal information. They might show a pattern of sharing personal details online, then deleting the posts soon after.

This could be for any number of reasons, from not wanting to be a burden on loved ones or growing up in a culture where feelings were swept under the rug.

In any case, it’s still a good idea to follow up with your loved one. Let them know that it’s okay to be vulnerable, and that you still love them — no matter what.

Depression is known to create sudden shifts in mood, including increased:

  • irritability
  • sadness
  • nervousness
  • tension
  • panic
  • grief
  • crying spells

Men are also more likely to experience irritability, aggression, and misplaced anger, while women carry feelings of sadness.

Someone with concealed depression may stray from their baseline of emotions. Maybe they’re normally a calm driver, but now they’re displaying road rage in traffic. Or perhaps you’ve never seen them cry at the movies, but now they’re getting teary-eyed at commercials.

It can swing in the other direction as well. Maybe your loved one normally laughs out loud at a funny show, but now they seem “flat” or uninterested. These are all mood changes associated with masked depression.

In 1979, scientists documented a peculiar phenomenon called “depressed realism.” Essentially, the theory is that those with depression have a more realistic view of the world, and their role in it, more than their non-depressed counterparts.

For someone with hidden depression, this may come out in conversation as a cynical comment about reality. You might hear something like, “It’s not like any of this matters anyway, so who cares?”

While it may be true to some degree, it’s also a deviation from the perspective of nondepressed individuals, who have “optimistic illusions.” This means that when they experience something bad, they deem it as impermanent or insignificant, or assign a positive meaning to it. In others words, this is the rose-colored glasses effect.

While more recent studies have supported this theory, additional research is still needed to reach a consensus in the psychology community. Until then, be aware that a sudden change in someone’s worldview could point to underlying depression.

If you believe that someone you love has hidden depression, you can help by offering emotional support and a safe place to talk about it. Share your observations in a nonjudgmental way and ask how you can be there for them.

Remember, depression can make small tasks feel impossible, so a little help can go a long way. For example, you may offer to take a morning walk with them, look online and help them find a therapist, or drive them to a nearby support group.

The SAMHSA National Helpline can be reached at 800-662-HELP. It’s a free, confidential, 24/7/365 information service for treatment and referrals.

The Suicide Prevention Hotline at 800-273-8255 can also help you or your loved one talk to a trained crisis worker, any time of the day or night.

TalkSpace and BetterHelp offer online therapy services, so you can work with someone from the comfort of your own home.

There are a number of great blogs and podcasts for depression support as well:

Through all of this, be sure to find support for yourself as well. After all, you can’t give from an empty cup. A therapist can help you navigate stress and point you to additional books, podcasts, forums, and resources. Remember, take it one day at a time.