Depression has many faces. Sometimes, it is a young woman who cries all day and can’t get out of bed. Other times, it is the boss who snaps and shouts at his employees. It can also be a mother who can’t connect with her newborn or an elderly gentleman who sits alone in the park.
It is also that friend who, on the outside, seems to have everything together and everything going for them, but beneath that exterior of confidence and success, they struggle with debilitating depression.
Approximately 5.9% of the population in the United States is living with some form of depression. Because depression can manifest in many ways, it is not always obvious that someone is struggling with it.¹
It may not even be evident to you that you are struggling with depression because how you feel doesn’t match what you might think depression should look like.
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Hidden depression is one of the terms used to describe depression that doesn’t have a typical set of symptoms. It is also referred to as “masked depression,” and the symptoms are usually somatic (relating to the body) rather than psychological (relating to the mind).²
However, it is essential to note that “hidden depression” is not an official diagnosis or a subtype of depression. People with the so-called “hidden depression” would generally be diagnosed with major depressive disorder (MDD) if their symptoms met the criteria for a clinical diagnosis.
So, why are we even talking about hidden depression?
We are talking about it because the term provides a helpful way to group and recognize symptoms that aren’t always associated with depression.
The symptom most commonly associated with depression is sadness, but it is not the only core symptom. To be diagnosed with a major depressive episode, you need to have at least one of the core symptoms and five of the recognized additional symptoms for at least two weeks.
The other core symptom is anhedonia, which is the loss of interest or pleasure in previously meaningful or pleasurable activities.
It can be hard to spot a loss of interest or a feeling of emptiness in ourselves, let alone in others. Sometimes, however, if you look a little more closely, the signs are there: the friend who starts turning down social invitations, the colleague who begins missing deadlines, the amateur artist who quietly stops painting, or the once-active member of your church who no longer volunteers regularly.
The secondary symptoms of hidden depression include:
Unexplained aches and pains—headaches, backache, and musculoskeletal aches
Gastrointestinal tract disturbances—persistent stomach cramps, nausea, constipation, or diarrhea
Dizziness or palpitations
Chronic fatigue or a lack of energy
Sexual dysfunction or a loss of interest in sex
Sleep disturbances—not being able to sleep, sleeping at strange hours, or sleeping excessively
An inability to concentrate
Nonadherence to medical treatment for an existing medical condition
Other signs to look out for include significant weight changes, increased use of alcohol, nicotine, or other drugs, or increased irritability, aggression, or pessimism.
Hiding symptoms of depression may be intentional, but it may also be unintentional. If you feel that someone you love is hiding their depression from you, there is a good chance that they are hiding it from themselves, too.
It is possible that they don’t realize that headaches, fatigue, and an inability to concentrate are symptoms of depression. After all, many of us lead busy, stressful lives, and it is easy to explain away physical symptoms.
It is also possible that they are not yet ready to admit that the emptiness they feel might be depression. People who live seemingly “happy” lives—with careers, a family, and friends—might feel guilt or shame for feeling sadness or emptiness.
There are many reasons why someone might hide their depression from others, even those closest to them. These include:
In the past, mental illness was associated with significant amounts of stigma. While attitudes have changed, someone struggling with depression may still fear being judged or treated differently by others.
Many people think that they can—and possibly should—fix their depression on their own. What if they just try hard enough, they can get over it?
Unfortunately, this is rarely the case and individuals with depression often self-medicate (for example, with alcohol) to manage their symptoms.
In some families and cultures, people don’t speak about their emotions. They keep their troubles to themselves and pretend that everything is okay. Men, in particular, have been socialized to believe that being vulnerable and seeking help are signs of weakness.
Many people living with depression feel painfully alone. If you suspect a friend or family member of depression, reach out to them. Don’t force them to speak if they are not ready, but let them know you are there to listen and provide support if needed.
The sooner depression is treated, the better the prognosis. Left untreated, depression is likely to worsen, and depressive episodes are more likely to reoccur. One of the dangers of depression is the increased risk of suicide. Globally, almost a million people commit suicide every year.³
If you suspect that your loved one is having suicidal thoughts, you can seek help via one of these sources of support:
Suicide & Crisis Lifeline—Call or text 988 for confidential support
Crisis Text Line—Text “Hello” to 741741 to connect with a crisis counselor who can provide you with support and helpful information
Veterans Crisis Line—Call 1-800-273-TALK and press 1, or text 838255
While depression should be treated by a professional—with antidepressant medications, psychotherapy, or a combination of the two—there are small habits you can adopt to manage your depression better.
If you suspect you or a loved one is depressed, introduce some or all of these habits into your daily life:
Go outside and spend time in nature. You can go to the park, take a walk in the forest, or spend some time at the beach.
Take advantage of the benefits of feel-good endorphins by engaging in regular physical activity. Choose an activity you enjoy so it won’t feel like a chore. Outdoor exercises like walking, running, or biking will give you more opportunities to spend time in nature.
Take control of your thoughts by practicing daily meditation or mindfulness exercises.
Make sure that you are getting enough good-quality sleep. You can improve your chances by avoiding screens before bed and in bed and waking at regular times.
Eat healthy meals full of fruits, vegetables, whole grains, and fish. Avoid processed foods, red meat, added sugar, and alcohol.
Take the time to connect with family and friends, as this has been shown to improve mental well-being and resilience.
Depression is a complex illness that can affect people differently. Not everyone who has depression will appear sad. Hidden depression is an informal term used to describe people who might be suffering from depression but don’t appear to fit the profile.
These individuals may appear to be doing well to others, but this is not necessarily the case. Somatic symptoms such as headaches, stomach problems, fatigue, and sleep problems may indicate that they are living with depression.
Prevalence of depression | Pan America Health Organization
Depression, a hidden burden | World Health Organization
What is smiling depression? | Psych Central
Nurtured by nature | American Psychological Association
How meditation helps with depression | Harvard Health Publishing