If you know someone with depression—or experience the condition yourself—you know that the signs and impact it may have on daily life can be profound. Your appetite may suffer, your relationships may be affected, your mood may be hopelessly low and you may literally be unable to get out of bed in the morning.
But did you know that you may have a friend or coworker with depression who shows few or any outward signs of the disease at all—who seems otherwise “normal” and perhaps even “happy”?
It may sound hard to believe, but concealed depression, as this sort of depression is known, is real.
What is concealed depression?
Concealed depression isn’t a separate type of depression; rather, it describes the way a person with depression may be able to hide their symptoms especially well.
Harish Mangipudi, DO, a psychiatrist at Summerville Medical Center in Charleston, South Carolina, explains that concealed depression entails many of the features that are involved in a traditional diagnosis of depression. These depression signs are noticeable to and experienced by the affected individual, but they may be entirely obscured from others.
Those who have concealed depression typically bottle up their thoughts and feelings in an effort to appear “okay” and often appear from the outside to be high-functioning adults.
“Concealed depression is typified by the ‘Happy Mask,’” says marriage and family therapist Bruce Conn of Coliseum Medical Centers. “But inside, this is the silent sufferer of depression who tries to feel better by helping others and keeping up a good front. In reality, they’re exhausted and questioning themselves all the time.”
And they may even fail to reveal their symptoms to their healthcare providers. Among the more than 1,000 Californians polled in a 2011 survey conducted by University of California, Davis researchers, 43 percent said they wouldn’t tell their primary care doctor about their depression symptoms.
Why does concealed depression occur?
Flip through the channels on your television or take a look through your social media feed, and it’s obvious we live in a world that encourages only the highlights of life to be shared. It’s understandable, then, that people with depression may feel alone and that they need to conceal their problems.
They may do so because they don’t want to worry or burden others with their condition. They may also feel like they can’t be helped. Or they may think that no one will understand what they’re going through.
It’s important to remember that clinical depression, or major depressive disorder, can be extremely dangerous if not managed. Depression can cause powerful changes in mood and, in extreme circumstances, may lead to thoughts of death or suicide.
Are symptoms of concealed depression different?
Symptoms of concealed depression are similar to those of major depressive disorder. According to the National Institute of Mental Health, a diagnosis of depression would involve experiencing some of the following signs nearly every day for at least two weeks:
- Persistent sadness, anxiety or feelings of emptiness
- Pessimism and low self-esteem
- Feelings of isolation
- Irritability
- Feelings of guilt
- Exhaustion or low levels of energy
- Restlessness
- Trouble concentrating or making important decisions
- Sleep problems
- Weight gain or loss
- Suicide attempts
Because those with concealed depression tend to hide symptoms, it can be difficult for loved ones to recognize these signs and offer help.
If you notice someone is showing any signs of depression, Conn recommends talking to them in person, asking them how they are doing and waiting for the answer.
“You can make the investment by listening,” he says. “Once they answer, follow up by saying something like, ‘Do you want to tell me more about that?’”
You may find they’ll open up and share more of what they’re going through.
There are many ways to get help
Depression can occur for many different reasons. Sometimes a life crisis can bring it on, but sometimes the condition can arise for no apparent reason.
Regardless of the onset, it’s important for those who are experiencing any form of depression to realize it’s not their fault and to get help. And if you are experiencing any symptoms of depression—even if you’re able to otherwise put on a brave face and make it through the day—take those signs seriously and seek help from a professional.
After an official diagnosis, a mental health professional can help you come up with a treatment plan that’s right for you. The goal of treatment is to determine any stressors in your life that may be contributing to depression and to help you better handle difficult feelings and situations.
Some of the most common treatment methods include:
- Psychotherapy such as cognitive behavioral therapy or interpersonal therapy
- Medications like antidepressants, mood stabilizers and antipsychotics
- Electroconvulsive therapy may also be helpful in cases where depression is resistant to other modes of treatment
Your doctor may also recommend supportive strategies, including:
- Regular exercise to help improve mood
- Light therapy, a treatment that utilizes a light box in order to normalize melatonin levels
Dr. Mangipudi also recommends getting adequate amounts of sleep, eating a proper diet and keeping in touch with friends and loved ones if you’re dealing with depression.
If you or someone you know is feeling suicidal, call the National Suicide Prevention Lifeline at 1-800-273-8255 or call 911 in case of immediate danger.
“Depression is real and not just ‘in one’s head,’ says Mangipudi. “If you feel chronically depressed, seek out help. There are resources and professionals who want to help.”