Recognizing Smiling Depression in Teens

What is smiling depression, and what can you do to help a young person who has this condition?

Call Hillcrest Adolescent Treatment Center at (800) 275-1707 today to learn more.

What Is Smiling Depression?

Smiling depression is an informal term to describe someone who has a depressive disorder, but who doesn’t exhibit obvious or easily identifiable symptoms. It is also sometimes referred to as high-functioning depression.

Neither smiling depression nor high-functioning depression are official diagnoses. In most cases, young people who are affected in this way likely have either:

• An atypical form of major depressive disorder (MDD) 
• Persistent depressive disorder, which used to be called dysthymia

Though researchers have not been able to pinpoint the prevalence of smiling depression among adolescents and teens, they have gathered considerable data to demonstrate that depression is not uncommon among young people in the United States.

According to the 2024 edition of the National Survey on Drug Use and Health (NS-DUH), about 3.8 million adolescents, or around 15.4% of the population ages 12-17, had at least one major depressive episode in the previous 12 months. 

How to Recognize Smiling Depression in Teens

As noted in the previous section, most teens with smiling depression probably have either major depressive disorder or persistent depressive disorder. To recognize that a teen is struggling with one of these conditions, it can be helpful to understand both their diagnostic criteria and common warning signs.

Diagnostic criteria

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes nine criteria for major depressive disorder.

To be accurately diagnosed with MDD, a teen must have at least five of the following symptoms during a two-week period:

• Pervasive sadness, emptiness, hopelessness, or irritability 
• Loss of interest in most or all activities 
• Significant change in appetite, which may lead to considerable unintentional weight gain or loss 
• Abnormal sleep patterns, which may include insomnia or hypersomnia
• Restlessness or delayed physical responsiveness
• Low energy and persistent fatigue
• Unrelenting feelings of worthlessness or inappropriate guilt 
• Difficulty focusing, concentrating, and making decisions 
• Recurrent thoughts of death and dying, which may include suicidal thoughts and behaviors 

To be diagnosed with persistent depressive disorder, which used to be referred to as dysthymia, a young person must experience low mood most days for a period of at least two years.

During this period, the DSM-5 notes, the individual must also exhibit two or more of the following symptoms:

• Appetite loss or overeating
• Insomnia or hypersomnia
• Low energy
• Poor self-esteem
• Impaired concentration and/or indecisiveness
• Recurrent feelings of hopelessness

Warning signs

The diagnostic criteria for depressive disorders aren’t always easily observable by others. And the nature of the condition means that the symptoms of smiling depression can be challenging to identify.

But here are a few warning signs that could indicate something is amiss:

• Unexplained drop in grades
• Panicking or being unduly hard on themselves after making mistakes
• Uncharacteristic behavior problems in school
• Frequent headaches, stomach aches, or other types of physical distress that don’t have a clear medical cause
• Becoming defensive or hostile when confronted with even minimal criticism
• Quitting teams, clubs, or other extracurricular activities that they used to enjoy
• Withdrawing from friends and family members
• Forcing themselves to socialize and otherwise maintain the outward appearance that everything is going well for them, even when you suspect that they’re struggling

Perhaps the best advice for identifying smiling depression or any other mental health concern among teens is to note changes. 

Though adolescence is of course a time of change, sudden and significant differences is mood, attitude, energy, eating habits, and behaviors can be indicators that a young person is struggling with their mental health.

What Causes Smiling Depression in Teens?

To identify potential causes of smiling depression in teens, you need to answer two questions:

• What puts a teen at risk for depression?
• Why would a teen attempt to hide their depression?

Depression risk factors

There’s no single cause of depression. Instead, experts have identified an array of factors that can put people at risk of developing a depressive disorder, such as:

• Gender (teen depression is more common among girls than among boys)
• Family history of mental illness
• Loss of a parent due to separation, divorce, or death
• Personal history of being abused or assaulted
• Overwhelming academic stress
• Bullying and other forms of online and in-person harassment
• Having a disability or a serious illness

Research suggests that exposure to social media may also increase the likelihood that a teen will develop depression or another mental health concern. 

According to an April 2025 paper in the Journal of Psychiatry and Psychiatric Disorders, “excessive and problematic” use of social media by adolescents has been associated with elevated rates of major depressive disorder, anxiety, and mood dysregulation. 

The authors of that paper also reported that the overuse of social media can also worsen the symptoms of attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, and body dysmorphic disorder. 

Why would a teen hide their depression?

As with the causes of depression itself, there’s no single answer to why a teen might try to hide the fact that they’re depressed.

Instead, that choice could results from a range of influences, including:

• Having parents who use demeaning language when talking about people with mental illnesses
• Growing up in a community where mental health stigma is prevalent
• Believing that their depression is a sign that they are inherently flawed
• Having a deep fear of failing or being judged negatively
• Trying to protect their loved ones from being “burdened” by their depression
• Hoping that their symptoms will simply disappear if they work harder
• Believing that they deserve to be unhappy

Ways to Support a Teen With Smiling Depression

If you suspect that your teen has developed smiling depression, here are a few tips for how to respond:

• Don’t ignore your suspicions. You know your child better than anyone else, and you are uniquely positioned to notice when something is off about them.
• Talk to your teen about your concerns. Be sure to approach the topic from a place of love and support, not criticism. 
• Listen to them without judging them, dismissing their feelings, or implying that what they’re going through is somehow their fault.
• Talk to their teachers, coaches, and/or guidance counselors to get their perspective and suggestions.
• Make an appointment for them with a therapist or counselor in your area.

Learn More About Treatment for Smiling Depression in Southern California

Hillcrest Adolescent Treatment Center is a safe and highly supportive environment where teens can receive personalized care for smiling depression, other mental health concerns, and co-occurring addictions.

At our residential treatment center in Agoura Hills, CA, teens benefit from a three-phased approach that incorporates a wide range of evidence-based 

To learn more about how we can help your teen, or for answers to any questions you have about any aspect of our programming, please visit our Contact page or call us today.