SMILING DEPRESSION

It is known as “smiling depression”, “atypical depression” or “masked depression” . “Smiling depression” is a type of major depressive disorder that is different from classic depression symptoms and has atypical features, that is, it is one of the subtypes of major depression. Compared to other types of depression, people with smiling depression may not show constant depressive symptoms. They may show good reactions when they experience good events. 

WHO IS IT MORE SEEN IN?
Smiling depression can occur at any age and in any gender, but some groups may be more prone to smiling depression. Smiling depression may have some demographic and clinical characteristics compared to other types of depression. (1) In general, depression is more common in women than in men, which may increase the likelihood of women developing smiling depression. (2) Smiling depression is generally more common in young adults and middle-aged individuals. This type of depression may be more common in adolescence and young adulthood. (3) Family history may increase the risk of smiling depression. People with a family history of depression may be at higher risk for this type of depression. (4) Certain personality traits may increase the risk of smiling depression. For example, emotional sensitivity or more emotionally unstable personality traits may be associated with smiling depression. (5) People with smiling depression are often overweight or obese. Being overweight or obese may also increase the risk of smiling depression. (6) Emotional or physical trauma may increase the risk of smiling depression. This risk may be higher in people who have been sexually, physically, or emotionally abused during childhood. (7) There may be a relationship between smiling depression and eating disorders (e.g., binge eating disorder or bulimia nervosa). Individuals with these types of eating disorders may be at risk for smiling depression. In summary, the risk factors for smiling depression can vary from person to person, and any individual may have one or more of these factors. However, these risk factors alone do not guarantee that a person will develop smiling depression.

There are some important differences between smiling depression and classic depression. (1) In smiling depression, people may frequently experience episodes of overeating and gain weight. In classic depression, loss of appetite and weight loss are more common symptoms. (2) People with smiling depression tend to sleep excessively, that is, they experience hypersomnia. People with classic depression usually experience insomnia. (3) People with smiling depression tend to respond well and positively to positive events. People with classic depression generally feel indifferent or unhappy to positive events. (4) People with smiling depression may be oversensitive to negative events and may react more emotionally when a negative event occurs. People with classic depression generally experience emotional numbness or apathy. (5) Smiling depression and classic depression may respond to treatment in different ways. Smiling depression may respond better to some antidepressant medications and therapies. (6) People with smiling depression tend to continue social interactions, but people with classic depression often experience social isolation and withdrawal from relationships… An important point to remember is that types of depression can manifest differently in each individual. A person may experience some symptoms of smiling depression but not others. Diagnosis and treatment should be based on examination of these symptoms and a proper assessment.

WHAT ARE THE REASONS?
The causes of smiling depression depend on a complex set of interacting factors: (1) Family history may increase the risk of smiling depression. Genetic factors may make this type of depression more likely. (2) An imbalance of chemicals in the brain may be a cause of smiling depression, as it is the case with many types of depression. (3) Stressful life events, especially traumatic experiences in childhood, may increase the risk of smiling depression. (4) Personality traits such as emotional sensitivity, low self-esteem, and perfectionism may increase the risk of smiling depression. (5) Social isolation may trigger or worsen the symptoms of smiling depression. (6) Smiling depression appears to be slightly more common in women, although it can also occur in men. However, it is also known that smiling depression is less recognized and reported in men. (7) Smiling depression can occur in all age groups, but is more common in young adults and middle-aged adults. (8) Chronic physical health problems may increase the risk of smiling depression. Similarly, physical health problems such as obesity and diabetes have been associated with this type of depression… Smiling depression can vary in its symptoms and risk factors from person to person. Treatment can often include MetaPsychotherapy and medication. It is important to seek professional help in the diagnosis and treatment of this type of depression. Finally, different sources may provide different results regarding the visibility of smiling depression in terms of gender and age. In general, depression can affect anyone regardless of gender and age and may show individual differences. In today's era when there is constant pressure for happiness and a positive mood, there is a possibility that more "hidden" or "atypical" types of depression such as smiling depression are on the rise. Smiling depression is a condition in which a person appears happy or cheerful on the outside but experiences symptoms of depression on the inside. Various factors may play a role in this situation: (1) Social media allows people to showcase the best moments and happy moments of their lives. This may cause people to tend to present their own lives as more positive and perfect. These expectations may increase as society tends to value happiness and positivity. (2) Many personal development movements emphasize constant happiness and positive thinking. This may create pressure on people to present a positive image to the outside world. (3) The competitive business world, intense work tempo and social pressures may increase the desire of individuals to present a positive image to the outside world… Smiling depression is often seen in individuals who appear happy or normal to others when viewed from the outside. For this reason, this type of depression can be difficult to recognize and diagnose. Individuals may try to hide their inner distress, which can delay the diagnosis of depression.Therefore, it can be difficult to say for sure whether smiling depression is on the rise. However, it is important for society to adopt a more open, understanding and supportive approach to mental health issues. Individuals should feel comfortable expressing their true feelings and seeking help to cope with emotional difficulties. It is also important to raise awareness and increase awareness of emotional health.

EXAMPLE CASES: “MERYEM AND DURSUN”
My client, whom I named “Meryem” , was a 32-year-old teacher and was a very cheerful and positive person on the outside. Her students, friends and family always knew her as a happy and energetic person. However, a different story was being written in her inner world. Meryem often felt empty, without energy and unhappy. Especially when she came home from work or was alone, she would experience inner distress. This situation reflected an atypical type of depression called “smiling depression”, where she masked herself from the outside and put on a smiling face. Meryem hid these inner distresses for a long time, but eventually decided to see a psychotherapist and get help from MetaPsychotherapy… My client, whom I named “Dursun” , had achieved great success in the business world and was quite popular socially. From the outside, he seemed like a successful businessman and a positive person. However, Dursun was experiencing constant restlessness and internal war in his inner world. He had to go to work smiling every day, but after leaving work, he would often feel tired and hopeless. When Dursun felt emotionally exhausted and could no longer continue his internal battle, he decided to seek professional help. During the therapy process, an atypical depression called “smiling depression” was diagnosed and a MetaPsychotherapy treatment plan was created… These two cases reflect a situation where smiling depression is a situation where a person tries to hide their internal emotional difficulties in order to conform to external expectations or social norms. Such situations may reflect complex psychological situations where the person has difficulty expressing their true emotional state and experiences internal battle. Therefore, the diagnosis and treatment of smiling depression is important.

DIAGNOSIS AND TREATMENT
The diagnosis and treatment of smiling depression should be made by a professional psychotherapist and psychiatrist. Below is basic information about the diagnosis and treatment of smiling depression: (1) The diagnosis of smiling depression is made by a qualified health professional such as a psychiatrist or psychotherapist. The first step is to make a detailed clinical assessment of the person's symptoms and medical history. (2) The "Diagnostic and Statistical Manual for Mood Disorders" (DSM-5), published by the American Psychiatric Association, includes the symptoms and criteria that define smiling depression. It is evaluated whether it meets these criteria. (3) Considering that smiling depression may sometimes be associated with medical problems, a physical health assessment can also be made... MetaPsychotherapy plays an important role in the treatment of smiling depression. MetaPsychotherapy helps the person understand the symptoms of depression and learn how to cope with these symptoms. Antidepressant medications are often used in the treatment of smiling depression. Selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MOAIs) can be especially effective. Medication can help relieve and control symptoms. For some people, electroconvulsive therapy (ECT) or other alternative treatment approaches may be considered. Lifestyle changes such as regular physical activity, healthy eating, and regular sleep can also help. Treatment is customized to the person's symptoms and needs. Treatment for smiling depression often takes time, and it is important for the person to work closely with a qualified psychotherapist. In order for treatment to be effective, it is important for the person to take medication regularly and attend therapy sessions.

10 QUESTION SMILING DEPRESSION TEST
Below is a 10-question test that I suggest you can use to assess for signs of smiling depression. However, this test is only an assessment tool and is not a formal diagnosis. If you think you or someone else has signs of smiling depression, it is best to talk to a professional.

1. Have you been feeling the need to overeat or sleep a lot lately?

2. Do you enjoy doing the activities you want, or do you often feel disinterested or lacking in energy?

3. Have you experienced declines in your work or school performance?

4. Do you often feel overly sensitive or emotionally volatile?

5. Do you need something negative to happen to feel good? That is, do you not feel happy even when positive things are happening?

6. Have you experienced a significant change (increase or decrease) in your body weight?

7. Avoiding social activities or experiencing social isolation?

8. Do you tend to feel worthless or helpless?

9. Have you experienced significant changes in your sleep patterns (hypersomnia or insomnia)?

10. How long have you felt like smiling depression symptoms have been affecting your life?

This test can help you assess potential signs of smiling depression, but you will need to see a professional to make a definitive diagnosis. If these test results worry you or you are experiencing symptoms of depression, it is important to talk to a healthcare professional.