mission prep logo
GET HELP
mission prep logo

Recognizing Hidden Depression in
High-Achieving Teens

CALL (866) 901-4047
INSURANCE VERIFICATION

We all know what a high-achieving teen looks like: they’re top of achievement boards academically, captains of sports teams, and social butterflies – and they seem to manage all this responsibility effortlessly.  

But what if, underneath the surface, a high-performing teen isn’t as confident and self-assured as they seem? What if they’re trying to push down feelings of depression or anxiety? 

Here’s the thing: Many teenagers feel pressure to be “perfect.” But perfection is a myth. As a result, they may appear as calm as a swan gliding across the surface of a lake, but underneath, they’re paddling frantically against self-doubts to stay afloat. 

Depression can’t stay hidden forever. It can take a serious toll on a teenager’s emotional and physical health, and, eventually, their performance and achievements. If you’re concerned about hidden depression in yourself or someone else, advice and support are available. In the meantime, it can help to understand what hidden depression is, as well as how it can affect teenagers. 

This page can help by discussing:

  • What hidden depression in teens is
  • Mental health issues in high-performing teens
  • Signs of hidden depression in high-achieving teenagers
  • How to identify concealed depression in successful teens
  • Treatment for hidden depression in high-achieving teens
  • When to seek help for hidden depression in teens
Hidden depression in high-achieving teens

What Is Hidden Depression in Teens?

Hidden depression in teens, sometimes known as “smiling depression,” is when teenagers feel the typical underlying symptoms of depression but try to disguise how they feel through positivity or over-achieving.1 

Hidden depression isn’t a recognized medical diagnosis, so there are not a lot of available studies on who it affects and why. However, it’s possible to come to some practical theories around why some teens may conceal depression, such as the following. 

A Teen’s Society and Culture May Influence How They Show Their Feelings

Certain cultures approve of emotional expressions, but others may frown upon them. Plus, in general, most societies see positive expressions of emotion in a more favorable light. Thus, a teen may hide their depression to feel approved of or like they “fit in.”2

Their Family Dynamics Might Influence Internal Pressures

Family environments in which there’s a lot of academic or personal pressure might affect how a teen feels they need to perform and whether they attempt to hide signs of depression.3

A Teen’s Personality Traits May Determine Emotional Expressions

Personality traits, such as perfectionism, may be associated with hidden depression. A teen may not wish to admit to themselves or others that they’re struggling, as this may indicate in their mind that they’ve “failed.” Plus, teens with perfectionistic traits may be at more risk of developing depression as they often set themselves impossibly high standards.4

They May Have “Persistent Depressive Disorder”

Often, many people think of “major” depression when considering the signs of depression. However, persistent depression can have more mild to moderate symptoms than major, but typically goes on for longer. This means that it’s either possible for a teen to hide that they feel depressed, or people don’t notice as they seem to be functioning normally.5

Although high-achieving teens could have hidden depression, they may still experience the common signs of depression, including: 6

  • Persistent sadness or hopelessness
  • Constant fatigue or lethargy
  • Low motivation and loss of interest in activities
  • Feelings of isolation
  • Risky behaviors, such as self-harm
  • Low self-esteem and self-worth
  • A lack of enjoyment in life
  • Thoughts about death

These symptoms of depression can have serious and long-lasting effects on a teenager’s life, even if they seem to be functioning well right now. It can help to understand the pressures that high-performing teens are often under, including how these can impact their mental health. 

Mental Health Issues in High-Performing Teenagers

Globally, one in seven 10-19 year olds experience symptoms of a mental health condition, with depression and anxiety being the leading causes of illness in teenagers. This high rate of mental health difficulties could come down to how adolescents are especially vulnerable to academic demands, feeling socially isolated, and stigmas that could prevent them from speaking about their difficulties.7

On an important note, it’s good to highlight that “high-functioning” depression and anxiety are not formal diagnoses. While some teens may be skilled at hiding their symptoms, labeling them as “high functioning” could lead to feelings of guilt and shame if they wish to express themselves. Teens who battle to keep their depression and anxiety under control may see themselves as “failing” – contributing further to their negative emotions. 

Having said as much, the following are some factors that could impact the mental health of high-performing teenagers.

Academic Pressures and Mental Health Issues in Teens

The recent academic environment may be more competitive than in previous decades. This means that teenagers might be under more pressure than ever to achieve high grades and outperform their peers to get into a “top” university. 

Due to this academic pressure – as well as personal and family expectations – a teen may tie their self-worth to their accomplishments. This means they might feel like they’ve “failed” if they think they haven’t achieved as they wanted. In situations such as this, a teenager may start to rely on outside sources of approval. Meaning they can’t reassure themselves that they’ve done the best they could – leaving them vulnerable to anxiety and depression. Additionally, teenagers who attend high-performing schools may be particularly prone to symptoms of depression due to the pressure of the school’s high standards.8,9

“Toxic Positivity” and Mental Health Issues in Teens

If a teen has a history of high performance, others might struggle to understand why they feel sad or low. After all, they’re successful – so what do they have to worry about? “Toxic positivity” is when people use encouragement to minimize or reduce painful emotions. However, the result of toxic positivity is that a teenager doesn’t actually feel better, but instead understands that it’s not acceptable to show how they really feel. As a result, they might push down their emotions and disguise them with a smile. 

Constantly feeling like they have to be positive adds to the expectations that are already mounting up in a teenager. Left unchecked, this could contribute to mental health conditions such as anxiety and depression.12

Family Pressures and Mental Health Issues in Teens

While schools with high-performance records are linked to student populations with higher rates of mental health issues, input from parents might play a role in how teens manage these pressures. For instance, if parents express high expectations for a teenager, criticizing them when they don’t live up to these, a teen may be more at risk of developing depression or anxiety.9

Stress and Mental Health Issues in Teens

It’s not just academic pressures which can cause stress for a teen: social pressures, body image issues, an evolving identity, and family dynamics are other sources of potential stress. However, teenagers’ brains are wired differently than adults, which means they often respond to stress uniquely – and it can affect their brains in different ways.10

Many teens have reported feeling anxious or depressed as a result of stress. However, they also may be less willing to express that this stress is taking a toll on their health than adults are. This indicates that teenagers may be more prone to hidden depression and anxiety than adults.11

Hidden depression in teenage girl

Signs of Hidden Depression in High-Achieving Teenagers

Identifying concealed depression in successful teens can be difficult – they might work very hard at hiding how they’re feeling. However, they may be more likely to let their true emotions show in periods of downtime. Thus, a parent or caregiver may be in the best position to spot the signs of hidden depression in high-achieving teenagers. 

The signs of hidden depression in high-achieving teens include:13

  • Seeming persistently sad (especially when they think they’re not being watched by others)
  • Changes in sleep patterns, such as difficulties falling or staying asleep
  • Constant tiredness or fatigue
  • Struggling to control emotions, such as becoming tearful or angry without a clear cause
  • Weight and appetite changes
  • Withdrawing from friends or family
  • Showing a lack of interest in activities they once enjoyed
  • Difficulties concentrating or making decisions
  • Having less energy or motivation
  • Exhibiting self-destructive behaviors, such as self-harm

Even if a teen is high-achieving, this doesn’t mean they can’t develop mental health conditions such as depression. Plus, depression is difficult to hide completely – there likely will be indicators such as the signs listed above. If you’re worried about hidden depression in a teen, there are steps you can take. 

Identifying Concealed Depression in Successful Teens

If you’re worried that someone you know has hidden depression, the good news is that there are clinically proven treatments that work for treating depression. Plus, a mental health professional can advise you on the best course of treatment.

In the meantime, if you’re trying to identify concealed depression in a successful teen, consider trying the following steps.

1. Take Time to Learn About Depression and Why a Teen Might Try to Hide it

Understanding the signs of depression, and that what a teen is exhibiting is not a lack of motivation but instead a mental health issue, puts you in a strong position to know how to support them.

2. Talk to Them

If a teen is trying to hide what they’re going through, they may not feel safe expressing their feelings. Encouraging them to be open about their emotions can let them know they have your support and they won’t be judged. 

3. Validate What They're Going Through

Being overly positive in an attempt to encourage a teen could minimize what they’re going through. Instead, try to express that you understand they’re having a tough time by saying something like, “I’m sorry, that must be hard on you. I’m here for whatever you need.”

4. Help Them Focus on What They're Doing Right

Instead of targeting their areas for improvement, praise them for everything they’ve done right – including opening up to you.

5. Encourage "Downtime"

We all need to relax, but a high-performing teen might feel like they can’t. It’s important to help them find the time for self-care, including relaxation time, healthy eating, exercise, and sleep.

It could be tough to get a high-achieving teen to open up about their depression, but it’s important to keep trying. Depression can have serious implications for a teen’s emotional and physical health, both in the short and long term. If you’re worried about the mental health of a teenager, professional mental health advice can help you take the right measures to protect someone you care about.

Treatment for Hidden Depression in High-Achieving Teens

There are a variety of effective therapy options for teens with concealed depression. A mental health professional can talk you through the best options for you or someone you care about, including:

Cognitive Behavioral Therapy (CBT)

CBT can help a teen identify and understand the thoughts and feelings that lead to depression. It can also provide them with the skills to cope with pressure and stress outside of therapy.

Interpersonal Therapy

Expectations and communication patterns in relationships can contribute to depression. Interpersonal therapy can help teens understand these issues and how to work through them.

Eye Movement Desensitization and Reprocessing (EMDR)

Depression sometimes comes from negative experiences in our past. EMDR can help teens process these experiences in a safe, supportive environment – helping them build positive self-beliefs and ways of coping with challenges. 

Transcranial Magnetic Stimulation

TMS can be effective in treating treatment-resistant depression. It’s a non-invasive treatment that uses magnetic fields to activate nerve cells in targeted areas of the brain – helping improve teens’ outlook and mood. 

Depending on a teen’s needs, these therapies can be offered as a part of a residential mental health treatment program or outpatient program. A doctor may also recommend medication as part of a treatment plan. While medication sometimes has an important place in treatment, it’s usually most effective when combined with therapy. 

Also, group therapy for hidden depression can be an excellent way for a teen to understand that what they’re going through is nothing to be ashamed of – they’re not to blame. 

Treatment for hidden depression in high-achieving teen boy

When to Seek Help for Hidden Depression in Teens

Hiding the signs of depression won’t make them go away; depression is not something we can “snap out of” and it can have serious implications for a teenager’s life. Depression can be very difficult to cope with alone, but Mission Prep can help. 

Our team of trained, empathetic professionals understands the pressures that teenagers face – and how they can impact their mental health. We offer depression treatment programs in various locations to meet each teen’s needs and ensure their voice is heard. Contact us today for support and advice.  

References

  1. Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender Differences in Depression in Representative National Samples: Meta-Analyses of Diagnoses and Symptoms. Psychological Bulletin, 143(8), 783. https://doi.org/10.1037/bul0000102
  2. Zhao, L., Han, G., Zhao, Y., Jin, Y., Ge, T., Yang, W., Cui, R., Xu, S., & Li, B. (2020). Gender Differences in Depression: Evidence From Genetics. Frontiers in Genetics, 11, 562316. https://doi.org/10.3389/fgene.2020.562316
  3. Angold, A., & Worthman, C. W. (1993). Puberty onset of gender differences in rates of depression: A developmental, epidemiologic, and neuroendocrine perspective. Journal of Affective Disorders, 29(2-3), 145–158. https://doi.org/10.1016/0165-0327(93)90029-j
  4. University of North Carolina at Chapel Hill School of Medicine. (n.d.). Menstrually related mood disorders. UNC Center for Women’s Mood Disorders. Retrieved February 26, 2025, from https://www.med.unc.edu/psych/wmd/resources/mood-disorders/menstrually-related/
  5. Mohammadi, S., Seyedmirzaei, H., Salehi, M. A., Jahanshahi, A., Zakavi, S. S., Firouzabadi, F. D., & Yousem, D. M. (2023). Brain-based Sex Differences in Depression: A Systematic Review of Neuroimaging Studies. Brain Imaging and Behavior, 1. https://doi.org/10.1007/s11682-023-00772-8
  6. Van de Velde, S., Bracke, P., & Levecque, K. (2010). Gender differences in depression in 23 European countries: Cross-national variation in the gender gap in depression. Social Science & Medicine, 71(2), 305–313. https://doi.org/10.1016/j.socscimed.2010.03.035
  7. Khesht-Masjedi, M. F., Shokrgozar, S., Abdollahi, E., Golshahi, M., & Sharif-Ghaziani, Z. (2017). Comparing depressive symptoms in teenage boys and girls. Journal of Family Medicine and Primary Care, 6(4), 775. https://doi.org/10.4103/jfmpc.jfmpc_129_17
  8. Cyranowski, J. M., Frank, E., Young, E., & Shear, M. K. (2000). Adolescent onset of the gender difference in lifetime rates of major depression: A theoretical model. Archives of General Psychiatry, 57(1), 21–27. https://doi.org/10.1001/archpsyc.57.1.21
  9. Gutman, L. M., & McMaster, N. C. (2020). Gendered Pathways of Internalizing Problems from Early Childhood to Adolescence and Associated Adolescent Outcomes. Journal of Abnormal Child Psychology, 48(5), 703. https://doi.org/10.1007/s10802-020-00623-w
  10. Chaplin, T. M., Gillham, J. E., & P Seligman, M. E. (2009). Gender, Anxiety, and Depressive Symptoms: A Longitudinal Study of Early Adolescents. The Journal of Early Adolescence, 29(2), 307. https://doi.org/10.1177/0272431608320125
  11. Staiger, T., Stiawa, M., Mueller-Stierlin, A. S., Kilian, R., Beschoner, P., Gündel, H., Becker, T., Frasch, K., Panzirsch, M., Schmauß, M., & Krumm, S. (2020). Masculinity and Help-Seeking Among Men With Depression: A Qualitative Study. Frontiers in Psychiatry, 11, 599039. https://doi.org/10.3389/fpsyt.2020.599039
  12. Hawton, K. (2000). Sex and suicide: Gender differences in suicidal behaviour. British Journal of Psychiatry, 177(6), 484-485. https://doi.org/10.1192/bjp.177.6.484
  13. Kornstein, S. G. (1997). Gender differences in depression: Implications for treatment. Journal of Clinical Psychiatry, 58(Suppl 15), 12–18. PMID: 9427872.
  14. Kornstein, S. G., Schatzberg, A. F., Thase, M. E., Yonkers, K. A., McCullough, J. P., Keitner, G. I., Gelenberg, A. J., Davis, S. M., Harrison, W. M., & Keller, M. B. (2000). Gender differences in treatment response to sertraline versus imipramine in chronic depression. American Journal of Psychiatry, 157(9), 1445–1452. https://doi.org/10.1176/appi.ajp.157.9.1445

WE ACCEPT MOST MAJOR INSURANCES

aetna logo
anthem logo
healthnet logo
firsthealth logo
beacon logo
bluecross blueshield logo
magellan health logo

We Also Work With Many Other Insurance Carriers

PLEASE REACH OUT TO VERIFY YOUR BENEFITS

ARE YOU OR A
LOVED ONE STRUGGLING

with anxiety, depression, or other mental health concerns?

Find out if Mission Prep is right for you by reaching out to us and speaking with one of our admissions representatives.

CALL (866) 901-4047
VERIFY YOUR INSURANCE
mission prep logo

QUICKLINKS

Facilities

What We Treat

What Makes Us Different

Privacy Policy

Phone: 866-845-1391

Email: info@missionprephealthcare.com

Corporate Office: 30310 Rancho Viejo Rd. San Juan Capistrano CA 92675

Facebook Instagram Tiktok

Copyright 2024 © Mission Prep Healthcare. All Rights Reserved