You suspect smiling depression in a patient. Before revealing the answer, decide how you would assess for this.

Look closely at the eyes and more subtle, involuntary aspects of expression, which often fail to match a maintained smile around the mouth, since this mismatch can be a useful clue. Ask direct, specific questions about mood, interest, energy, sleep, and suicidal thinking, rather than relying on the outward presentation, since a cheerful manner can mask a genuinely severe depressive illness. Ask the person directly about the smile itself, since they may explain it as a deliberate choice: not wanting to worry others, feeling ashamed of being depressed, or simply being used to putting on a brave face. Given the significant suicide-risk implications of a hidden depressive illness, ensure suicidal thinking is enquired about explicitly rather than assumed absent because of the outward presentation.