Morning Depression: Diurnal Variation of Depressive Symptoms

What Is Morning Depression?

Morning depression is one of the core symptoms of melancholia, a characteristic found in some people with major depressive disorder. People with morning depression may experience feelings of extreme sadness, frustration, anger, and fatigue. These feelings are often worse in the morning than in the afternoon or evening.

Morning depression is also known as diurnal variation of depressive symptoms or diurnal mood variation. This condition is different from seasonal affective disorder, which is related to changes in seasons.



Causes of Morning Depression: Circadian Rhythms

Your body runs on a 24-hour internal clock that causes you to feel sleepier at night and more awake and alert during the day. This natural sleep-wake cycle is known as the circadian rhythm.

The circadian rhythm, or body clock, regulates everything from heart rate to body temperature. It also has an impact on energy, cognition, alertness, and mood. These daily rhythms help you maintain a stable mood and keep you in good health.

The rhythms of certain hormones, such as cortisol and melatonin, also help your body prepare for certain events. For example, your body produces cortisol when the sun comes up. This hormone gives you energy so you can be active and alert during the day. When the sun goes down, your body releases melatonin, a hormone that makes you sleepy.

When these rhythms are disrupted, your body begins to produce hormones at the wrong time of day. This can have a negative effect on your physical health and emotional well-being. When your body produces melatonin during the day, it can make you feel very tired and irritable. A disrupted circadian rhythm may contribute to depression.

A recent study found that people with depression often have disrupted circadian rhythms. Researchers discovered that the genes responsible for regulating these rhythms were weaker and often disrupted in the brains of people with depression. Any disruptions in the body clock and sleep patterns can cause mood changes and an inability to sleep. This is especially true for people with morning depression.

You may be able to stabilize your circadian rhythm by making certain lifestyle adjustments. Exercise frequently, go to bed at the same time every night, and eat meals at regular times. Treatments that synchronize the sleep-wake cycle with the body clock, such as light therapy, may help some people with morning depression.



Symptoms of Morning Depression

People who have depression with melancholic features often experience severe feelings of melancholia in the morning, but feel better as the day goes on. This condition is often more difficult to diagnose and treat than other types of depression.

Symptoms may include:

  • trouble waking up and getting out of bed in the morning
  • a profound lack of energy when you start your day
  • difficulty facing simple tasks, such as showering or making coffee
  • delayed physical or cognitive functioning ("thinking through a fog")
  • inattentiveness or a lack of concentration
  • intense agitation or frustration
  • lack of interest in once-pleasurable activities
  • feelings of emptiness
  • changes in appetite (usually eating more or less than usual)
  • hypersomnia, or sleeping longer than normal

See your doctor if you believe you have morning depression.



Diagnosing Morning Depression

To make an accurate diagnosis, your doctor or therapist will ask you about your sleep patterns and mood changes throughout the day. For example, they may ask you the following questions:

  • Are your symptoms generally worse in the morning or in the evening?
  • Do you have trouble getting out of bed or getting started in the morning?
  • Do your moods fluctuate dramatically during the day?
  • Do you have trouble concentrating more than usual?
  • Do you find pleasure in the activities that you enjoy?
  • Have your daily routines changed recently?
  • What, if anything, improves your mood?


Treatments for Morning Depression

Unlike other forms of depression, morning depression doesn’t respond well to selective serotonin reuptake inhibitors (SSRIs). SSRIs are commonly prescribed antidepressants that can help ease symptoms. However, serotonin–norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor) may be helpful for people with morning depression.

Electroconvulsive therapy (ECT) can also be an effective treatment. In this procedure, electric currents are passed through the brain to intentionally trigger a seizure. The treatment appears to cause changes in brain chemistry that can reverse symptoms of depression.

ECT is a fairly safe treatment that’s done under general anesthesia, which means you’re asleep during the procedure. The electric currents are administered in a controlled setting to achieve the best outcome with the fewest possible risks.

Talk therapies — such as interpersonal therapy, cognitive behavioral therapy, and psychotherapy — can also treat morning depression. They’re especially effective when combined. These therapies can help you address any issues that may be contributing to your depression and making your symptoms worse. Issues might include conflicts in a romantic relationship, problems in the workplace, or any negative thought patterns you’re experiencing.

Light therapy, also known as bright light therapy or phototherapy, can also help treat people with morning depression. In this type of therapy, you sit or work near a light therapy box. This box emits bright light that mimics natural outdoor light.

The exposure to artificial light is believed to affect the brain chemicals linked to mood. Although generally recognized as a treatment for seasonal affective disorder, some people with depression may find this approach helpful.

Making small shifts in sleep patterns may also help. Try:

  • going to bed and waking up at the same time every day
  • refraining from taking long naps
  • creating an environment that promotes sleep, such as a dark, silent, cool room
  • avoiding foods and drinks that can prevent a good night’s sleep, such as caffeine, alcohol, and tobacco
  • avoiding strenuous exercising for at least four hours before bedtime

Taking these steps can help stabilize your circadian rhythm so that your body produces the correct hormones at the proper time. This will improve your mood and overall symptoms.

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