Morning Depression

Morning depression, not to be confused with seasonal affective disorder (SAD), is also known as diurnal variation of depressive symptoms (DV) or diurnal mood variation.

Morning depression is one of the core features of melancholia found in major depressive disorder (MDD). Patients with DV typically experience a worsening of depressive symptoms in the morning as opposed to in afternoon or evening.

Causes of Morning Depression: Circadian Rhythms

Nearly every function of the human body undergoes measurable changes over the course of a 24-hour day.

The rhythms of hormones such as melatonin and cortisol (which affect sleep cycles and have been well-studied) but there are a lot of other changes going on as well. The circadian rhythm, or body clock, regulates everything from heart rate to body temperature and impacts functions such as cognition, alertness, and, especially, mood.

Diurnal mood variation has been shown to be, in large part, due to weakened circadian functioning. For instance, one 1997 Harvard Medical School study found that people were more likely to be in a bad mood if they were awake when their body clock expected them to be asleep—even if they'd had plenty of sleep.

More recent research has found that any misalignment of the body clock, sleep patterns, and the external light-dark cycle may induce mood changes, especially in people who are more susceptible to depression. Therefore, anything that helps stabilize a person's circadian rhythms including exercise, stable relationships, exposure to sunlight, maintaining regular meal times, and correctly timed medications will have a positive impact on mood.

Treatments that synchronize a person's sleep-wake cycle with his or her biological clock, such as light therapy, may help some people who are suffering with depression.

Symptoms of Morning Depression

If an individual's body clock is "out of whack," his low mood states may become chronic over time, making him believe "this is just how I am." This "absorption" of the depression into one's personality is one reason why melancholic depression is often more difficult to diagnose and treat than other types of depression.

Symptoms of morning depression may fly under the radar, so to speak, but there are some clues:

  • ? trouble getting started in the morning or a profound lack of energy
  • trouble facing simple tasks such as showering or making coffee
  • slowed down physical or cognitive functioning ("thinking through a fog")
  • ?lack of concentration or inattentiveness
  • intense agitation or frustration
  • lack of interest in once-pleasurable activities
  • empty or "numb" feelings
  • changes in appetite (usually eating more than usual)
  • hypersomnia (sleeping longer than normal)

Diagnosing Morning Depression

In order to diagnose melancholic depression, a doctor or mental health professional will ask a patient about changes in sleep patterns and usually some form of 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 more trouble concentrating than usual?
  • Do you find pleasure in activities that you enjoy?
  • Have your daily routines changed recently?
  • What, if anything, improves your mood?

Treatments for Morning Depression

Melancholic depression doesn’t respond as well to selective serotonin reuptake inhibitor (SSRI)  as do some other forms of depression.

Studies show, however, that serotonin–norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor) may be effective for this type of depression, as are older tricyclic antidepressants. Currently, electroconvulsive therapy (ECT) has proven to be the most effective treatment for melancholic depression.

Talk therapies, such as interpersonal, cognitive behavioral therapy, and psychotherapy, are also effective in treating melancholic depressions, especially in combination with other therapies. This may be because patients with morning depression generally identify their mood states as deriving from internal sources in contrast with others who identify outside influences when describing their symptoms.

Promising new research suggests that even small shifts in sleep patterns may affect mood states. For instance, it has been found that sleep deprivation and sleep phase advance (in which a person's sleep-wake cycle is incrementally shifted) have an antidepressant effect in some people.

Light therapies like those used for patients with SAD have also shown promise. Studies are ongoing, however.