Morning Depression – Diurnal Mood Variation Signs and Treatment

Do you wake up in the morning feeling down and blue? Does this happen to your significant other or any family member?

Well, they may be experiencing diurnal mood variation, also known as the morning depression, which is expressed by melancholic depression in the morning.

Melancholic depression involves a significant weight loss, loss of pleasure in all activities, despair, and morning depression (1). Morning depression symptoms can include symptoms of major depressive order, such as extreme sadness, frustration, fatigue, and irritation (2).

The mornings can be difficult for people with morning depression, especially for those who had disrupted sleep the night before. When struggling with morning depression, waking up and facing a day full of choices can feel completely tremendous, and drifting back off to sleep may be a much more desirable option.

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What is Morning Depression or Diurnal Mood Variation

The term diurnal mood variation refers to significant daily changes in overall mood state by individuals who suffer from depression. Traditionally, the unambiguous patterns of these diurnal mood changes were thought to portray various subtypes of depression, although empirical evidence for this has been mixed currently. Recently, diurnal mood variation is closely linked to melancholic depression, also known as somatic depression, where people feel worse during the early morning.

Morning depression is when an individual feels excessively sad and melancholic during the morning period. Research has shown that a person with morning depression will usually have symptoms that will meet the criteria for major depressive disorder (MDD) (3). However, these symptoms may go away or lessen in intensity during the afternoon and evening.

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Causes of Morning Depression

Doctors and researchers have not found a specific cause for morning depression. However, they believe there are several contributing factors.

Circadian biologists believe that since it occurs at the same time every day, there seems like an imbalance in a person’s circadian rhythm. Circadian rhythm is a natural internal process that regulates the sleep-wake cycle and repeats every 24 hours. This system is influenced by environmental cues, especially light. Research suggests the imbalance in the body’s circadian rhythms can be due to the following factors (4):

  • A family history of depression
  • Past or current drug or alcohol use
  • Medical conditions such as sleep disorders, chronic pain, anxiety, and attention discrepancy
  • Trauma
  • Recent changes or critical life events, such as divorce or the death of a loved one

Signs and Symptoms of Morning Depression

A person with a diagnosis of morning depression may feel the following symptoms, and they will be significantly more at early times of the morning (5):

  • Depressed mood during the early morning, almost every day
  • Diminished or no enjoyment in nearly all activities after waking up
  • Significant weight loss
  • Sleep difficulties
  • Restlessness
  • Fatigue, even after waking up in the morning 
  • Feelings of worthlessness or excessive guilt
  • Difficulty concentrating
  • Suicidal thoughts and self-harm
morning-depression-signs


Moreover, an individual with severe morning depression will have the following symptoms:

  • Trouble waking up in the morning
  • Physical strain getting out of bed
  • Common over-sleeping
  • Struggle with rational thinking, especially in the morning
  • Difficulty completing regular morning tasks, such as getting dressed and brushing the teeth

Diagnosis and Evaluation of SAD

Morning depression can be diagnosed by physicians, psychiatrists, or clinical psychologists. They will run through some basic questioning about your day to day activities, moods, and thoughts. They will use the following:

  • DSM-5: Your mental health professional will do criteria check for Major Depressive Disorder (MDD) registered in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) issued by the American Psychiatric Association (6).
  • Diagnostic Interviews: Your general practitioner or physician may do an extensive interview session with you to ask you about your mood variation. They may also you’re your partner or children to find out more about your day to day routine if you wish to include your family. This assessment procedure’s overall goal is to enable the clinician to gain precise knowledge of your presenting symptoms, including the frequency, intensity, and duration.
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  • Ruling out any medical condition: Your doctor or physician will try to rule out any medical condition, such as Hypothyroidism, which may be causing depressive symptoms. For this, they may conduct some blood tests, MRI scans, and PET scans. 

Overall, the mental health practitioner will look for extreme sadness and fatigue triggered by your overall sleep cycle or external stressors. To fully meet the diagnostic criteria, the symptoms mentioned above need to be present for at least two weeks and should cause significant impairment every morning.  

Morning Depression Treatment

There are four types of treatments for individuals with Morning depression or major depressive disorder (MDD): Cognitive Behavioral Therapy (CBT), light therapy, Electroconvulsive therapy (ECT), and medications. All these three treatments aim to support individuals with Morning Depression to improve their quality of life psychologically, emotionally, occupationally, and physically. They also focus on improving their relationships, school, work, and social engagement that previously seemed frozen by their excessive melancholic mood. We will now look at each treatment in detail:

  1. Cognitive Behavioral Therapy (CBT): This consists of cognitive restructuring and exposure techniques to reduce morning depression and enable depressed individuals to cope more effectively with their sadness. CBT treatments also include psychoeducation for the child and the parents to better understand separation anxiety (7). Furthermore, the individual is taught about breathing retraining and progressive muscle relaxation. Research has shown that CBT is an effective treatment for depression. This type of therapy is also available as a group telephone-administered, and self-help therapy in which patients work through a standardized protocol independently (8). Research has also shown that these treatments are as equally effective for people suffering from chronic morning depression.
cognitive behavioral therapy cbt
  • Light Therapy: This is also known as a bright light therapy or phototherapy, which effectively treats people with morning depression. A lightbox is placed in front of the individual, which emits bright light, similar to the outdoor light. This exposure to light affects the brain’s chemical, which boosts a happy mood (9).
depression-light-therapy
  • Electroconvulsive therapy (ECT): With this treatment, electric currents are passed through the brain to deliberately activate a seizure. This passing of the current causes the brain to change its chemicals, which reduces depression. ECT is a fairly safe treatment done under general anesthesia, which means you’re asleep during the procedure. Research has shown that ECT is effective for morning depression, MDD, and other depressive disorders (10).
Electroconvulsive Therapy (ECT)
What is Electroconvulsive Therapy (ECT)?
  • Medications: Research has shown that several medications can effectively treat morning depression, such as selective serotonin reuptake inhibitors (SSRIs), anti-depressants, mood stabilizers, and antipsychotics. However, medications are not usually the preferred treatment type in children or adolescents with morning depression due to negative side effects. Hence, they are given when all other treatment options have failed. 

References

  1. Gili, M., Roca, M., Armengol, S., Asensio, D., Garcia-Campayo, J., & Parker, G. (2012). Clinical patterns and treatment outcome in patients with melancholic, atypical, and non-melancholic depressions. PloS one7(10), e48200. https://doi.org/10.1371/journal.pone.0048200
  2. Wirz-Justice A. (2008). Diurnal variation of depressive symptoms. Dialogues in clinical neuroscience10(3), 337–343.
  3. Tana, J. C., Kettunen, J., Eirola, E., & Paakkonen, H. (2018). Diurnal Variations of Depression-Related Health Information Seeking: Case Study in Finland Using Google Trends Data. JMIR mental health, 5(2), e43. https://doi.org/10.2196/mental.9152
  4. https://www.webmd.com/sleep-disorders/circadian-rhythm-disorders-cause
  5. Levandovski, R., Dantas, G., Fernandes, L. C., Caumo, W., Torres, I., Roenneberg, T., Hidalgo, M. P., & Allebrandt, K. V. (2011). Depression scores associate with chronotype and social jetlag in a rural population. Chronobiology international28(9), 771–778. https://doi.org/10.3109/07420528.2011.602445
  6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4. Washington, DC: APA Press; 2000. text rev.
  7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:  Author.
  8. Watts, S., Mackenzie, A., Thomas, C. et al. CBT for depression: a pilot RCT comparing mobile phone vs. computer. BMC Psychiatry 13, 49 (2013). https://doi.org/10.1186/1471-244X-13-49
  9. Oldham, M. A., & Ciraulo, D. A. (2014). Bright light therapy for depression: a review of its effects on chronobiology and the autonomic nervous system. Chronobiology International, 31(3), 305–319. https://doi.org/10.3109/07420528.2013.833935
  10. https://www.mhanational.org/ect

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