Diurnal Mood Variation

The Link Between Morning Depression and Circadian Rhythm

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Diurnal mood variation, also known as morning depression, is a symptom of depression typically characterized by feeling worse (sadder, more lethargic) in the morning, but better as the day progresses. It may be caused by irregularities in a person's circadian rhythms.

This symptom often is associated with a subtype of major depressive disorder known as melancholic depression. Sometimes lifestyle or behavior changes can help a person cope with morning depression. Light therapy and/or medication also might help. 

Symptoms

Generally speaking, people with depression who have diurnal mood variation feel worse—sadder, gloomier, lacking in motivation—in the morning, but tend to perk up as the day progresses. There are lots of ways this tendency to feel more depressed in the a.m. manifests:

  • sleeping longer than normal, which is known as hypersomnia
  • trouble waking up or even getting out of bed
  • lethargy and lack of energy, making it hard to start or complete basic morning activities, such as making coffee or breakfast, showering, shaving, brushing teeth, getting dressed, and so on
  • feeling as though moving through a fog, leading to problems with focusing or concentrating
  • frustration or irritation
  • lack of enthusiasm about or interest in getting on with the day, even if there are pleasurable activities on the agenda

Causes

The cause of diurnal mood variation isn't fully understood, but it's thought to be related to a person's circadian rhythm—the natural pattern of variations in wakefulness, body temperature, blood pressure, and hormones that the body progresses through during the course of a 24-hour day.

It's not hard to understand how irregularities in these rhythms might play a role in depression. Even people who don't have a mood disorder can experience problems around how well or how long they sleep based on changes in circadian rhythm.

In fact, in vulnerable people, particularly those with depression, any irregularity in the internal clock, sleeping patterns, and external light and dark cues (when the sun rises and sets, for instance), can cause mood swings and instability. Even self-imposed inconsistency in sleep patterns (going to bed and getting up at different times) can impact a person's mood. 

On a positive note, research suggests that making changes to try to stabilize the relationships between such activities as sleep, wakefulness, eating, exercise, meal times, and the timing of medication can help decrease the impact of diurnal mood variation.

Treatment

It is unclear if depression causes circadian rhythm disturbances or if circadian rhythm disturbances help contribute to depression. Still, there are small changes you can make to try to help stabilize your circadian rhythm that may help.

  • Go to bed and get up at the same time every day.
  • Don't take naps. If you must take a nap, make it short.
  • Make your bedroom a place that is conducive to sleeping. Keep it quiet, cool and dark.
  • Don't do any activities in your bed other than sleep or have sex. Your brain associates your bed with what you do there, so if you are watching TV or playing games, it will be harder for your brain to shut down.
  • Avoid alcohol and caffeine before bedtime, as both can interfere with getting to sleep and/or the quality of sleep. The same holds true of tobacco: If you smoke, knowing that it might help your mood whether you have depression or not is one of many good reasons to kick the habit.  
  • Regular activity is important for helping to regulate mood and sleep well, but timing is key: Get in your daily workout at least four hours before you hit the hay.
  • Shut down all electronic screens, including the television and even your cell phone, at least one hour before bedtime. The light from these screens can trick the brain into thinking it's morning, making falling and staying asleep more difficult. 

    Phototherapy may be beneficial as well. Also known as light therapy or light box therapy, phototherapy involves shining full-spectrum bright light directly into the eyes. A person being treated with light therapy will either sit in a lightbox or be fitted with visor designed to expose the eyes to light. The light mimics natural outdoor light and may work by affecting brain chemicals that are associated with mood. Phototherapy is used to treat an array of medical problems, most notably bipolar disorder, as well as sleep disturbances such as insomnia, schizoaffective disorder, and premenstrual syndrome. 

    Certain medications used to treat depression may also relieve diurnal mood variation—specifically, serotonin-norepinephrine reuptake inhibitors (SNRIs). Examples of SNRIs include Cymbalta (duloxetine), Fetzima (levomilnacipran), and Pristiq (desvenlafaxine). These drugs block the reabsorption of two brain chemicals—seratonin and norepinephrine—so that more of these neurotransmitters remain available in the brain.  

    Research suggests that a so-called atypical antidepressant, agomelatine, might be even more effective in treating diurnal mood variation in major depression. This drug, which is sold under the brand name Valdoxian in Great Britain but isn't yet available in the United States, is a synthetic form of the hormone melatonin. It seems to help improve sleep patterns in addition to helping to release of norepinephrine and dopamine.

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