According to the World Health Organization, depression affects approximately 5 percent of adults worldwide (or 280 million people). Furthermore, according to this study published by JAMA Psychiatry, 10.4 percent of Americans have struggled with major depressive disorder during a 12-month period and 20.6 percent have dealt with a lifetime prevalence.
Some people with depression — and particularly major depressive disorder — have noticed that their symptoms are worse in the morning than in the afternoon or evening. Four common questions about morning depression are answered below, complete with additional information about the symptoms of depression, circadian rhythm, and medical advice for addressing this issue.
Table of Contents
(click on a question to be directed quickly)
Why is Depression sometimes worse in the morning?
What are the symptoms of Severe Depression?
How do you treat Morning Depression?
What role does Cortisol play in morning depression?
Why Is Depression Sometimes Worse in the Morning?
This medically reviewed article from Healthline Media (which is owned by the Red Ventures company and has a prominent “do not sell my info” option) explains that morning depression is also referred to as diurnal mood variation or diurnal variation of depressive symptoms.
For people struggling with this condition, circadian rhythm disruption is a common factor, according to this study published by PNAS.
The circadian rhythm is the 24-hour internal body clock that regulates the sleep-wake cycle and causes humans to feel tired at night and alert in the daytime. It also regulates other bodily processes, including heart rate, body temperature, mood, and cognition.
What Are the Symptoms of Severe Depression?
The following are some of the most common symptoms of severe depression and diurnal mood variation:
- Difficulty waking up or getting out of bed in the morning
- Very low energy when starting one’s day
- Difficulty performing simple tasks like taking a shower or making coffee
- Slowed physical or cognitive functioning
- Difficulty concentrating
- Becoming easily agitated or frustrated
- A lack of interest in activities one once enjoyed
- Negative thought patterns and feelings of emptiness
- Changes in appetite (eating more or less than usual)
- Hypersomnia (sleeping longer than normal)
Because people with major depressive disorder and morning depression often experience circadian rhythm disruptions, it’s important to note that they also tend to struggle with poor sleep. They may sleep longer than usual or be more tired, but that doesn’t necessarily mean they’re getting quality rest when their head hits the pillow.
How Do You Treat Morning Depression?
For most people who experience morning depression, the most effective treatment plan is multi-faceted and typically includes a combination of the following:
Talk Therapy
According to this study published by Ontario Health Technology Assessment Series, talk therapy — including cognitive behavioral therapy, interpersonal therapy, and supportive therapy — can significantly reduce depression symptoms.
Working with a therapist to evaluate triggers, change thought patterns, and develop healthy coping skills can be very beneficial, especially to those struggling with major depression.
Medication
Many people also notice significant improvements in their morning depression symptoms when they take antidepressants. Specifically, serotonin-norepinephrine reuptake inhibitors (or SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) for those who deal with morning depression.
According to this article published by Healthline Media, norepinephrine is a hormone that increases alertness and energy, so it makes sense that a drug that increases the availability of norepinephrine would be more effective.
Light Therapy
Light therapy utilizes a special device known as a lightbox or light therapy box. This box produces a bright light that mimics the natural light from the sun.
Being exposed to this kind of light alters brain chemicals and, per this article published by the International Journal on Disability and Human Development, can combat symptoms of seasonal depression. It may also help to increase alertness and improve mood in the morning.
Electroconvulsive Therapy
According to the American Psychiatric Association, electroconvulsive therapy (or ECT) is used in extreme cases with who have severe major depression and do not respond to other treatment options.
This therapy involves brief electrical stimulation to the brain while an individual is under anesthesia. For people whose morning depression is not helped by other, less invasive treatments, ECT may be the best choice.
Lifestyle Changes
Lifestyle changes may also help those with morning depression to reduce their symptoms and experience improvements in their mood. Some potentially effective lifestyle changes include:
- Sticking to a consistent bedtime and wakeup routine
- Eating meals consistently and at regular times
- Avoiding long naps
- Sleeping in a dark, cool, and quiet room
- Avoiding substances that interfere with sleep, including caffeine, alcohol, and tobacco
- Exercising regularly (but not too close to bedtime)
What Role Does Cortisol Play in Morning Depression?
An individual’s morning salivary cortisol levels may be an independent risk factor for major depressive disorder and diurnal mood variation.
Cortisol is the body’s primary stress hormone. It is produced by the adrenal glands and plays a key role in many bodily functions, including the following:
- Managing the use of carbohydrates, fats, and proteins
- Controlling inflammation
- Regulating blood pressure
- Increasing blood sugar levels
- Controlling the sleep-wake cycle
- Increasing energy to help people handle stressful events
In healthy individuals, the body naturally produces cortisol when the sun rises. This, in turn, gives people the energy they need to wake up and remain alert throughout the day.
If a person’s circadian rhythm is disrupted, which often happens in those with diurnal mood variation, they may feel tired in the morning and have trouble getting up and staying awake because they aren’t producing enough cortisol. They may also be producing melatonin (a hormone that causes one to feel tired) during the day.
References
World Health Organization: Depression
Hasin DS, Sarvet AL, Meyers JL, et al. Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States. JAMA Psychiatry. 2018;75(4):336–346. doi:10.1001/jamapsychiatry.2017.4602
Healthline Media: Morning Depression: What It Is and How to Treat It
Li, J. Z., Bunney, B. G., Meng, F., Hagenauer, M. H., Walsh, D. M., Vawter, M. P., … & Bunney, W. E. (2013). Circadian patterns of gene expression in the human brain and disruption in major depressive disorder. Proceedings of the National Academy of Sciences, 110(24), 9950-9955.
Health Quality Ontario (2017). Psychotherapy for Major Depressive Disorder and Generalized Anxiety Disorder: A Health Technology Assessment. Ontario health technology assessment series, 17(15), 1–167.
Virk, G., Reeves, G., Rosenthal, N. E., Sher, L., & Postolache, T. T. (2009). Short exposure to light treatment improves depression scores in patients with seasonal affective disorder: A brief report. International journal on disability and human development : IJDHD, 8(3), 283–286.
American Psychiatric Association: What is Electroconvulsive Therapy (ECT)?
Harris, T., Borsanyi, S., Messari, S., Stanford, K., Cleary, S., Shiers, H., . . . Herbert, J. (2000). Morning cortisol as a risk factor for subsequent major depressive disorder in adult women. British Journal of Psychiatry, 177(6), 505-510. doi:10.1192/bjp.177.6.505
Written By: Natalie T.
Medically Reviewed By: Dr. Kyle Zrenchik, PhD, LMFT
Last Updated : 04/18/2023
Disclaimer: ALL IN Therapy Clinic aims to improve people’s lives. We do this through providing effective mental health counseling by passionate professionals. Inspired by this, we write content for your own education. Also, our content is researched, cited, reviewed, and edited by licensed mental health professionals. However, the information we provide is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Additionally, it should not be used in place of the advice of a qualified healthcare provider.
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