# Morning Depression



## David Baxter PhD

*Why do I wake up depressed?*
By Rachel Nall, RN, BSN, CCRN, _MedicalNewsToday.com_
June 15, 2018                                                

There are many types of depression. Some, called diurnal variations, involve symptoms getting worse at certain times of the day.Symptoms of depression  can include feelings of helplessness, sadness, and hopelessness, and  these may be worse in the morning. The common term for this diurnal  variation is morning depression.

      Diurnal means that symptoms seem to occur or grow more severe every  day at around the same time. For some people, this happens in the  afternoon or evening.

*Symptoms of morning depression*
_Symptoms of depression can include diminished or no enjoyment in activities and difficulty sleeping._ 

      A person with morning depression will have the diagnostic symptoms of  major depressive disorder. These symptoms will arise or, more often,  intensify in the morning.

      The symptoms may dissipate or feel less severe as the day goes on.

      Doctors diagnose depression according to criteria listed in the _Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition_ (DSM-5).

      To receive a diagnosis of depression, a person must experience five or more of the symptoms listed below for 2 weeks or more.

      A defining aspect of the condition is a depressed mood or a loss of interest or pleasure in activities once enjoyed.

      Other symptoms include:


a depressed mood lasting for most of the day, almost every day, though it may be worse at certain times of day 
diminished or no enjoyment in nearly all activities 
significant weight loss without effort or a decrease in appetite 
difficulty sleeping or sleeping too much 
restlessness throughout most days of the week 
 fatigue or a feeling of no energy throughout most of the week 
feelings of worthlessness or excessive guilt 
difficulty concentrating, thinking, or making decisions throughout most of the week 
recurrent thoughts of death, suicide, or self-harm 
 In addition, a person with morning depression may notice the following symptoms:


difficulty waking up in the morning 
physical difficulty getting out of bed 
frequent over-sleeping 
difficulty thinking clearly, especially in the morning 
difficulty completing regular morning tasks, such as getting dressed and brushing the teeth 
 In a person with morning depression, these symptoms will reduce or disappear as the day progresses.

*Causes*
      Doctors have not identified a specific cause of morning depression, but there are many contributing factors.

      Because morning depression occurs at around the same time every day,  doctors often connect it to imbalances in a person's circadian rhythm.

      The body's circadian rhythm is a process that signals the sleep-wake  cycle, among other things. Hormonal changes throughout the day can  influence the circadian rhythm. One of these hormones is melatonin,  which makes a person sleepy.

      While people who are not clinically diagnosed with depression often  experience changes in mood throughout the day, those with morning  depression seem to have more pronounced highs and lows that occur daily  or almost every day.

Some research suggests  that imbalances in a person's internal body clock and the amount of  sleep and light exposure could lead to mood changes, especially in those  with depression.

      Beyond changes to the body's natural rhythms, several other factors  may contribute to morning depression and major depressive disorder.  These factors include:


a family history of depression 
past or ongoing drug or alcohol addiction 
medical conditions that can affect a person's mood, such as sleep disturbances, chronic pain, anxiety, and attention deficit hyperactivity disorder (ADHD) 
recent changes in life circumstances, such as divorce or loss of a loved one 
trauma 
*Diagnosis*
      Doctors begin to diagnose depression and any diurnal variations, such  as morning depression, by asking a person about their symptoms.

      They may ask questions about changes in mood, sleep, weight, and  appetite. The doctor will attempt to establish how long these symptoms  have lasted and whether they are improving or getting worse.

      They will also try to rule out other possible causes, such as a medical condition that can cause similar symptoms. Hypothyroidism is one example.

      Some medications can also lead to mood changes and symptoms of  depression, so a doctor will also ask about any drugs a person is  taking.

*Treatment*
      Anyone having suicidal thoughts or thoughts of self-harm should seek emergency medical attention. A doctor can help to provide immediate and continuing care.

      Many treatments for depression exist. They include:


 *Psychotherapy*: This can help a person to recognize  negative thought patterns and learn positive behaviors. Group or family  therapy can help to strengthen relationships. 
 *Medications*: Among those that can help are  anti-depressants, mood stabilizers, and antipsychotics. It may take time  and some trial-and-error to find the right drug and dosage. 
 *Exercise*: Getting regular exercise, especially  outdoors, can help to reduce mild to moderate depression symptoms.  Exercising outside can be especially beneficial for people with morning  depression, as it may reduce insomnia and ensure plenty of exposure to natural light. 
 *Brain stimulation therapies*: While rarely a first-line  treatment, brain stimulation therapies, such as electroconvulsive  therapy and repetitive transcranial magnetic stimulation, may reduce  symptoms of severe depression. 
 Some people also benefit from alternative therapies, including acupuncture, meditation, and yoga. While these can help people to feel better and maintain good mental health over time, they should not replace medical treatment for major depressive disorder.

*Coping*
      While pursuing medical treatments, a person may wish to adopt habits  that can help them to cope with symptoms. Positive changes can include:


 *Improving sleep hygiene*. A person can help to promote  better-quality sleep by darkening the bedroom, keeping the temperature  cool, and eliminating distractions from screens, such as those on cell  phones, computers, and televisions. 
 *Preparing for the next morning at night*. Setting out  clothes and items for work or school, and putting together lunches in  advance can make mornings easier if a person has little motivation or  energy when they wake up. 
 *Getting enough rest*. Going to sleep and waking up at the same times, and trying to get 8 hours of sleep per night can improve symptoms. 
 *Allowing for extra time in the morning*. Waking up earlier or adjusting a work schedule to start later, if possible, can relieve pressure and stress in the morning. 
 *Using light cues*. Light can communicate to the body  that it is morning and time to wake up. Opening the curtains right away  or timing an overhead light to turn on at the same time every day can  help the body to wake up. 
 A doctor or therapist can make individual recommendations based on a person's symptoms and needs.

*Outlook*
      According to some research, morning depression is a common form of diurnal depression.

      If a person has morning depression, medical treatments and support are available to help.


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