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.