Diurnal mood variation is a symptom of depression in which an individual regularly feels low in the morning and experiences an increasingly positive mood as the day progresses. This condition can also be referred to as morning depression. While it is possible that the cyclical nature of symptoms in this type of depression may discourage a person from getting help, it is important to speak with a licensed mental health professional when symptoms of severe depression come up consistently, even if they fade during different parts of the day.
Depression can present in different ways. Some people experience a depressed mood, while others may simply feel irritable. Some people can feel depressed throughout the day. Those with diurnal mood variation feel worse in the morning than they do at other times of day. Although the term diurnal mood variation is not used to describe a condition in the Diagnostic and Statistical Manual (DSM-5), the symptom is included under depression with melancholic features. Melancholic depression typically involves significant weight loss, loss of pleasure in nearly all activities, profound feelings of despondency or despair, early morning awakening, and morning depression.
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Diurnal mood variation differs from seasonal affective disorder (SAD), or depression with seasonal pattern as it is classified by the DSM-5. Individuals diagnosed with SAD are affected by the time of year, rather than time of day. SAD typically starts in the fall or winter and subsides by spring.
The circadian rhythm likely plays a role in diurnal mood variation. The circadian rhythm is an internal 24-hour clock that helps humans stay alert during the day and become tired at night. It dictates the sleep-wake cycle and impacts heart rate, body temperature, hormone secretion, energy level, and mood. When there is a disturbance in the circadian rhythm, hormones are produced at the wrong time of day, resulting in possible wakefulness at night and fatigue during the day. Research shows that many people with depression have a disturbance in their circadian rhythm, and this is believed to be especially true for people who experience morning depression.
People with diurnal mood variation usually have feelings of sadness, loss of pleasure, and low mood that are characteristic of depression in general. Additionally, they may experience trouble getting out of bed or an extreme lack of energy in the morning. They might also tend to sleep longer than normal, experience difficulty facing typical daily tasks (such as showering or making the bed), and face delayed cognitive function, or feelings of “fogginess” in the morning. As the day progresses, those with morning depression typically notice that their mood improves.
To diagnose diurnal mood variation, medical and mental health providers obtain information about sleep patterns and changes in mood over the course of the day. This helps them differentiate between diurnal mood variation and other specific variations of depression.
Once diagnosed, diurnal mood variation may be treated similarly to other forms of depression, through the use of therapy, medications, or a combination of both. Cognitive behavioral therapy (CBT) has been found to be effective in the treatment of depression, including morning depression. This type of treatment addresses thought patterns that could contribute to depressive symptoms. Medication may also be used in the treatment of diurnal mood variation. However, selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed type of antidepressant, are often not as effective for morning depression as they are for other types of depression. Rather, serotonin norepinephrine reuptake inhibitors (SNRIs) are often used to address diurnal mood variation.
Light therapy, or phototherapy, can also be used to treat morning depression. This type of treatment involves exposure to a light therapy box, which mimics natural light. This typically improves the disruption in circadian rhythm believed to cause diurnal mood variation.
Treatment providers may also recommend that individuals change their sleep habits to improve sleep and overcome morning depression. Common recommendations include avoiding caffeine, refraining from taking naps, maintaining a set bedtime and wake time, sleeping in a dark and cool room, and avoiding exercise a few hours before bedtime.
- Reluctance to seek therapy with morning depression: Leah, 39, thinks she is depressed but is confused about her symptoms. She has noticed that when she wakes up in the morning, intense feelings of fatigue and hopelessness make it immensely difficult to get out of bed. This is becoming an obstacle in Leah’s life because she must get out of bed early enough to get to work. As a result, her employer has spoken with her about her tardiness and asked her to work harder at being on time. As Leah finds that her energy and mood increase as the day progresses, she is reluctant to see a therapist, thinking her symptoms are not severe enough to seek treatment. However, her conversation with her employer causes her to realize that her difficulty getting out of bed in the morning is affecting other areas of her life, so she decides to bring her issue to a therapist, who diagnoses her with diurnal mood variation depression. Since the diagnosis, Leah has been able to utilize a combination of light therapy and counseling to reduce the disruption of her circadian rhythm and minimize her morning depression.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM 5 (5th ed.). Arlington, VA: American Psychiatric Publishing, Inc.
- Kerr, M. (2017, June 27). Morning depression: What it is and how to treat it. Retrieved from http://www.healthline.com/health/depression/morning-depression#Overview1
- Schimelpfening, N. (2017, January 31). What is diurnal mood variation? Retrieved from https://www.verywell.com/diurnal-mood-variation-1067149