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Do people with depression experience worse symptoms at certain times of the day?

While people with depression can experience severe lows at any point during the day, many experience worse symptoms in the morning. When this happens, a person may find their energy and motivation is so low that even the act of getting out of bed early in the day feels impossible. These symptoms gradually improve over the course of the day, so that by early evening the individual may feel up to everyday activities such as cooking dinner, taking out the garbage, or even going out with friends.

Such significant changes in mood can be terribly demoralizing for a person with depression, as each evening they may think the symptoms of the illness are over, only to wake up the next day feeling as sad, empty, and unmotivated as ever.  It can also be very confusing to family members and friends who simply can't understand why, if their loved one seemed just fine last night, they are dragging again the next day.

Some studies suggest that the extreme fluctuations in mood, energy, and motivation present in many people with depression may be caused by a misalignment of the body's internal clock (physiological or behavioral changes that follow a roughly 24-hour cycle) and external time of day. These and other studies have led scientists to explore depression treatments focused on resetting the body's clock using such techniques as bright light treatment, sleep deprivation, and new antidepressant medications.

In general, any successful depression treatment — whether it be medication, bright light treatment, sleep deprivation, a depression-specific psychotherapy, or a combination of these treatments — will also be effective in stabilizing a person's mood.

References

Courtet P, Olie E. Circadian dimension and severity of depression. European Neuropsychopharmacology. 22, S476–S481(2012).

Li JZ, Bunney BG, Meng F, Hagenauer MH, Walsh DM, et al. 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 (2013).

Monteleone P, Martiadis V, Maj M. Circadian rhythms and treatment implications in depression. Progress in Neuro-Psychopharmacology & Biological Psychiatry. 35 1569–1574 (2011).

Pail G, Huf W, Pjrek E, Winkler D, Willeit M. Bright-light therapy in the treatment of mood disorders. Neurosychobiology. 64:152–162 (2011).

Salvatore P, Indic P, Murray G, Baldessarin RJ. Biological rhythms and mood disorders. Dialogues in Clinical Neuroscience. Vol 14 . No. 4 . (2012).

Wirz-Justice A. Diurnal variation of depressive symptoms. Dialogues in Clinical Neuroscience. 10(3): 337–343 (2008).

The Question Was Answered By

Professor of Psychiatry and Psychology
University of Pittsburgh School of Medicine

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