A Time to Cry, and a Time to Laugh

By Neuroskeptic | August 10, 2010 12:25 pm

This was trending on Twitter last night:

I feel really groggy and tired in the middle afternoon, but awake and energetic late at night. #idothistoo

I don’t do Twitter but, ugh, fine, #idothistoo. However, in my case, the effect is sometimes more dramatic. If I’m in a depressive episode, my mood follows the same cycle, worse in the afternoon and better later in the evening, often to the point that some symptoms entirely disappear at nighttime.

In medical terms, this is called diurnal mood variation and it’s considered a hallmark of clinical depression. The classical diurnal variation is progressive improvement throughout the day; waking up is said to be worst, especially when you wake up in the early hours of the morning (so-called “late insomnia”).

In my experience, this is true but only when my depression is severe: I wake up two or three hours early feeling terrible, and then gradually improve. In milder episodes, I wake up at a normal time, or later than normal, and my mood is worse in the afternoon than the morning before recovering again.

Yet another phenomenon is the antidepressant effect of sleep deprivation. Staying awake the whole night often produces dramatic improvements in mood, though unfortunately the effect is transient and is lost when you do eventually fall asleep. This is unsurprising, if you think about classical diurnal mood variation: it’s almost as if mood improves in proportion to the length of time spent awake. Again, I can confirm this from my personal experience.

Why does all this happen? No-one knows; many neurotransmitters and hormones have a circadian cycle – the best known being cortisol but almost everything is affected to some degree. Clearly a great many people experience diurnal cycles of energy – as Twitter shows – and the variations in depression are, presumably, an extreme form of the same phenomenon. The case of the man with almost no monoamines is also interesting: his symptoms showed a diurnal course, though it was reversed – better in the morning.

Diurnal variation is one of the few good things about depression. It’s why the phrase “unrelenting misery” is not quite accurate: there is some relenting. You get to take a break, if only partial. It’s even been suggested that it might be beneficial to schedule psychotherapy for the late evening, to maximize the mental energy available, and I can see how this would work, though it would rely on your therapist not having anything to better to do that night.

When depressed I’ve made use of this by staying up much later than usual; I generally go to bed around midnight but during an episode this often becomes more like 2 am, so as to squeeze as many hours of relative normality into the day.

CATEGORIZED UNDER: antidepressants, mental health
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  • http://hierosolyma.wordpress.com veri

    OMG I think I'm depressed. All this time I though it was just my menstral cycle. I'm so confused now. I need to marry a psychologist. Dump him with all my problems before sleeping.

  • http://www.blogger.com/profile/02341540204488429731 Nick Cecchi

    i know anxiety and insomnia are closely related to depression and are often the symptoms that present for underlying depression – how do you think Anxiety, or General Anxiety Disorder or Agoraphobia fit into this model?

  • Art

    Has anybody done a PET/dopamine study for sleep deprivation in depression? This study suggests that extra release of dopamine is one of the compensatory mechanisms in sleep deprivation. That could explain improvement in mood.

    The other interesting question is the direction of causality between poor sleep and bad mood. I've chronic insomnia and for me it's pretty clear, poor sleep causes depression-like symptoms. I think this might be true for a lot of people. A number of longitudinal studies came out recently, see example, that indicate that insomnia is a more persistent condition that greatly increases the risk of depressive symptoms.

  • http://www.blogger.com/profile/08010555869208208621 The Neurocritic

    According to one recent study, the majority of depressed people with diurnal mood variation are actually worse in the evening:

    Of the 809 participants (96.7%) with DMV unrelated to environmental events, only 31.9% (N = 258) reported morning worsening, while 19.5% (N = 158) and 48.6% (N = 393) reported afternoon and evening worsening, respectively.

    Perhaps this has some relation to the metaphor, Dark Night of the Soul?

  • http://www.blogger.com/profile/14435500267078592636 moodindigo

    This comment has been removed by the author.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    moodindigo: Interesting. In my experience more melancholic features are definitely associated with DMV worse in the morning, worst of all when accompanied by early-morning waking.

    Whereas atypical features i.e. sleepiness mainly, are worst in the afternoon/early evening.

    Another thing that must be related, but that I've rarely seen discussed, are depressive dreams. I rarely have these and when I do it's generally a bad sign. By depressive I mean dreams based around rejection or failure etc. in which you really feel the associated pain (i.e. not just some random dream which happens to include failing to fly to the moon or something.)

    Dreams generally happen during the early hours of the morning. And the time when the brain's serotonin neurons are entirely switched off, is during REM (dreaming) sleep…

  • http://www.blogger.com/profile/08820607553556177222 SustainableFamilies

    So I once had a conversation with a… I wish I could remember his title. He worked a neurology clinic but he was not a neurologist… he was like a chiropractor of neurology…

    So are we all trusting of this random person of unknown titles advice yet?

    Anyway I have to say his advice was awesome. Which was simply to make yourself go to be close to when the son comes down and wake up when the sun comes up. When it's night keep your room pitch black which helps signal production of melatonin (supposedly?) and when waking up in the morning immediately walk outside into the light for at least 5 minutes or so signaling serotonin production (supposedly?).

    While I know it worked for me, I also know that means virtually nothing since placebos tend to work for stuff like this. Does it seem like my quack was on to anything?

  • http://www.blogger.com/profile/08820607553556177222 SustainableFamilies

    wow my dyslexia is off the charts.

    “make yourself go to bed” rather

    and sun, not son obviously.

  • http://www.blogger.com/profile/14435500267078592636 moodindigo

    This comment has been removed by the author.

  • Anonymous

    How much of DMV is inherent to the individual's biology and how much to just the order of society?

    I can imagine any number of external night features that might appeal to a depressed person — not knowing everyone else is being productive at work at that moment (and not being conspicuous in his non-productivity), not being molested by 100 passers-by, not being easily seen, etc.

    Is there any evidence that DMV folks on shifted sleep schedules feel better when they've been up longer, even when such times correspond to regular business hours?

  • http://www.blogger.com/profile/14435500267078592636 moodindigo

    This comment has been removed by the author.

  • Anonymous

    Congratulations on your excellent blog, which I just stumbled upon. I wonder if you – or anyone – can help me. It remains a mystery to me what exactly my problem is – some doctors say depression, others have hinted at mild bipolar. I have tried numerous antidepressants and am now on Lexapro (and have also started taking St. John's Wort). I wake up feeling fine, then suddenly, at around 4 or 5 pm, I feel VERY depressed, exausted, and sometimes in dispair. It's a very strange feeling and hard to describe – as if this 'cloud' comes over me or a 'switch' controlling my brain hormones is swittched 'off'. It´s a terrible feeling. Then, a couple of hours after, this TERRIBLE feeling starts to lift and in the evening I feel perfectly fine. However, it dispairs me to think that the same thing will happen tomorrow – and the following day etc. Is there any kind of neurological exam or other kind of medication which can help me with this? Thank you.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Anonymous: I can't say anything about your specific case, but this does sound a lot like my diurnal mood variation during “mild” phases. The low period is always in the afternoon, lasts 2 or 3 hours, and it has pretty clear start and end points. Yours sounds like it happens a bit later in the day than mine, mine tends to be more like 3 pm to 6 pm.

    Anyway the point it, it's not just you. Google afternoon depression, it happens to lots of people.

    Afternoon mood dips are a key feature of what people used to call atypical depression.

    In which case it's probably a case of finding the right antidepressant. This can take a while, but keep going…

    I've also noticed that the mood dips can be avoided if I get some kind of meaningful activity going before they start. Once you get into one, it's hard to snap out of it, but if I get busy with something, I often “don't have time” to go into one.

    It might also be a good idea to get tested for diabetes (glucose tolerance), and thyroid problems. These can cause symptoms at particular times of day.

  • Anonymous

    Thank you very much for your response. I just got a blood exam looking precisely for these things and it was fine, perfectly healthy. Have tried lots of different antidepressants (as well as Lamictal), but will keep on trying. Now I'm adding St John's wort and also will try homeopathy, in addition to antidepressants. I have found that if I exercise, especially prior to the time this happens, this mood swing is not as intense (endorphins?). When I posted my first comment I felt like the world was ending and now, just a couple of hours later, am starting to feel fine. Just the strangest thing. I'm sure in a couple of decades (hopefully in the near future) this suffering will be ended really quickly by some kind of surgeory which fixes the 'defective' brain synapse, hormone etc. Anyways, thank you again and I will keep following your excellent blog.

  • http://www.blogger.com/profile/05026223483117357541 usethebrainsgodgiveyou

    I was surprised to see you discuss your depression on your blog. I remember initially being ashamed to get my pills from the pharmacist, like they would KNOW, and that was a scary thought.

    You almost regard yourself clinically, and that may be what it takes for remission.

    I hope you find peace. Dammit, I hope I find it, too! You sure as hell aint alone.

  • http://www.blogger.com/profile/05026223483117357541 usethebrainsgodgiveyou

    Whoever said “Life is hard and then you die” was a blessed genius…

  • https://twitter.com/Johnwbh Johnwbh

    Amazing, my depression has followed this pattern for years but I never realised there was a name for it or it was a common thing. Thanks so much.

    Now what to do about it….

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Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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