Depression worse in the morning

SAMHSA’s National Helpline | SAMHSA

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

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Last Updated: 08/30/2022

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The psychotherapist spoke about two types of depression that are treated differently

First of all, the psychotherapist draws attention to the fact that it is incorrect to call depression a bad mood or despondency. Depression has certain symptoms, the first, of course, is mood. With depression, it is reduced for more than two weeks in a row without a specific reason, a person experiences longing, guilt, and hopelessness. Also, citizens are faced with difficult thinking, unwillingness to show some kind of activity, it is difficult for them to get up in the morning, communicate, and go about their daily activities. Depression is characterized by sleep disturbance, a change in appetite, and in a short time people can lose 10-15 kilograms, but it also happens the other way around, when the appetite rises sharply.

But depression is different. Tatyana Karavaeva says that psychotherapists distinguish between endogenous and psychogenic depression.

The first type is caused by chemical processes in the brain, when the content of serotonin and other neurotransmitters decreases. Endogenous depression is characterized by early awakenings, when people wake up at 5-6 in the morning and no longer fall asleep, in the first half of the day they feel the worst due to a decrease in serotonin levels. Toward evening, the concentration of serotonin in the body grows, it becomes a little easier.

This type of depression is also characterized by masks, that is, unusual symptoms. Patients complain of pain in the heart, arrhythmia, heartburn, bloating, difficulty breathing. It is not easy to diagnose masked depression, people undergo many examinations by doctors in search of the cause of the deterioration in well-being.

Psychogenic depression of another kind. Its cause is life's difficulties, when a person loses a loved one, becomes unemployed, or, for example, gets divorced. If endogenous depression most often manifests itself in autumn or spring, then psychogenic depression is in no way connected with the season, the reason is exclusively in a negative event.

In case of psychogenic depression, a person cannot fall asleep for a long time because of disturbing thoughts, a bad mood haunts him regardless of the time of day, covers him with a wave of melancholy, relief comes only when he manages to get distracted.

If a person can cope with despondency or a bad mood, as a rule, on his own, then depression should be treated by a specialist, emphasizes Tatyana Karavaeva. This is especially true of endogenous depression, where the main method is the normalization of the balance of essential substances in the body. But drugs are also used in the treatment of psychogenic depression, they are an additional support for cognitive-behavioral psychotherapy.

It is also impossible for citizens to self-diagnose themselves, as a rule, there is no magic analysis that would accurately indicate depression, the symptoms of the disease are still individual, and even psychotherapists with extensive experience conduct a long survey of the patient to understand whether they deal with depression and, if so, what type it is.

Tatyana Karavaeva also does not recommend leaving depression without treatment. This disease, like many others, does not go away on its own, and over time, the symptoms can only get worse.

as for antidepressants/therapy, I would recommend always starting with therapy (except for a really serious clinic), in half of the cases after a month it becomes obvious that no antidepressants are needed here
with drugs, in general, everything is not easy. finding the right antidepressant for this person is sometimes a big problem, it can take months


You're absolutely right, I didn't put it very neatly. To take drugs or not is the choice of a person, based on consultation with his psychologist and psychiatrist. It makes sense to select the drug and the dose only with a specialist and nothing else, because there are quite serious side effects, the exit and entry into the cycle of taking are potentially dangerous. At the same time, there are people who are afraid of pills, like fire. Chemistry, damn it. And statistics is a stubborn thing, and not just the lobby of pharmaceutical companies. With the invention of the SSRI, the suicide curve plummeted. And yes, there are cases of acute depression where therapy just doesn't work.

You are also right that sleep is a complex phenomenon and it is difficult to say unequivocally what influences what. In principle, chronic sleep disturbances (for whatever reasons) cannot be accompanied by direct good health, since fatigue accumulates and general biology does not feel very good, to put it mildly. That is, it is important to sleep - enough and of high quality. You can’t replace sleep with caffeine and something else, you can’t deceive the body.

I think you're talking about the fact that after the therapy the morning depression itself (diurnal mood variation, PMV) disappears, and sleep and problems with it are a separate matter.

In principle, I really believe that everything is rather complicatedly connected. Physiology, psychology, etc. Sleep affects mood. And vice versa.

From: lokkova
2010-05-19 07:57 pm (UTC)

there are people who are afraid of pills. but there have already appeared (and in considerable numbers) people who "sit" on antidepressants for years and cannot imagine their life without them ((and there are those who choose pills instead of psychotherapy


2010-05-19 04:21 PM (UTC)

Here is a link to one of the studies, that combined therapy is more efficient each of the monotherapies separately. Specifically in this case, MDD in adolescents and the combination of CBT+SSRI were considered.

The edges are thin, there are conventions. Of course, your personal experience is more valuable than dry numbers. There are a lot of things people don't mention here, like the sustainability of the results. They investigated CBT, not psychodynamic therapy.

from: Waking_BEAR
2010-05-19 05:58 PM (UTC)

>>> In half the cases in a month, it becomes obvious that no antidepressants are needed here.

How much is a month, if measured in consultations? Thirty or, for example, four? From: lokkova
2010-05-19 07:50 pm (UTC)

I meant once a week, that is 4 meetings. but this is only for half of the cases and this is not a cure, but "it is clear that one can do without drugs"

If a person feels bad in the morning and feels good in the evening, or vice versa, then we are talking about a cyclothymic disorder. Such disorders, being a kind of mild form of TIR, are constitutional in nature. They are characteristic of cycloid accentuated people - people with a special type of nervous system structure. The "wavelength" of the difference in moods in cyclothymic disorder is different, short amplitudes (from several days to one day) are characteristic of labile-type cycloids.

From: alexey5351
2010-05-19 07:03 p.m. There are different opinions on this subject. There are quite specific articles, references in different versions of the DSM to diurmal mood variation and PMV, which are quite clearly correlated with MDD. The typification of people according to this or another sign is also a special matter, very ambiguous.

From: inconnue111
2010-05-19 06:10 pm (UTC)

to which I rightfully refer myself, ALL my life they wake up with difficulty and in a disgusting mood. :-( By dinnertime they come to terms with life, and in the evening they are cheerful and joyful like puppies on the lawn. That's how we live. :-) The biological rhythm is different. And you are cyclodias, cycloids. Why so?

From: alexey5351
2010-05-19 07:04 pm (UTC)

I would be uncomfortable.

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9004, AN AN

P. S. Anxiety, if persistent, seems to be a different symptom and a whole set of other conditions. That is, they are together, but generally speaking separate, no?

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2010-05-19 09:15 PM (UTC)
From: eojick_v_tumane
2010-05-20 06:36 pm (UTC)

, a mild form of MDP, are of a constitutional nature.They are characteristic of cycloid accentuated people - people with a special type of structure of the nervous system.The "wavelength" of the difference in moods in cyclothymic disorder is different, short amplitudes (from several days to one day) are characteristic of labile cycloids like. "This is treated with a shot in the back of the head or a light, contrasting sulfazine."
From such statements, although I understand with my mind that this is an ordinary medical typing, which they probably go through on the 1st course of honey,
I shrink internally, it becomes gray and hopeless, it seems that I have no right to life at all.
(And all decisions about the need for psychotherapy go away as if they never existed)
... What am I talking about at all, but to the fact that the topic of typing labels raised by Alexei 5351
is very important and relevant.
Diagnosis - leaves no choice.
A person without a choice cannot heal his soul.
He can be treated with medication and, with great luck, admitted to low-skilled work without liability.

9003 Thank you for your kind words To slightly balance the situation, I want to note that there are cases when diagnosis brings tangible benefits and simply saves people. Cases of acute depression and bipolar disorder that go undiagnosed and treated often result in self-medication with alcohol and drugs, sometimes with serious consequences. There is a documentary film by a famous English comedian about how he lived all his life with bipolar disorder, not knowing about it, what he did and how he coped. And how his life took a significant turn for the better after the diagnosis.

That is, I mean that the diagnosis does not always remove the choice. In principle, there is always a choice in a free society. Go to a specialist or not. To this or that. Listen to him or not. Therapy, pills, both, neither. Adults make decisions that often involve risk and are responsible for those decisions.

Specialists play a very important role in these decisions, because instead of gray uncertainty, which puts anxiety on top of everything else, at least some clarity comes. When a person has information, he can make his own decisions. When it is not there, it is more difficult to make decisions.

From: alexey5351
2010-05-20 07:49 pm (UTC)

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