Why Am I Depressed at Night?

Feeling “down” or “low” is a normal part of life, and can come and go at different times of the year or even different parts of the day. This is particularly true for teens and young adults. Development during adolescence and young adulthood is a time of self discovery and exploration–but can also be a time of extremes in emotion. If you find yourself feeling “blue” more often than not, it is possible that you may be suffering from depression. 

Many individuals with depression report their symptoms worsening at nighttime, which can affect their ability to get the proper rest they need in order to function during the day. This can create a dangerous cycle of fatigue, discontentment, and frustration, which can then continue to exacerbate depression. This article will give an overview of depression, explore the proposed reasons why symptoms seem to worsen at night, and provide some helpful suggestions to help manage nighttime depression.

What is depression?

Depression is a mental health disorder that can manifest itself in many different ways. The most common symptom is low mood and irritability. This usually causes a person with depression to find it difficult to engage in activities that they normally find enjoyable. In the United States, depression affects approximately 14.8 million adults, and 4.1 million adolescents aged 12 to 17. It is one of the most common mental health disorders in America. The DSM-5 defines depression as a period of at least two weeks in which a person experiences a depressed mood or loss of interest or pleasure in daily activities and experiences many other specified symptoms.

These symptoms may include:

• decrease or increase in weight
• decreased or increased sleep
• appearing slow or agitated
• fatigue or loss of energy
• feeling worthless or guilty
• poor concentration or indecisiveness
• thoughts of death or suicide plans or suicide attempts

After experiencing the loss of a loved one, undergoing an overwhelming period of stress in your life at work or school, or going through a breakup, it is understandable that you might begin to feel somewhat depressed. However, if this feeling persists for more than two weeks and starts to affect your ability to function on a daily basis, it may be more than simple heartache, sadness, or stress. Interestingly, for some people, depression can present without an apparent reason why. Depression often begins in a person’s teens, twenties, and thirties, but can happen at any point in a person's life. There are identifiable risk factors for depression.

Risk factors for depression include:

• Certain personality traits, such as low self-esteem and being too dependent, self-critical, or pessimistic
• Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a toxic relationship, or financial problems
• Family history of depression, bipolar disorder, alcoholism, or suicide
• Being LGBTQIA+ and lacking acceptance or support from family, friends, or community 
• History of other mental health disorders, such as anxiety disorder, eating disorders, or post traumatic stress disorder
• Abuse of recreational drugs and/or alcohol 
• Serious or chronic illness, including cancer, stroke, chronic pain, or heart disease
• Certain medications, such as some high blood pressure medications or sleeping pills 

Living with depression can be incredibly difficult, and can affect a person’s ability to engage in life in the way they desire. Furthermore, due to the stigma surrounding mental health, nearly 60% of people with depression do not seek medical help. It is common for teens and young adults in particular to experience variations in mood that can feel overwhelming, but if you are experiencing any of the symptoms listed above for an extended period of time, it is best to seek help from a mental health professional. 

Why do I get depressed at night?

Many people with depression experience an increase in the severity of their symptoms at night due to a combination of lifestyle choices and personal biology and brain chemistry. The following sections will offer some explanations as to why nighttime depression seems to be so common, and offer some tools to help you if you are experiencing an increase of your symptoms during the nighttime hours. 

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Mood and the circadian rhythm 

Human beings show a wide range of physiological changes throughout a twenty-four-hour period. These daily cycles are known as our circadian rhythm, which helps to regulate our core body temperature, secretions of hormones such as cortisol, activity in many of our organs, sleep-wake cycles, and even our mood. Dr. Anna Wirz-Justice, a chronobiologist from the Psychiatric Hospital of the University of Basel, Switzerland explains in an interview with Newsweek, “It is normal to have some mood changes throughout the day, but this high and low is exaggerated and worse in those with depressive symptoms.”

Our mood, alertness, and ability to perform certain tasks increase with the rising of our core body temperature, which begins in the morning and reaches a peak in the late afternoon. If you are someone that is prone to depressive symptoms, due to the circadian rhythm ramping down your core body temperature, energy, and mood during the nighttime hours in preparation for rest and sleep, these feelings can become more severe during this time period. Wirz-Justice explains that nighttime is when most people’s mood is at its lowest, and for people with depression, this can bring them even lower, increasing the seriousness of their already difficult-to-manage symptoms.  

Alterations in the sleep-wake cycle

One of the best ways to combat issues surrounding depression at night and its relationship to our circadian rhythm is to improve your sleep hygiene. Dysregulation of the circadian rhythm (i.e. staying up at night or sleeping during the day) can cause serious mental health issues and can worsen your depression. As a matter of fact, research suggests that night owls are more likely than early risers to experience psychological disturbances. This is best exemplified by the fact that individuals who engage in shift work (working outside of the traditional 9-5 hour workday), are 28% more likely to experience mental health problems than people with consistent weekday work schedules. 

Trying to get consistent, quality sleep is one of the best things you can do for your mental health. For most people, their natural circadian rhythm is aligned closely with the rising and setting of the sun. According to Wirz-Justice, trying your best to align your sleep schedule with your natural circadian rhythm can help improve your overall well-being. Here is a list of tips provided by the CDC to help get better quality sleep:

• Be consistent. Go to bed at the same time each night and get up at the same time each morning, including on the weekends.
• Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature.
• Remove electronic devices, such as TVs, computers, and smartphones, from the bedroom.
• Avoid large meals, caffeine, and alcohol before bedtime.
• Get some exercise. Being physically active during the day can help you fall asleep more easily at night.

Rumination, isolation, and insomnia 

Everyone has had the experience of laying in bed at night and not being able to fall asleep due to racing thoughts.  For individuals with depression, this particular time can be a difficult one. During this time their feelings of guilt and shame seem to be at the forefront of their mind, and they may have a difficult time focusing on anything other than negative thoughts. This type of thinking is known as rumination and can exacerbate an individual's depressive symptoms and their ability to find sleep during the nighttime hours. In a study on the subject of rumination and sleep, Dr. David A. Kalmbach and Dr. Vivek Pillai explain, “Individuals having difficulty falling or staying asleep may be especially vulnerable to intrusive thoughts given that the inability to sleep creates a period of unstructured time in bed at night marked by social isolation and limited behavioral distractions…”

For many people, bedtime is a time of solitude. There is a great deal of research to suggest that social isolation can have negative effects on your overall health and well-being. In fact, Julianne Holt-Lunstad, Ph.D., a professor of psychology and neuroscience at Brigham Young University, found that a lack of social connection heightens health risks as much as smoking 15 cigarettes a day or having alcohol use disorder. Her work in the field has shown that social connection is crucial link between emotional and physical well-being. 

One of the most difficult parts of suffering from depression is the isolation and loneliness. One of the defining features of depression is the loss of interest in activities that at one point brought joy and happiness. For a person with depression, getting together with friends and family could feel like the last thing on earth that they would want to do, even when doing those things at one point brought them a great deal of happiness. This can create a type of social isolation and loneliness throughout the daytime that continues into the night, when there are hypothetically less distractions (such as schoolwork, your job, chores, or the company of others) to keep the negative thoughts from taking over. Furthermore, the frustration and anxiousness that arises from not being able to fall asleep and get a proper night's rest in order to be prepared for the next day only make it harder to fall asleep. 

The Anxiety and Depression Association of America offers some insight into how to ward off the loneliness and rumination that comes with depression at night: 

Journaling

Writing down recurring negative thoughts or feelings during the day time hours can help tackle some of the negative thinking that might keep you up later at nighttime. Writing can help you to identify any distorted thinking and maladaptive behaviors and give you an opportunity to adjust.

Challenge your thinking

Ask yourself if there is any truth behind the negative thinking that you are engaging in during the nighttime hours. For example, if you are caught up thinking about how “no one likes you”, ask yourself if this is really the case. It is almost a guarantee that the answer will be no.

Limit rumination

Excessively rehashing thoughts, memories or moments in time are a part of depression during the nighttime hours. Try being more aware when it happens and redirect yourself by thinking of more positive things. With practice, this will become easier to do. Meditation and deep breathing can be helpful in this practice. 

Stay connected

Depression can drive you to isolate yourself from your loved ones, and distance yourself from the things you once liked to do. It can be helpful to reach out to your friends and family and explain to them what you are going through, and offer them suggestions on how they can help. In doing so, you will hopefully recognize that you are really not alone and that you have a support system. 

Avoid blue light exposure

Many young people turn to their phones when they are having a difficult time falling asleep in bed or are feeling particularly lonely or depressed. Unfortunately, there have been countless studies that have shown that exposure to blue light, the type of light that is emitted by your phone, before bedtime has a negative effect on your ability to fall asleep, and can cause a litany of other negative health consequences. For this reason, while you may be laying in bed unable to fall asleep, feeling lonely and depressed and have the inclination to jump on social media to distract yourself for a little while, the exposure to the screen light on your phone will only make it harder to fall asleep later on. The National Sleep Foundation recommends that you should cut off-screen time at least 30 minutes before bedtime. It should be noted that excessive mobile phone use has been linked to symptoms of depression and anxiety, so choosing to read a book instead of looking at your phone when you can not fall asleep can be a much better option if you are looking for a distraction.

How Charlie Health can help

Unfortunately, living with depression can make it difficult to seek help, especially if your sleep patterns have been disturbed due to worsening depression symptoms at night. Finding the motivation to make a phone call in order to connect with a licensed therapist can feel like an insurmountable task. That being said, based on recent research, the mental health community estimates that 80% of people with depression feel better once they’ve started treatment, so if you identify with any of the symptoms and behaviors highlighted above, just know that help is available and that you can feel better in time. 

At Charlie Health, our virtual IOP that can help with depression includes:

• Individual therapy
• Supported groups
• Family therapy 

What works for one patient may not be sufficient for another. It’s essential to work with a qualified mental health care provider to get a personalized care plan to fit your needs. Our virtual IOP allows teens and young adults struggling with depression and other serious mental health issues to access care from the comfort of home. We have Admissions team members available 24/7. Reach out today to get the help you need.