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Major depressive disorder: afternoon and evening diurnal mood variation is common

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Madhukar H Trivedi

Correspondence to: Madhukar H Trivedi, MD, Mood Disorders Program & Clinic, Department of Psychiatry, University of Texas Southwestern Medical Center, Exchange Park Express, American General Tower, 6363 Forest Park Road, Suite 13.354, Dallas, Texas, USA;



How common is diurnal mood variation (DMV) and how do patients with classic DMV (morning worsening) differ from those without it or from those with afternoon or evening worsening?


3744 outpatients aged 18–75 years with non-psychotic major depressive disorder (score ⩾14 on HAM-D-17) who were also enrolled in the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study. People with schizophrenia, schizoaffective disorder, bipolar disorder, anorexia nervosa, obsessive compulsive disorder or bulimia nervosa were excluded.


Primary and psychiatric care sites in the public and private sectors; time period not stated.


Clinicians used their judgement and the DSM-IV-TR diagnostic checklist to diagnose depression. Participants were assessed at baseline with the Inventory of Depressive Symptomatology-Clinician-rated (IDS-C-30) scale, to determine presence of DMV and when mood is lowest. Only those …

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  • Source of funding: National Institute of Mental Health.