In this brief blog, we will discuss endogenous depression, what causes it and what symptoms you can look out for.
Depression can be a very hard thing to deal with. Most people will fall into depression for reasons they don’t know or fully understand whilst others will fall into depression due to traumatic and stressful events they have experienced. This could be the loss of a family member, experiencing dangerous events such as armed robberies, accidents or even being involved in active combat. There are many reasons why someone may find their self-suffering from depression. Depression can come and go based o the events we experience but it can also last for very long periods of time. If you find that you are suffering from depression and you have been suffering from it for a very long period of time then you may want to seek a medical assessment from a suitable doctor or mental health professional.
What is endogenous depression?
Endogenous depression (also known as melancholia) is a type of major depressive disorder( clinical depression) and a mood disorder. It occurs due to the presence of an internal (cognitive, biological) stressor instead of an external (social, environmental) stressor. You will rarely see endogenous depression being diagnosed these days so if you feel you have endogenous depression then you may need to diagnose it yourself.
Endogenous depression is now diagnosed as a major depressive disorder which is a clinical depression which is known by symptoms such as an intense and persistent feeling of sadness for a long period of time. These symptoms will then cause your mood to be low and your sleep and appetite to be unusual. If this is beginning to sound more and more like you then you may want to get a medical assessment from your doctor or mental health expert.
What causes endogenous depression?
Endogenous depression can occur without the presence of a stressful or traumatic event. This means it can occur for no reason at all. It is thought to be caused by biological and genetical factors and is often referred to as . “biologically based” depression
A large majority of society suffer from endogenous depression but the main cause of endogenous depression isn’t yet known.
As of now, depression is thought to be caused by:
- psychological factors
- environmental factors
- genetic factors
- biological factors
Endogenous depression can be caused by a lot of things. This could be live events such as a death in a family, the end of a relationship with a friend, the loss of a job or another traumatic event such as the events of war or witnessing extreme violence.
Endogenous depression won’t always be caused by a particular event. In some cases, endogenous depression may be caused by nothing at all and will last for a short period of time before ceasing.
What is reactive depression?
Reactive depression is a category of clinical depression. It is depression which has come about due to events in someone s life. This could be severe life events such as witnessing extreme violence etc. reactive depression is different from the normal grief people may face.
What is the difference between endogenous depression and exogenous depression?
In the past endogenous depression and exogenous depression were characterized by the absence of a stressful event which caused the depression.
Endogenous depression will occur without any obvious signs of trauma or signs of stress. This type of depression has now been thought to be caused by genetic and biological factors. In so many ways it is classified as a biologically based depression.
On the other hand, it can also be caused by a stressful or traumatic event which has taken place. Exogenous depression often seems as a reactive type of depression.
In the past, mental health counsellors would have differentiated between exogenous depression and endogenous depression but they are now broadly classed as Major depressive disorders.
What are the main symptoms of endogenous depression?
As endogenous depression may be caused with no apparent reason, this means your symptoms may come about out of nowhere. The number of symptoms you may face will differ from one person to another and will also differ in there severity from one person to another.
The symptoms of endogenous depression include?
- You may have no appetite for food or may start eating way too much
- You may have a lot of muscle aches
- You may experience a lot of thoughts about suicide
- You may be fatigued
- You may have no motivation
- You may have trouble sleeping or staying asleep
- You may constantly feel sad or hopeless
- You may be socially isolated
- You may have no interest in doing any activities, hobbies and other things that you once liked
- You may have a low sex drive
- You may have constant headaches
- You may have trouble making decisions, thinking or concentrating
The symptoms of endogenous depression above will also be some of the symptoms of major depressive disorder.
How do you diagnose endogenous depression?
If you think you are suffering from endogenous depression then you should see a mental health counsellor or expert to diagnose your case. If you are under 18 you may be able to get help for this by speaking to CAMHS, a mental health service provided for under 18s by the NHS in the UK.
Your mental health expert will want to know your:
- Medical history
- Any medication you are currently taking or have recently taken in the past
- Any traumatic events you may have recently experienced
- What you think are the symptoms which you are facing
- If any of your family members have suffered from endogenous depression before
- Any mental health conditions you have faced in the past
- When you started experiencing the symptoms which you are facing
- Did the symptoms of endogenous depression begin after you experienced a stressful or traumatic event
Your mental health expert may also give you a mental health questionnaire to see how you are currently feeling and if you have a major depressive disorder.
To be diagnosed with a Major Depressive Disorder you will need to meet certain criteria which are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The Diagnostic and Statistical Manual of Mental Disorders (DSM is used by most mental health experts to diagnose most mental health conditions.
One of the main signals used to determine if you have a major depressive disorder is if you have a low or depressive mood and have lost interest in activities which you had liked to d before.
The Diagnostic and Statistical Manual of Mental Disorders (DSM had been used to differentiate between endogenous depression and exogenous depression but this is no longer done. Endogenous depression is now diagnosed if there are any signs of a major depressive disorder.
How to treat endogenous depression?
Endogenous depression is hard to treat as the symptoms cannot always be traced and tackled.
Endogenous depression can be treated by:
- Lifestyle changes
- Electroconvulsive therapy
Lifestyle changes can be used to treat endogenous depression as they may help tackle hobbies or things which you used to like but no longer do. Lifestyle changes may also encourage more social interaction. The aim of lifestyle changes as a means to treat this type of depression will be to tackle some of its symptoms. By encouraging lifestyle changes your mind and body may see new changes which are beneficial and uplift your mood.
Some of the lifestyle changes you make include:
- Ensuring you get at least 7 hours of sleep each night
- Make sure you eat 3 times a day with a balanced meal
- Keep a journal
- Be more social, go out with your friends etc
- Do more activities which you would have done in the past
You may be able to treat endogenous depression by using psychotherapy which is known as talk therapy. Talk therapy involves having a meeting session with a mental health expert and discussing what is happening with you and how it is making you feel etc. You will have to meet with your mental health expert on a regular basis
There are two main types of psychotherapy. These are cognitive behavioural therapy (CBT) and interpersonal therapy (IPT).
Cognitive behavioural therapy can be used as a method to identify your negative thoughts and thereby find ways to address each of your negative thoughts. Cognitive behavioural therapy will help you find some positives and reduce your negative thoughts.
Interpersonal therapy may help if your endogenous depression has been brought about due to any relationships you may have had.
In most cases, a combination of medication and therapy is effective in treating people with endogenous depression and in effect Major Depressive Disorders.
Medication can be used to treat people with endogenous depression. Some f the medications used to treat endogenous depression and people with major depressive disorders include selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs).
Some mental health experts may also prescribe their patients with tricyclic antidepressants (TCAs), but these drugs aren’t used as often as they once used to be. These medications increase levels of certain brain chemicals that result in a decrease in depressive symptoms.
Selective serotonin reuptake inhibitors are a type of antidepressant medication that may be taken by people with Major depressive disorders including panic attacks, depression and anxiety.
Examples of selective serotonin reuptake inhibitors include:
- escitalopram (Lexapro)
- citalopram (Celexa)
- paroxetine (Paxil)
- fluoxetine (Prozac)
- sertraline (Zoloft)
Selective serotonin reuptake inhibitors will usually have side effects which you will usually face at an extreme level in the first 2 weeks of you taking these types of antidepressants. The side effects will become much better and you will begin to see the benefits of taking these types of antidepressants after 4 to 6 weeks.
Selective serotonin and norepinephrine reuptake inhibitors are another type of antidepressant medication that can be used to treat people with endogenous depression and by default Major depressive disorders.
Examples of selective serotonin and norepinephrine reuptake inhibitors include:
- duloxetine (Cymbalta)
- desvenlafaxine (Pristiq)
- venlafaxine (Effexor)
In some cases, tricyclic antidepressants might be used as a treatment method for people with endogenous depression and by default major depressive disorders. Examples of tricyclic antidepressants include:
- imipramine (Tofranil)
- nortriptyline (Pamelor)
- trimipramine (Surmontil)
TCAs can have much more serious side effects than other antidepressants.
Some side effects of TCAs include:
- weight gain.
If you are unsure about the TCA you have been prescribed then ensure you discuss these concerns with your pharmacy or doctor. If you also find that you are experiencing severe symptoms then you should discuss this with your pharmacy and doctor as well.
If you also feel the medication isn’t working or you are getting worse then you should also report this to your doctor or pharmacy. If your symptoms don’t seem to be improving you should still continue taking your medication and should not stop until your doctor tells you to. Your doctor may then a combination of medication for you or switch you to a different treatment.
Stopping your medication abruptly could lead to severe withdrawal symptoms.
If you feel the medication is working for you, you should also not stop taking it either.
In some cases, it can take up to 12 weeks to see an improvement in symptoms.
Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT) is one way of treating endogenous depression. It could be used if medication and therapy don’t seem to be reducing your endogenous depression symptoms.
ECT involves attaching electrodes to the head that send pulses of electricity to the brain, triggering a brief seizure. At first glance, it may sound like a scary procedure but it is much safer than first thought and has been used to treat people with endogenous depression by changing the chemical interactions in their brain.
Can you get better with endogenous depression?
Yes, you can get better with endogenous depression through treatment but not everyone will react to endogenous depression treatments. Some people will see their endogenous depression treatments get better if they simply stick to their treatments whilst others will not need any form of treatment to see their endogenous depression symptoms slowly fade away.
Some people may need to try several different forms of antidepressants and treatment options before their symptoms begin to fade away.
Some people will have to be on their medication and undergo treatments for their endogenous depression for long periods of time whilst others may seem that their n symptoms fade after a few weeks or months of treatment.
You should always continue taking your treatment unless your doctor has asked you to stop. If you abruptly stop taking your medication you may find that the symptoms reappear and you may also face withdrawal symptoms if you are taking an antidepressant.
Conditions which may be related to endogenous depression?
Below are some of the conditions which may be related to endogenous depression. It is important that you do not self diagnose yourself but seke the help of a mental health expert.
- atypical depressive disorder
2 postpartum depression
3 bipolar disorder
4 schizoaffective disorder
5 alcohol abuse
6 social phobia
7 bipolar disorder
9 tobacco addiction
10 temporal lobe epilepsy
If you are suffering from depression, anxiety, loneliness or any similar mental health issue then seeking help for it may be a good option. Mental health issues such as depression, loneliness and anxiety can affect anyone of us.
If you are under 18 then CAMHS, an NHS run programme may just be the answer for your mental health struggles.
You should look to see if you meet the CAMHS referral criteria and then fill in the CAMHS referral form.