Endogenous Depression: An internal cognitive or biological depression

We all get down in the dumps every once in awhile, but what happens if this lasts for long periods of time? It might be endogenous depression, however, what is endogenous depression and what are the symptoms, causes, and treatments? How does it affect our brains and what are some tips to help prevent it? In this article, you will find a full guide to everything you need to know about endogenous depression, including tips on how to prevent it. 

Endogenous depression
Endogenous depression

What is endogenous depression?

Endogenous depression (melancholia) is a type of major depressive disorder (MDD) and mood disorder. It’s rarely diagnosed as endogenous depression now and more often diagnosed as a major depressive disorder, also known as clinical depression. It’s a depression known for its constant and intense feelings of sadness for long periods of time. These feelings end up having a negative impact on behavior, mood, and physical functions such as appetite and sleep. Roughly 7% of adults in the U.S. go through endogenous depression each year. The word “endogenous” means “to grow from within”. “Endo-“ meaning “within” and “-genous” meaning “producing”.

Difference between endogenous depression and exogenous depression

Endogenous depression comes from the Latin background “from within” and comes from an internal cognitive or biological factor. For example, a family history of depression. Exogenous depression, also known as reactive depression, comes from the Latin background “from without” and comes from an external stressor such as a traumatic event or stress. Unlike endogenous depression, a lack of physical depressive symptoms such as lack of appetite and sleep doesn’t occur.

It was thought that the two types of depression should be treated differently, but as it turns out, they can and are treated with the same treatments- psychotherapy and medication. However, a 2012 study found that there are different pathways in the brain that are in charge of both types of depression. While the results are early and there is more to explore, they might mean that the different types of depression will be treated in different ways in the future.

Symptoms of endogenous depression

The symptoms of endogenous depression vary between types, frequency, and severity. It commonly appears out of nowhere. Coming from social, biological, cognitive, and environmental factors, constant feelings of sadness and distress arise.

Since some symptoms can be attributed to a biological factor, the rates of endogenous depression tend to be higher in adults. However, it can occur in people of all ages. Many of the symptoms in younger people and children who suffer from endogenous depression tend to go untreated. In many cases, people are unable to identify their own symptoms so the first few stages of the depression go untreated.

Overall, endogenous depression can be characterized by:

  • A loss of interest in essential activities or hobbies
  • Sleeping poorly, having trouble falling asleep
  • Constant feelings of sadness and hopelessness
  • Lack of motivation
  • Lower sexual libido
  • Lower appetite or overeating
  • Decline in concentration
  • Fatigue
  • Suicidal thoughts

Causes of endogenous depression

Endogenous depression occurs due to an internal stressor (cognitive, biological)- an unwanted chemical change inside the brain. It doesn’t come from an external factor such as stress or a traumatic event. For example, if depression runs in the family, it’s inheritable and could be diagnosed as endogenous depression.

Although initially caused by a genetic and biological factor, it’s been found that serotonin levels go hand-in-hand with depression levels, too. One study found out that someone who was once treated with an antidepressant, the pill that increases serotonin in the brain, and then taken off it, were more likely to relapse into another depressive state.

Endogenous depression
Endogenous depression

Risk factors of endogenous depression

The causes of endogenous depression come from an internal stressor and their potential risk factors include the cognitive or biological internal factor/stressor. People who have a family history of depression and/or bad personal relationships are at risk for endogenous depression. Also, people are more likely to have a history of disorders that run in the family.

The brain and endogenous depression

A big part of endogenous depression is simply a chemical imbalance in the brain– but it’s not always so simple. Another possibility of problems in the brain could also be a faulty mood regulation. A chemical imbalance isn’t just one chemical being too high while the other is too low. Rather, there are so many chemicals and neurons involved in the brain and that are responsible for our perceptions, how we experience life, and are responsible for our moods. It’s an incredibly complex system.

The most common brain chemicals that cause a mix-up and lead to endogenous depression are:

  • Gamma-aminobutyric acid (GABA) is an amino acid that works as a neurotransmitter to help relieve anxiety.
  • A decline in serotonin, the neurotransmitter that regulates mood and appetite. Science has shown that chronic low levels of serotonin lead to suicidal thoughts.
  • Norepinephrine can trigger anxiety by raising blood pressure and constricting blood vessels. It also plays a large role in the brain reward system.
  • Lithium carbonate, a mood stabilizer used to treat bipolar disorder, helps prevent damage to high levels of the neurotransmitter glutamate.
  • Dopamine influences motivation and how someone sees reality. Also involved in the brain reward system, low levels of dopamine have been connected to psychosis– a form of distorted and twisted thinking.
Endogenous depression
Endogenous depression

One study found in The Journal of Neuroscience found that the hippocampus is smaller in some depressed women. Studying 24 women who had a history of depression, researchers discovered that on average, the hippocampus is 9%-13% smaller in those depressed compared to those who weren’t depressed. It was also found that stress can suppress the production of new neurons in the hippocampus.

Researchers also found that giving people a drink that lowered serotonin levels provoked a negative mood change. This directly correlates with the theory that low serotonin levels in the brain directly related to depression.

Diagnosis of endogenous depression

In order to be diagnosed with endogenous depression, you must meet the criteria according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The main criteria to be diagnosed, according to the DSM, with endogenous depression is:

Have a depressed mood/loss of passion and interest in daily activities for more than two weeks.

Treatments for endogenous depression

There are two types of treatment, often combined, for endogenous depression: therapy and mediation. These are in addition to lifestyle changes such as diet and exercise.

Therapy in endogenous depression

Talk therapy, also known as psychotherapy, involves meeting with a therapist on a regular basis and can help the patient cope with their condition as well as any related issues. Interpersonal therapy (IPT), one of the main types of psychotherapy helps the patient work through troubling relationships that might be contributing or cause of endogenous depression. Cognitive behavioral therapy (CBT), the other type of talk therapy, is used to help the patient replace their negative beliefs with positive ones as well as practice positive thinking. It also helps with improving how the brain responds to negative situations.

Electroconvulsive therapy (ECT) may be used if medication and psychotherapy aren’t improving the depressive symptoms. ECT uses attached electrodes to the head to send pulses of electricity to the brain. These pulses trigger a brief seizure. It’s meant to change the chemical interactions in the brain.

Medication for endogenous depression

The most common types of medications used are Selective Serotonin and Norepinephrine reuptake inhibitors (SNRIs) and Selective Serotonin Reuptake inhibitors (SSRIs). Some people might be prescribed a type of tricyclic antidepressant (TCAs). Common SNRIs are Cymbalta, Pristiq, and Effexor. Common SSRIs are Prozac, Lexapro, and Zoloft. Common TCAs are Pamelor, Surmontil, and Tofranil.

These medications are meant to increase certain brain chemicals that result in depressive symptoms. Often, the medication needs to be taken for a minimum of four weeks before symptoms begin to change and improve. However, in some cases, it may take up to 12 weeks before improvement is seen.

According to the National Institute of Mental Health (NAMI), people who didn’t get better after trying their first antidepressant medication had better results after trying a combination of treatments or another medication altogether.

Effects of endogenous depression

The effects of endogenous depression can be exhausting while experiencing them. The most common effects are:

  • Guilt due to an imaginary wrongdoing
  • Constipation
  • Severe anxiety
  • Misery
  • Loss of libido
  • Insomnia
  • Lack of drive to move
  • Suicidal thoughts
  • Loss of appetite

Prognosis of endogenous depression

Overall, the prognosis is good with endogenous depression because it’s treatable. If someone with endogenous depression sticks to their treatment plan, they should see a positive difference within several weeks. However, length of recovery also depends on how early treatment is sought.

It’s essential to keep taking medication or going to therapy even after the symptoms stop unless a healthcare provider says otherwise. Ending treatment too early can result in withdrawal symptoms which is also known as antidepressant discontinuation syndrome.

Endogenous depression
Endogenous depression

Tips to prevent endogenous depression

Roughly 50% of people who have had one depressive episode will do so again. The likelihood of relapsing into an endogenous depressive episode goes up with each episode.

  • Going outside and getting active. According to a study, not exercising can increase the risk of depression. It’s also good to continue doing activities that were done before the onset of depression.
  • Making sure to get a good night’s sleep is essential. Studies show that a lack of sleep can lead to depression.
  • Don’t suppress your feelings. It’s been found that people who suppress their feelings, negative or positively, look at the world in a more negative way.
  • Smile! Smiling is proven to make you happier- even if you don’t feel like smiling. One study done in Wales found that people whose ability to frown were inhibited by cosmetic botox injections were actually happier, on average, than people who can frown.
  • Don’t blame yourself. People who are prone to depression tend to blame themselves for every misstep- a blame that isn’t always worthy. This blame can lead someone right back into depression.
  • Don’t take on too much. Stress and depression don’t mix well.
  • Eating healthy with a diet full of whole grains, lean meats, veggies, and protein is said to be good for depression, also known as The DASH diet. The western diet is proven to come with an increased risk of depression.
  • Avoiding (too much) social media. According to several studies, the use of social media raises the risk of depression-, especially in teens.
  • Staying clear of lots of alcohol and drugs is a big help when trying to avoid and prevent depression. Alcohol and drugs are both natural depressants. One study found that moderate intake of wine can be healthy, but copious amounts of alcohol can lead to endogenous depression.

How do you deal with depression? Let us know in the comments below!

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