What Does Endogenous Depression Mean?

An older term used to specify diagnosis by cause

Medically reviewed by Dakari Quimby, PhD

Endogenous depression is a mental health disorder that occurs suddenly without an obvious reason. It happens without the presence of common triggers like stress, trauma, or grief.

Endogenous depression is a term rarely used in current mental health treatment. Instead, its symptoms are classed as a subtype of major depressive disorder (MDD). Symptoms of this problem involve long spells of low mood and extreme sadness. Treatment often combines certain drugs, talk therapy, and lifestyle changes.

This article describes endogenous depression, its causes, symptoms, and treatment. It also explains how to deal with long-term symptoms and living with this problem.

Understanding Endogenous Depression in Today's Terms

Endogenous depression is an outdated term. It was used in the past when a diagnosis of depression was categorized as being either endogenous (internal) or exogenous (external, also called reactive). The distinction was made based on the belief that each type of depression required different treatment.

Endogenous depression occurs without obvious external triggers. Instead, the cause is attributed to internal genetic or biological causes. As a result, endogenous depression is also called biogenic depression.

In current mental health practice, the diagnosis and treatment of depression do not discriminate between disorders caused by internal versus external factors. Endogenous depression is considered a subtype of major depressive disorder (MDD), a mood disorder that involves constant and severe sadness along with social withdrawal.

MDD can lead to a prolonged dark mood and interfere with daily activities. Treatment is based on your symptoms rather than whether their causes are internal or external.

Causes and Risk Factors

Endogenous depression does not occur as a result of a single cause. It is often described from the person having it as happening for no reason and appearing suddenly. However, certain internal factors can increase your risk of endogenous depression:

• Genetics: While there is no depression gene, this disorder can run in families. Having a close relative with depression or another mood disorder can increase your risk of having it.

• Psychological factors: Having a personality that involves aspects such as negative self-concept, sensitivity to rejection, rumination (dwelling on negative feelings), and other negative thoughts can contribute to depression.

• Brain changes: Based on imaging studies, scientists have found that the frontal lobe of your brain becomes less active during depression. Changes in how your pituitary gland and hypothalamus respond to hormone stimulation may also be factors.

• Other medical conditions: Research has found links between depression and a wide range of physical health-related conditions, such as certain forms of cancer, stroke, epilepsy, obesity, anxiety, and attention deficit hyperactivity disorder (ADHD).
  

Differences From Exogenous or Reactive Depression

Exogenous depression differs from endogenous depression because external factors of life trigger exogenous depression. Exogenous depression is referred to as "reactive depression" because it occurs in reaction to a specific identifiable event.

Common causes of exogenous (reactive) depression can involve the following:

• Loss of a job

• Loss of a loved one

• End of a personal relationship

• Long-term loneliness

• Seasonal changes

• Stress

• Traumatic experience

• Physical or mental abuse

• Certain medications

Is Depression Caused by a Chemical Imbalance?

While some research has pointed toward a chemical imbalance as the cause of depression, other evidence suggests that the disease is more complex. The challenge counters that blaming a chemical imbalance for depression is over-simplistic. This approach says that depression occurs as a combination of genetics, life circumstances, personality, and many different chemical reactions in your brain, all of which work together in this disorder.

Symptoms: Episodes of Endogenous Depression

Episodes of endogenous depression involve a set of signs and symptoms that are present for most of the day, nearly every day, for at least two weeks. These can include following:

• Feeling sad, down, worried, or worthless

• Feeling fatigued with low or no energy

• Feeling anxious, empty, guilty, or hopeless

• Being forgetful and/or indecisive

• Lacking interest in friends, family, and activities once found pleasurable

• Difficulty concentrating or remembering

• Getting too much or too little sleep

• Eating too much or too little food

• Physical pain such as headaches, cramps, or digestive problems unrelated to physical conditions that do not improve with treatment

• Thoughts of suicide and/or death

Emergency Help for Depression

If you or a loved one is having thoughts of suicide, call 911 immediately or call the 988 Suicide & Crisis Lifeline (formerly the National Suicide Prevention Lifeline) at 988.

How to Talk About Depression "From Within"

If you recognize symptoms of depression "from within," contact a healthcare provider to discuss your concerns. While it can be difficult to talk about mental health, doing so is the first step in finding the cause of your problem and getting proper treatment.

You may feel more comfortable talking about your concerns if you write them down and bring your notes to your appointment. To get the most from your appointment, follow these strategies from the American Academy of Family Physicians on ways to talk to your healthcare provider about mental health:

• Discuss the physical, mental, emotional, or behavioral changes you've noticed.

• Note key personal information such as lifestyle changes, traumatic events, or other stressors.

• Review your family history of mental illness.

• Discuss whether your symptoms may be related to other physical or mental conditions or treatments you are taking to manage them.

• Consider bringing a relative or friend who can take notes or help you absorb all the information you receive during the appointment.

• Create a specific plan for your next steps and the steps you will take to address your concerns.

After your appointment, follow through with the treatment advised by your healthcare provider. This may include consulting a mental health specialist, taking medication, or making lifestyle changes. If advised, schedule any recommended medical tests to rule out physical causes for your symptoms.

Treating Endogenous Depression

Treatment for depression involves a plan that is tailored to your symptoms and individual needs.

Medication, psychotherapy, or a combination of the two are typically used to treat episodes of major depressive disorder. Research indicates that a combination of antidepressants and psychotherapy treatment is the most effective approach.

Antidepressants

Antidepressants are prescription medications used to relieve symptoms of depression and anxiety. There are several classes of antidepressants, and often many medications within each class of antidepressant.

Everyone has different reactions to a specific drug, so it may take some trial and error to find the right medication for your condition. The following medications are some of the most commonly used to treat depression.

Selective serotonin reuptake inhibitors (SSRIs):

• Celexa (citalopram)

• Cipralex (escitalopram)

• Paxil (paroxetine)

• Prozac (fluoxetine)
  

• Lexapro (escitalopram)

• Luvox (fluvoxamine)
  

• Zoloft (sertraline)

Serotonin-norepinephrine reuptake inhibitors (SNRIs):

• Cymbalta (duloxetine)

• Effexor (venlafaxine)
  

• Fetzima (levomilnacipran)

• Pristiq (desvenlafaxine)

Norepinephrine–dopamine reuptake inhibitor (NDRI): Wellbutrin, Zyban (bupropion)

Noradrenergic and specific serotoninergic antidepressants (NaSSAs): Remeron (mirtazapine)

Psychotherapy

Psychotherapy includes several approaches. The specific approach used for your treatment depends on your symptoms and preferences. Research indicates that the following therapies are used most often in treating depression:

• Cognitive behavioral therapy (CBT): This treatment is a type of psychotherapy that helps you learn how to identify and change the automatic destructive or irrational thought thoughts that are causing symptoms of depression.

• Interpersonal therapy (IPT): Interpersonal therapy involves initiating techniques that help you learn about yourself. This helps you get a better understanding of your thoughts and feelings and those around you so you can work on the relationships in your life.

Recurrent Endogenous Depression Episodes

Major depressive disorder can potentially be a lifelong illness. Rather than having one episode of endogenous depression, it is possible to have additional episodes after periods of time without symptoms.

Episodes of depression can recur in at least half of the people diagnosed with a major depressive disorder who receive treatment and recover. This can occur within weeks to years after the first episode has been treated and symptoms have been resolved.

Recurrent depression episodes may have triggers that are different from the initial episode. If you have several recurrent depression episodes, your mental health professional may advise long-term maintenance treatment to manage your condition.

Learn More: Managing Treatment-Resistant Depression

Lifestyle and Habits to Form With Endogenous Depression

Certain lifestyle changes and habits can support the treatment and management of endogenous depression. The following strategies for self-care can play an important role in managing symptoms of depression:

• Return to activities you once enjoyed.

• Remain connected to family and friends.

• Maintain a healthy lifestyle by eating well, reducing stress, and getting regular exercise.

• Follow regular sleep and meal schedules.

• Take daily medication as prescribed.

• Keep a mood journal to track how your feelings change from day to day in case medication changes are needed.

• Avoid alcohol and other drugs.

• Continue your treatment plan for as long as recommended.

Learn to recognize symptoms of depression. Contact your mental health provider if you notice changes in the way you feel or act so they can intervene with medication changes or therapy as early as possible.

Learn More: 3 Ways Stress Can Make You Sick

Summary

In contrast to depression caused by life triggers (reactive depression), endogenous depression can seem to occur without a clear cause. Endogenous depression is a form of major depressive disorder.

No matter the source of your symptoms, depression can be treated. Medication and psychotherapy are the two approaches most often used and may be used together. The right approach can help you rebound from your symptoms and improve your life.

Don't overlook changes such as long-term low mood, social withdrawal, or loss of interest in normal activities. Contact your healthcare provider for ways to manage these symptoms and get specialized treatment.

Read the original article on Verywell Health.