Endogenous depression is a type of major depressive disorder (MDD). Although it used to be seen as a distinct disorder, endogenous depression is now rarely diagnosed. Instead, it’s currently diagnosed as MDD. MDD, also known as clinical depression, is a mood disorder characterized by persistent and intense feelings of sadness for extended periods of time. These feelings have a negative impact on mood and behavior as well as various physical functions, including sleep and appetite. Nearly 7 percent of adults in the United States experience MDD each year. Researchers don’t know the exact cause depression. However, they believe that it may be caused by a combination of:
- genetic factors
- biological factors
- psychological factors
- environmental factors
Some people become depressed after losing a loved one, ending a relationship, or experiencing a trauma. However, endogenous depression occurs without an obvious stressful event or other trigger. Symptoms often appear suddenly and for no apparent reason.
Researchers used to differentiate endogenous depression and exogenous depression by the presence or absence of a stressful event before the onset of MDD:
Endogenous depression occurs without the presence of stress or trauma. In other words, it has no apparent outside cause. Instead, it may be primarily caused by genetic and biological factors. This is why endogenous depression might also be referred to as “biologically based” depression.
Exogenous depression happens after a stressful or traumatic event takes place. This type of depression is more commonly called “reactive” depression.
Mental health professionals used to differentiate between these two types of MDD, but this is no longer the case. Most mental health professionals now make a general MDD diagnosis based on certain symptoms.
People with endogenous depression start to experience symptoms suddenly and for no apparent reason. The type, frequency, and severity of symptoms may vary from person-to-person.
The symptoms of endogenous depression are similar to those of MDD. They include:
- persistent feelings of sadness or hopelessness
- loss of interest in activities or hobbies that were once pleasurable, including sex
- lack of motivation
- trouble concentrating, thinking, or making decisions
- difficulty falling asleep or staying asleep
- social isolation
- thoughts of suicide
- muscle aches
- loss of appetite or overeating
Your primary care provider or mental health professional can diagnose MDD. They’ll first ask you about your medical history. Make sure to notify them about any medications you’re taking and about any existing medical or mental health conditions. It’s also helpful to tell them if any of your family members have MDD or have had it in the past.
Your healthcare provider will also ask you about your symptoms. They’ll want to know when the symptoms started and if they began after you experienced a stressful or traumatic event. Your healthcare provider may also give you a series of questionnaires that examine how you’re feeling. These questionnaires can help them determine whether you have MDD.
To be diagnosed with MDD, you must meet certain criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is often used by mental health professionals to diagnose mental health conditions. The main criteria for an MDD diagnosis is a “depressed mood or a loss of interest or pleasure in daily activities for more than two weeks.”
Although the manual used to distinguish between endogenous and exogenous forms of depression, the current version no longer provides that distinction. Mental health professionals might make a diagnosis of endogenous depression if symptoms of MDD developed for no apparent reason.
Overcoming MDD isn’t an easy task, but symptoms can be treated with a combination of medication and therapy.
The most common medications used to treat people with MDD include selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Some people may be prescribed tricyclic antidepressants (TCAs), but these drugs aren’t used as extensively as they once were. These medications increase levels of certain brain chemicals that result in a decrease in depressive symptoms.
SSRIs are a type of antidepressant medication that may be taken by people with MDD. Examples of SSRIs include:
- paroxetine (Paxil)
- fluoxetine (Prozac)
- sertraline (Zoloft)
- escitalopram (Lexapro)
- citalopram (Celexa)
SSRIs may cause headaches, nausea, and insomnia at first. However, these side effects usually go away after a short period.
SNRIs are another type of antidepressant medication that can be used to treat people with MDD. Examples of SNRIs include:
- venlafaxine (Effexor)
- duloxetine (Cymbalta)
- desvenlafaxine (Pristiq)
In some cases, TCAs might be used as a treatment method for people with MDD. Examples of TCAs include:
- trimipramine (Surmontil)
- imipramine (Tofranil)
- nortriptyline (Pamelor)
The side effects of TCAs can sometimes be more serious than those from other antidepressants. TCAs may cause drowsiness, dizziness, and weight gain. Carefully read the information provided by the pharmacy and speak to your doctor if you have any concerns. The medication usually needs to be taken for a minimum of four to six weeks before symptoms begin to improve. In some cases, it can take up to 12 weeks to see an improvement in symptoms.
If a certain medication doesn’t seem to be working, talk to your provider about switching to another medication. According to the National Institute of Mental Health (NAMI), people who didn’t get better after taking their first antidepressant medication had a much better chance of improving when they tried another medication or a combination of treatments.
Even when symptoms do begin to improve, you should continue taking your medication. You should only stop taking medication under the supervision of the provider who prescribed your medication. You may have to stop the drug gradually instead of all at once. Suddenly stopping an antidepressant can lead to withdrawal symptoms. Symptoms of MDD can also return if treatment is ended too soon.
Psychotherapy, also known as talk therapy, involves meeting with a therapist on a regular basis. This type of therapy can help you cope with your condition and any related issues. The two main types of psychotherapy are cognitive behavioral therapy (CBT) and interpersonal therapy (IPT).
CBT can help you replace negative beliefs with healthy, positive ones. By deliberately practicing positive thinking and limiting negative thoughts, you can improve how your brain responds to negative situations.
IPT may help you work through troubling relationships that may be contributing to your condition.
In most cases, a combination of medication and therapy is effective in treating people with MDD.
Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT) may be done if symptoms don’t improve with medication and therapy. ECT involves attaching electrodes to the head that send pulses of electricity to the brain, triggering a brief seizure. This type of treatment isn’t as scary as it sounds and it has improved tremendously over the years. It may help treat people with endogenous depression by changing chemical interactions in the brain.
Making certain adjustments to your lifestyle and everyday activities can also help improve symptoms of endogenous depression. Even if the activities aren’t enjoyable at first, your body and mind will adapt over time. Here are some things to try:
- Go outside and do something active, such as hiking or biking.
- Participate in activities that you enjoyed before you became depressed.
- Spend time with other people, including friends and loved ones.
- Write in a journal.
- Get at least six hours of sleep each night.
- Maintain a healthy diet that consists of whole grains, lean protein, and vegetables.
Most people with MDD get better when they stick to their treatment plan. It typically takes several weeks to see an improvement in symptoms after beginning a regimen of antidepressants. Others may need to try a few different types of antidepressants before they start to notice a change.
The length of recovery also depends on how early treatment is received. When left untreated, MDD can last for several months or even years. Once treatment is received, however, symptoms can go away within two to three months.
Even when symptoms begin to subside, it’s important to keep taking all prescribed medications unless the provider who prescribed your medication tells you that it’s okay to stop. Ending treatment too early can lead to relapse or withdrawal symptoms known as antidepressant discontinuation syndrome.
There are numerous in-person and online support groups as well as other resources available for people coping with MDD.
Many organizations, such as the National Alliance on Mental Illness, offer education, support groups, and counseling. Employee assistance programs and religious groups also may offer help for those with endogenous depression.
Suicide Help Line
Dial 911 or go to the emergency room right away if you’re having thoughts of harming yourself or others. You can also call the National Suicide Prevention Lifeline at 800-273-TALK (8255). This service is available 24 hours per day, seven days per week. You can also chat with them online.
If you think someone is at immediate risk of self-harm or hurting another person:
- Call 911 or your local emergency number.
- Stay with the person until help arrives.
- Remove any guns, knives, medications, or other things that may cause harm.
- Listen, but don’t judge, argue, threaten, or yell.
If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.