Article on endogenous depression. The difference between endogenous depression and exogenous depression, causes of endogenous depression, symptoms, and treatment of endogenous depression.
In many fiction writers’ books, when it comes to robots, emotions are very often the main point of conflict. Can robots have empathy as humans? Why are emotions so important to us, do they make us human?
Imagine a life without feelings. Only cold pragmatism. No love, fear, hate, affection and a whole palette of colors. Depression, like many other mental illnesses, is very different from all others.
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We know how to cure appendicitis, how to stop bleeding, how to repair a broken bone, problems of this kind in our bodies have been successfully dealt with by the human species for many years, and diseases that once seemed incurable lose their power over our lives with each new scientific discovery.
But when it comes to our psyche, and especially emotional disturbances, the light of science darkens, forcing doctors to go by feel, trusting their intuition and senses to save those trapped in their own brains and unable to break free.
Exogenous and Endogenous Depression
At this point, there are two types of depression: endogenous and exogenous. Endogenous depression is caused by biological factors or a genetic predisposition, unlike exogenous depression, where there is always an external stimulus (severe stress or a traumatic event). It is now rarely diagnosed as endogenous depression, more often as a major depressive disorder, or as clinical depression.
It used to be thought that treatment for these two types of depression was different, but it has since been found that they can be treated in the same way – using psychotherapy and medication.
However, a 2012 study showed that there are different pathways in the brain responsible for both types of depression. Although the results are early and there is still much to study, they may mean that different types of depression will be treated differently in the future.
Symptoms of endogenous depression
Endogenous depression increases the likelihood of developing other illnesses, as well as self-inflicted injuries and suicide attempts. It can also cause the patient to become alienated from his or her environment, as well as to become addicted to drugs. Nevertheless, symptoms can be greatly reduced by appropriate medication.
Patients suffering from endogenous depression may hide psychiatric symptoms, go to a general practitioner instead of a psychiatrist, with somatic complaints such as headaches, muscle pain, numbness or abdominal pain for fear of being diagnosed with a mental illness that would brand them as psychotic.
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They may also genuinely believe that physical symptoms are the cause of their bad moods and not the other way around. In addition to the symptoms listed above, sufferers of endogenous depression appear:
- constant sadness or a feeling of uselessness
- digestive disorders, resulting in weight loss or gain
- lack of motivation
- insomnia and difficulty concentrating and remembering new information
- loss of interest in sex
With endogenous depression, people have difficulty expressing their opinions, feelings, and coping with everyday activities. They feel insecure and helpless. Quality of life decreases. In the more acute stages, symptoms such as hallucinations as well as suicidal ideation and social isolation occur. Patients may injure themselves.
Endogenous depression can also be a symptom of other mental illnesses, such as schizophrenia. When combined with psychosis, depression can signal bipolar affective disorder, drug or alcohol dependence, or psychoorganic syndrome. The prognosis for comorbidities is twice as bad in depressed patients.
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Symptoms can vary with age. Even preschool children may be susceptible to depression. Children are more likely to experience irritability or worsening school grades, while adults are more likely to experience symptoms such as confusion and somatic illness.
Causes of endogenous depression
Endogenous depression is caused by an internal stressor (cognitive, biological) – an unwanted chemical change within the brain. It does not come from an external factor, such as stress or a traumatic event. For example, if depression runs in the family, it is hereditary and can be diagnosed as endogenous depression.
Although it was originally caused by genetic and biological factors, serotonin levels have also been found to be closely related to levels of depression. One study found that patients treated with antidepressants that increased serotonin levels in the brain were more prone to relapse after discontinuing the course.
The brain and endogenous depression
Basically, endogenous depression is just a chemical imbalance in the brain, but it’s not that simple. It doesn’t mean there is too much of some substance and not enough of another. There are a huge number of chemicals and neurons that are responsible for our perception, the way we experience life, and our moods, so it’s an incredibly complex system.
The most common brain chemicals that cause confusion and lead to endogenous depression are:
- Gamma-aminobutyric acid (GABA) is an amino acid that acts as a neurotransmitter to help relieve anxiety.
- It reduces serotonin, a neurotransmitter that regulates mood and appetite. Science has shown that chronically low serotonin levels lead to suicidal thoughts.
- Norepinephrine can cause anxiety by raising blood pressure and constricting blood vessels. It also plays a major role in the brain’s reward system.
- Lithium carbonate, a mood stabilizer used to treat bipolar disorder, helps prevent damage to high levels of the neurotransmitter glutamate.
- Dopamine affects motivation and how someone sees reality. Low levels of dopamine, also involved in the brain’s reward system, have been linked to psychosis, a form of distorted thinking.
One study found in the Journal of Neurobiology showed that the hippocampus is smaller in women with depression. Studying 24 women who had a history of depression, the researchers found that, on average, the hippocampus was 9 percent to 13 percent smaller in those who were depressed compared to those who were not. It was also found that stress can inhibit the formation of new neurons in the hippocampus.
The researchers also found that drinking a serotonin-lowering drink causes negative mood changes. This is directly related to the theory that low levels of serotonin in the brain are associated with depression.
Treatment for endogenous depression
There are two types of treatment, often combined, for endogenous depression: psychotherapy and medication. Lifestyle changes such as diet and exercise are also mandatory.
Psychotherapy involves regular meetings with a psychotherapist who can help the patient cope with depression, as well as any related problems.
- Interpersonal therapy, one of the main types of psychotherapy, helps the patient work through anxious relationships that may be the cause of endogenous depression.
- Cognitive behavioral therapy, another type of therapy, is used to help the patient replace their negative beliefs with positive ones, and to practice positive thinking. It also helps to improve the brain’s response to negative situations.
The first drugs that were used to treat depression were MAO inhibitors. MAOI is an enzyme that acts as a “safety valve” in neurons. In fact, it simply controls that during the resting state, no neurotransmitters are released into the synaptic cleft, and that during activity too many are not produced.
These drugs can cause life-threatening effects such as headaches, tachycardia, vomiting, high blood pressure, arrhythmias, seizures, and even strokes. This is why MAO inhibitors are now only used as last-line drugs when nothing else helps, and their prescription requires patients to follow a diet, which can negatively affect their emotional state.
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Tricyclic antidepressants were invented next. They got this name because of their chemical structure, where they have three rings in their structure. These substances act in a radically different way than MAO inhibitors.
They block the reuptake of the neurotransmitters serotonin and norepinephrine into the neuron. This also increased their concentration in the synaptic cleft and, like MAO inhibitors, stimulated signal formation.They also have side effects such as loss of visual focus, dry mouth, urinary retention, tachycardia and even glaucoma.
Therefore, the physician who prescribes drugs in this group must skillfully and accurately select the concentration of the drug to minimize or avoid the occurrence of side effects.
Selective serotonin reuptake inhibitors. The most modern drugs for the treatment of depression. They have minimal side effects, are safe even in overdose, do not block muscarinic receptors, and certain representatives of this group are even used to treat children and adolescents.
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Medications often need to be taken for at least four weeks before symptoms begin to subside. In some cases, it may take up to 12 weeks to feel improvement.
In general, endogenous depression is treatable. If a patient sticks to their treatment plan, they usually notice positive changes within a few weeks. However, the length of recovery also depends on how well the treatment was chosen.
It is important to continue taking medication or going to therapy even after symptoms have stopped, unless the doctor says otherwise. Stopping treatment for depression too soon can lead to withdrawal syndrome, also known as withdrawal syndrome.
Tips for preventing endogenous depression
Approximately 50% of people who have experienced depression once have a chance of getting it again, and that number increases as the number of relapses increases.
- It is important to spend a lot of time outdoors and lead an active lifestyle. According to a study, lack of exercise can increase the risk of depression.
- It is very important to get a good night’s sleep. Studies show that lack of sleep can lead to depression.
- Don’t suppress your feelings.
- Smile more often. It is proven that smiling makes you happier, even if it is insincere.
- Don’t blame yourself. People prone to depression tend to blame themselves for every slip-up.
- Spend less time on social media. According to several studies, social media use increases the risk of depression, especially in teenagers.
- Stay away from alcohol and drugs. They are natural depressants. Moderate wine consumption can be beneficial, but large amounts of alcohol can lead directly to endogenous depression.
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Endogenous depression is an emotional disorder caused by changes in hormone and neurotransmitter levels, manifested by reduced mood, inhibited thinking and slowed motor activity. Leading symptoms include depression, loneliness, withdrawal, lack of positive emotions, lethargy, apathy, hypodynamia, difficulty remembering new information and solving intellectual problems. Clinical conversation, observation and psychological testing are used for diagnosis. The main method of treatment is pharmacotherapy, with psychotherapeutic sessions and biological therapies being used in addition.
The term “endogenous depression” indicates an internal, biological origin of the illness as opposed to reactive depressive disorder due to external factors. The synonymous name is circular, cyclical depression. It is characterized by a chronic course with periodic exacerbations, which develop independently, without the influence of life events, and can coincide with the specific seasons, for example, in the fall and spring. The prevalence of the endogenous form is low, ranging from 5 to 13% among all types of depression. The epidemiology is approximately the same in men and women, independent of the level of education and socio-economic well-being.
The leading role in the development of the disorder is played by endogenous factors – physiological features of the body, determined by the type of higher nervous activity, the activity of the immune and endocrine systems, hereditary features, the consequences of various harmful influences and severe somatic diseases. Among the causes of endogenous depression, the most common are:
- Genetic predisposition. Features of the synthesis of bioamines, hormones are inherited. It has been found that endogenous depression is more susceptible to people who have close relatives with the disease.
- Endocrine pathologies. Lack of serotonin, dopamine leads to the fact that a person ceases to experience pleasure and joy from everyday events. Patients with hormonal disorders are among the leading complaints of depression, apathy, weakness.
- CNS disorders. Emotional disorders may be caused by an imbalance in neurotransmission of impulses. Depressive manifestations arise as a consequence of neurological pathologies of the prenatal period and early childhood.
- Character accentuations. Features of the personal reaction to difficult situations are predisposing factors of depression of endogenous type. Heightened sense of responsibility, pedantry, uncertainty, anxiety, mistrust contribute to development of this disorder.
The main factor predisposing to the development of endogenous depression is heredity. The mechanism of genetic transmission of adaptive resources and peculiarities of the regulation of the production of neurotransmitters: noradrenaline, dopamine and serotonin have been revealed. The deficiency of these compounds is characteristic of the depressive disorder. Together with the features of the character and the presence of negative experiences, the lack of “happiness hormones” provokes depression, lethargy and apathy.
With low levels of dopamine, the patient has no desire to be active, is inert, sedentary, unable to adapt to stress, cope with anxiety and fears. Norepinephrine is a “mediator of wakefulness”, a decrease in the processes of its production and transmission is accompanied by lethargy of reactions in dangerous situations, nervous tension. Serotonin deficiency provokes insomnia, emotional instability, bad moods, and tearfulness.
Symptoms of endogenous depression
Depression of endogenous origin manifests itself in the classic triad: a depressed mood, slowed speed of thought processes and motor lethargy. The leading specific symptom is melancholy. During a depressive episode, patients constantly feel depressed, sad, and indifferent to people and events which used to bring joy. Episodes of gratuitous crying, fear and panic are possible.
Emotional state, as a rule, worsens in the morning and improves in the evening. A feeling of weakness, decreased appetite, digestive disorders, constipation, nausea, weight loss, lack of libido, inability to reach orgasm are characteristic. Patients complain of pressure and compressive pain in the head, chest and neck.
Mental (ideational) inhibition is manifested by decreased memory, inability to concentrate, slowness of speech, difficulty in making decisions and making choices. Patients become distracted and forgetful. They may overthink their answer, pause between sentences, and express their thoughts as concisely as possible. If professional activity is connected with intellectual work, cognitive impairment is already appreciable in the early stages of the disorder. Hypobulism is observed – inability to carry out volitional actions to the habitual extent. Patients take a long time to “tune up” to perform the task and talk themselves into it.
Because of the motor retardation, there is slowness. In the initial stages of the disease, patients adapt life situations to their condition: they postpone business meetings, refuse walks, visits to friendships and family celebrations. To justify their desire to lie down, to be alone, they report a deterioration in their well-being.
In the later stages of depression, lethargy becomes obvious, patients do not hide their condition – they spend most of the day in bed in a half-asleep state. The most severe motor disorders are stupor and depressive stupor. Rarely, against a background of full motor inhibition, bouts of uncontrollable despair develop, accompanied by motor and mental agitation – throwing, crying, screaming, self-inflicted wounds.
Severe depressive episodes proceed with depersonalization and derealization phenomena, delirium-like symptoms. Patients experience an excruciating sensation of the absence of any emotions and desires, a sense of alienation, the change of their own personality. Events occurring around them seem unreal, foggy, colorless, “as in a dream. There is a feeling of slowness and infinity of time. Hypochondria, ideas of self-blame, self-abasement, hopelessness and senselessness of the future arise. Patients remain in the world of their own thoughts, react poorly to external events, have poor perception of incoming information, and appear detached.
Endogenous depression is often accompanied by suicidal thoughts, which without the intervention of doctors and relatives lead to suicide attempts. Without medication and psychotherapy, irrational phobias with expressed anxiety and restlessness are formed. The main content of delusional ideas is the inevitability of punishment, retribution, death, suicide plans and predictions of fatal diseases and the torments associated with them. With a long-term course, depression provokes the development of a condition exhibiting a steady decrease in mood, motor activity and cognitive functions.
Examination of patients with suspected endogenous depression is performed by a psychiatrist and a clinical psychologist. The main tasks of diagnosis are the detection of hereditary aggravation and characteristic symptoms of the disorder and the differentiation of the endogenous form from the reactive (neurotic) one. Additionally, the patient is advised to consult a therapist, neurologist and endocrinologist to determine diseases that may provoke or sustain depression. Specific diagnostics include:
- Interview. The doctor clarifies the anamnestic data, specifies the symptoms, pays special attention to the presence or absence of a psychologically traumatic situation, the duration of depression, the dependence of the appearance of symptoms on the time of day and the season. In the case of a severe course, the interview is conducted in the presence of a relative who can supplement the patient’s information.
- Observation. Experts estimate the features of behavior and emotional reactions of the patient. Slowness, lethargy, apathy and “suffering” facial expressions are characteristic. Decrease in the motivational-volitional component manifests as lack of initiative and instability of contact. To maintain a conversation, the patient requires outside stimulation (requests, repetition of questions, encouragement).
- Questionnaires. Comprehensive techniques are used, such as the Standardized Multifactor Personality Assessment Method (SMIL), and narrowly focused tests – Hamilton Scale (HAMD), New Castle Scale of Endogenous and Reactive Depression (NEDRS), Hospital Anxiety and Depression Scale. The results are used to determine the severity of depressive symptoms, their persistence, and the risk of suicide.
Treatment for endogenous depression
Since endogenous disorder is based on internal, physiological causes, therapy is aimed at increasing neurotransmitter activity, eliminating concomitant somatic pathologies that support neurohumoral shifts, and correcting destructive ideas and behavioral patterns. A comprehensive approach to the treatment of the disorder consists of the following methods:
- Medication therapy. Medications are selected individually. Antidepressants are prescribed, reducing motor and mental retardation, depressed mood, delusions and suicidal thoughts. Additionally, normotimics are used. The general scheme of treatment supposes 2 months of monotherapy under strict doctor’s supervision, 6 months of treatment to consolidate the result, and another year to form remission.
- Psychotherapy. Individual psychotherapy sessions and group trainings are conducted in addition to medication therapy at the stage of improvement of well-being. Psychotherapeutic techniques allow quicker elimination of negative emotions, development of effective strategies for coping with stress, and adjustment of personal values and attitudes for more flexible psychological adaptation.
- Biological correction. Phototherapy is used – sessions of treatment with light that precisely replicates the properties of solar irradiation, which stimulates production of serotonin and endorphin. Another method of altering the activity of mediators is sleep deprivation – purposefully creating a stressful situation, provoking an increased synthesis of catecholamines and restoration of emotional tone.
Prognosis and prevention
Endogenous depression is well amenable to medication correction, so with proper long-term treatment and regular prevention of relapses, the prognosis is favorable. Preventing the primary development of the disease is quite difficult due to the fact that there is a hereditary predisposition. To minimize the risk of depression, it is necessary to avoid stressful situations, emotional and physical overload, not to abuse alcohol, to devote time to sports, walks, hobbies, meetings with friends and any activity that brings pleasure.
Peculiarities of pathogenesis, clinic and course of involutional and endogenous depression / V.I. Korostelev // Bulletin of Baltic Federal University named after I. Kant. Series: Natural and Medical Sciences. – 2016 – №2.
2. Lingering and chronic endogenous depressions (questions of psychopathology, clinic and nosological evaluation): Author’s dissertation abstract/Deekaya T.I. – 2005.