The main reason of endogenous depression is a genetic predisposition, which lies in the inheritance of abnormal genes. The disease is characterized by an abnormally low mood with a pessimistic evaluation of oneself and one’s position in the surrounding reality, inhibition of motor and intellectual activity, a decrease in motives and autonomic dysfunction. Doctors at Yusupovskaya Hospital diagnose endogenous depression using modern diagnostic methods, tests and questionnaires.
The disease is treated with new-generation pharmacological agents, which are effective and have no pronounced side effects. Psychotherapists provide psychological help to patients and their relatives. The medical staff is respectful of patients’ mental health problems.
Symptoms of endogenous depression
The diagnosis of endogenous depression is based on the standard clinical criteria of ICD-10 and the 1994 American Psychiatric Association DSM-IV. Masked endogenous depression may initially present with depressive episodes. Symptoms of the illness are observed throughout the episode. Patients assess their condition as somatic distress.
The leading symptom is not depression of mood, which in this case is insignificant and almost imperceptible, but a decrease in vital tonus with the appearance of vegetosomatic disorders. Patients complain of the appearance of the following symptoms:
- Uncomfortable sensations in the heart region;
- Nausea, esophageal spasms;
- Various pains;
- Uncomfortable, distressing sensations localized on the surface of the body or in the area of internal organs.
Autonomic vascular crises are not uncommon. There is a seasonal appearance of signs of endogenous depression, daily fluctuations of well-being with deterioration in the morning hours. The symptoms disappear after use of antidepressants.
In the second stage of development of depressive episode, somatovegetative disorders recede into the background. Although patients are not yet aware of and do not identify the feeling of sadness, the depressive coloring of the condition is already quite distinct, has a characteristic diurnal rhythm, is manifested by pessimism in the content of thinking, loss of ability to rejoice. Patients perceive the weakening of vital tonus not only as physical impotence but also as their own lack of willpower, due to which they have to make considerable efforts to overcome the least difficulties in mental and physical activity.
In the next stage of the development of endogenous depression, patients have a quite definite feeling of unmotivated sadness, more expressive disorders of thinking, which are manifested by depressive selectivity in the perception of reality or “super-valuable” ideas.
Symptoms of the disease can also be pronounced throughout the attacks. Somatic abnormalities typical of the previous stages remain, as well as daily fluctuations of well-being. The patient realizes that he or she has changed. The leading symptom is a steady deterioration of mood.
Patients are exaggeratedly pessimistic in their interpretation of truly negative but irrelevant facts. They develop super-valued ideas of guilt and inferiority. Patients perceive themselves as untalented, lazy, and regret mistakes and unfulfilled tasks. They lose interest in reality. Pathological changes in the psyche arise. Motor and ideatorial (having to do with ideas) inhibition is absent. The next stage is simple depression. It is expressed by symptomatology of the classical melancholic triad without formation of persistent depressive delusions.
Typical endogenous depression is manifested by the classical triad of leading symptoms:
- Decreased mood;
- Retarded thinking;
- Motor inhibition.
The main symptom is hypothymia – a stable decrease in mood, which has various shades and is accompanied by a decrease in the intensity of emotional, mental and motor activity. Vital (vital) longing is equivalent to general bodily sensations. The patient does not separate it from physical suffering. Patients may feel that painful longing sits behind the sternum, in the neck or head area. Sometimes patients complain of a grievous sense of lack of any desire or feeling or desire. Longing, in addition to a sense of one’s own altered self, may be accompanied by a sense of one’s surroundings. Patients perceive it as gray, faded, unreal. They have a feeling of a slowing down of the flow of time.
Slowing down of thinking in endogenous depression is not just a manifestation of passivity, but is a primary symptom. The patient is unable, for at least a limited time, to speak quickly or to perform thought operations at a rapid pace. A characteristic “melancholic face” is formed. Even young patients become similar to old people in pantomimicry. Sometimes motor inhibition reaches the degree of complete stupor – a depressive stupor develops. Against the background of motor stupor, the patient may experience a sudden burst of despair with bad motor excitement and may injure himself.
A pronounced depressed mood is accompanied by depressive delusions. The person’s primary fears – about the preservation of the body, the salvation of the soul, daily bread and material well-being – unfold.
Contrasting thoughts are quite common among thought disorders. The patient vividly imagines that he can involuntarily commit acts incompatible with his morals, for example, to stab his own child. He has suicidal thoughts and actions. The motive of suicide can be avoidance of expected suffering, self-punishment, to relieve relatives of worries. In endogenous depression, it is sometimes impossible to find psychologically understandable motives of suicide when the desire to die has the character of primary disorder of urges, and after suicide attempt the patient is not able to explain his act in a reasonable way.
In the depressive phase of the illness, patients have a shortened duration and a shifting rhythm of sleep. Dreams with depressive experiences can be a harbinger of an attack, and dreams with positive emotional coloring can be a harbinger of its end.
The most severe form of endogenous depression is melancholic paraphrenia. It occurs predominantly in old age. Patients have persistent fantastical delusions of nihilistic content – Kotar’s delirium. Sometimes patients have true hallucinations when they hear the moans of dying loved ones or see their anguish.
Treatment of endogenous depressive disorders
Psychopharmacotherapy plays a leading role in the treatment of endogenous depression. The choice of psychopharmacological drugs by the doctors at Yusupov Hospital is based on the results of identifying the leading clinical symptoms and understanding the mechanisms of the apparition and formation of depression. Psychotherapists take into account the gender, age and somatic condition of the patient. The main group of drugs used in the division of endogenous depressive disorders are antidepressants.
To achieve a therapeutic effect, the doctors at Yusupov Hospital select an individual dose of the medication, which is capable of producing an antidepressant effect without pronounced side effects, as quickly as possible. Adequate choice of medication and its dosage is evidenced by a steady tendency for improvement in the first two to three weeks of therapy. The following target “target symptoms” of endogenous depression are distinguished:
- Dreary depression;
- Anxiety agitation;
- Apathetic-adynamic state;
- Autonomic and psychosomatic manifestations.
According to the mechanism of pharmacological action, modern antidepressants are divided into agents that potentiate the effect of monoamines on the central nervous system and monoamine oxidase inhibitors. The first group includes heterocyclic antidepressants (mainly tricyclic or quadricyclic). Tricyclic antidepressants are subdivided into tertiary (imipramine, trimipramine, amitriptyline, doxepin) and secondary (protriptyline, desipramine, nortriptyline) amines.
The following groups of heterocyclic antidepressants are distinguished:
- With specific noradrenergic action (metapramine, myanserine, viloxazine);
- With predominant noradrenergic action (amoxapine, desipramine, nortriptyline, maprotiline);
- With specific serotonergic action (trazodone, fluvoxamine, fluoxetine, cipramil, sertraline, paroxetine);
- Those with a predominant noradrenergic effect and a specific serotonergic effect (mirtazapine);
- Those with a predominantly serotonergic effect (clomipramine);
- With a predominant dopaminergic effect (amineptine).
Antidepressant monoamine oxidase inhibitors are compounds of different chemical structures that inhibit the activity of the enzyme, noradrenaline in subcellular structures of the brain and increase the active concentration in the area of sensitive synapses. Irreversible monoamine oxidase inhibitors include nialamide. Reversible monoamine oxidase inhibitors include the following drugs:
Antidepressant monoamine oxidase inhibitors have pronounced psychostimulant effects. Monoamine reuptake inhibitors have different effects on central nervous system excitability: amitriptyline, azafen, maprotiline have both antidepressant and sedative effects, while imipramine and incanine have psychostimulant effects.
For the treatment of endogenous depression, doctors prescribe the following antidepressants in medium therapeutic doses:
Frequent and significant side effects of tricyclic antidepressants limit their use in patients with endogenous depressive disorders. In endogenous depressions, which are characterized by vital affect of ennui with ideatorial and motor retardation, a feeling of “emptiness” in the head, difficulty in assimilating new information, supervaluable ideas of self-blame and self-deprecation, and persistent suicidal tendencies, maximum therapeutic doses of antidepressants are used.
In the reversal phase of endogenous depression, antidepressant therapy is continued for six months after therapeutic effect has been achieved. When antidepressants are used to treat endogenous depressive disorder in elderly patients, complications often develop. Therefore, elderly patients are prescribed antidepressants at half the usual daily dose. Doctors at Yusupov Hospital constantly monitor the psychopathological and somatic condition of elderly patients.
An auxiliary role in the treatment of endogenous depression is given to non-pharmacological methods of treatment: psychotherapy, breathing and relaxation training, light therapy (phototherapy), sleep deprivation and electroconvulsive therapy. If you have signs of endogenous depression, book an appointment with a psychotherapist at Yusupovskaya Hospital online or by calling the contact center phone number.
When a person suffers from melancholy and low mood for weeks or months at a time when their life is going well, this could be a manifestation of endogenous depression. This is a mental disorder that is based on physiological causes. It doesn’t take stress or life’s turmoil for this illness to develop. It often occurs unexpectedly, when life is booming and there are no special problems.
Endogenous depression is severe. The person does not understand what is happening to him – why he feels bad when “everything is fine. He begins to engage in self-injury, tries to artificially raise his mood, but this only aggravates his general state of health. It is not uncommon for the illness to be accompanied by thoughts of suicide.
This is a dangerous condition that requires consultation and treatment by a psychotherapist or psychiatrist. It is important to find out the true internal causes of the disease. Often patients go to a therapist, neurologist with complaints of prolonged and persistent pain of different localization. For example, depression often proves to be the main cause of chronic back pain. The task of the general practitioner is to refer the patient to a psychiatrist or psychotherapist.
With the right therapy, the prognosis is favorable, and the person begins to enjoy life again.
Causes of endogenous depression
The disease is caused by internal causes associated with physical processes within the body:
- Aggravated heredity.
- Genetic abnormalities that lead to hormonal failures.
- Severe infectious diseases.
- Alcoholism, drug addiction.
- Violations in biochemical processes.
Psychological causes of endogenous depression act as a provoking or aggravating factor, but cannot cause the disease. External events have little effect on the onset of the illness, since any unpleasantness can lead to the onset of the disorder. It is not uncommon for several years to pass between the stressful situation and the first depressive manifestations, and the relationship is difficult to trace.
A patient with endogenous depression usually has a deficiency of “happiness” hormones. These are serotonin, dopamine and norepinephrine. They are responsible for an elevated mood, energy, and pleasure. They also help people to cope with stress. When they are deficient, hormonal imbalance occurs in the body, which leads to depressive manifestations.
Age-related changes or a lack of certain substances due to an unbalanced diet could also be the cause of the disorder. Such depression often occurs in people who tend to stick to rigid diets. The risk of the disease increases if there are relatives with mental disorders in the family.
The classic signs of endogenous depression are as follows:
- Unreasonable anxiety;
- slowness of thought reactions, that is, the person needs more time than usual to analyze the information received;
- apathy and lack of motivation;
- Slowness of movement;
- talking about the lack of meaning in life and suicide;
- feeble facial expressions;
- slow, drawn-out speech with pauses.
Endogenous depression is characterized by changes in the emotional state throughout the day. The most pronounced negative emotions usually arise in the morning, early awakenings with a feeling of melancholy and/or vague anxiety are characteristic, and by the evening, well-being slightly improves. Open expression of emotions is uncharacteristic for such people. They do not cry, scream or show aggression. They feel too tired and exhausted. Those suffering from depression are consumed with self-criticism, pessimistic thoughts about life and their own worthlessness.
A person’s perception of the world and self-perception changes. He may feel that the events that occur do not concern him. He looks at everything, as a spectator in the theater. This condition is characterized by the phrase: “this isn’t all happening to me.
In endogenous depression, the symptoms are also connected with physical well-being:
- Insomnia at night and sleepiness during the day;
- an increase or absence of appetite;
- constant fatigue;
- frequent exacerbations of chronic diseases;
- Gastrointestinal or cardiovascular disorders;
- lack of energy, even in the morning;
- Rapid fatigue that occurs with minor exertion.
The above manifestations do not disappear after rest or sleep, nor do they diminish with activities or hobbies. Lack of treatment leads to a worsening of well-being. Constant high anxiety, delusions about the inevitability of punishment and persistent thoughts about suicide arise.
The depressed person himself is so absorbed in self-destruction that he is unaware of the illness. Only family members and loved ones can recognize the illness in time. It is important to provide support, and to persuade them to seek qualified help.
Treatment and diagnosis of endogenous depression
Only a psychiatrist or psychotherapist can diagnose the illness and evaluate the seriousness of the condition. At the initial consultation, a face-to-face interview is conducted. During this, the doctor observes the client’s emotional reactions, speech and movements. Special test questionnaires are used to estimate the severity of depression.
For correct diagnostics of endogenous depression, the family medical history is important, as well as information about the presence of chronic or hereditary illnesses. If necessary, narrow specialists are involved. The following diagnostic measures may be recommended to the client:
- MRI of the brain;
- general blood analysis;
- hormonal studies;
- Ultrasound of the thyroid gland.
Given the organic cause of endogenous depression, treatment necessarily includes taking medications. Most often, these are antidepressants, anti-anxiety drugs, neuroleptics (for severe forms of depression). Medications are chosen according to age, symptoms and severity of the condition. The duration of the course is established by the doctor.
Psychotherapy acts only as a supplement to pharmacotherapy. Its main goal is to improve the quality of life of the patient suffering from endogenous depression.
During psychotherapy sessions, it is necessary to:
- Become aware of one’s painful condition. Accept that the feelings and thoughts are caused by the illness, that the patient is not to blame.
- Learn to accept and love yourself.
- Learn to use methods of relaxation and stress relief which are appropriate for the patient.
- Learn to express and describe hidden feelings and emotions to your doctor.
In a person with endogenous depression, the peculiarities of symptoms and treatment depend on the individual characteristics of the organism, the duration of the existing condition, the age of the disease’s debut and the patient’s age. The manifestations of the illness always have a so-called “individual pattern”, and only an experienced doctor can correctly diagnose and prescribe the necessary treatment.