Endogenous depression: when misfortune comes from within

Mood disorders and in particular depression are, after anxiety, the most common in clinical practice.

Being a problem that greatly affects psychological and emotional well-being and can be extremely disabling, studying and classifying the different types of depression is of great importance. One of the classifications that have been proposed throughout history it is the one that divides into endogenous and reactive depression, depending on its cause is internal or external.

Although it is considered today that dividing depression into these two groups is unreliable as external factors will always affect one way or another, it has been proven that there is one type of depression apparently caused by biological elements that have a particular group of symptoms. . In other words, it is considered to be true the presence of endogenous depressions, also called melancholic-type depression.

    Endogenous depression: distinctive features and symptoms

    Generally, when we talk about depression, we are generally referring to the disorder known as major depression. This disorder is mainly characterized by a sad and depressed mood, Abulia and anhedonia and other multiple symptoms. These characteristics are generally shared by all depressed people.

    however, endogenous depression has a number of unique characteristics so it is considered a different subtype. In endogenous or melancholic depression, the symptoms presented by the subjects tend to focus on the vegetative and anhedonic elements. In other words, these are symptoms linked to a lack of initiative, to inaction.

    The main feature of this type of depressive disorder is a very marked anhedonia or lack of enjoyment in the face of stimulation at a general level, accompanied by a strong passivity and lack of responsiveness. While anhedonia is also a common symptom of major depression, in the endogenous it is much more marked. These people do not identify their mood as sad or depressed but experience a different feeling that they are not at all able to explain, usually feeling empty.

    It is also common for them to present a certain psychomotor delay, In the form of both physical and mental sluggishness, and some internal restlessness and irritability. And do people with this disorder often experience a high level of anxiety and guilt, being one of the types of depression that carries a higher risk of suicide. It is also common for them to have trouble sleeping such as waking up early.

    Another thing to keep in mind is that it usually comes with a seasonal pattern, be more frequent in winter, And in general, depressive episodes tend to recur more frequently than in other typologies. In addition, there is usually some worsening of symptoms and mood in the morning.

      Some causes of internal origin

      When we think of a depressed person, we usually think of someone who, due to a painful event throughout their life or a lack of reinforcement in different areas of life, develops a pattern of thinking and negative behavior that causes the onset of a depressive disorder. This is a consideration studied by most theories that attempt to explain the origins of depression.

      This is not the case with endogenous depression. If it is true that indirectly the psychosocial aspects will affect the mental state of the individualThe person with melancholic depression does not have serious difficulty nor is generally poorly reinforced. In fact, it is common for these types of people to feel bad, but they either don’t know or have no reason. This among other things makes the person guilty which worsens the condition of the subject and is in fact a common feature of this subtype of depression.

      The main cause of this disorder is biological. However, by biological we do not mean that it is the product of a disease (which in fact would make the diagnosis could not be depression), such as infections or tumors. The problem would rather be at the level of cerebral metabolism, speculating on the presence of genetic factors as the cause of the disorder. Thus, the brain would naturally have difficulty in secreting or using hormones such as serotonin properly.

      Treat endogenous depression

      Research has shown that patients with this type of depression show a good response to medical-type treatments. This fact, along with the weaker effect that placebo usually has on this type of depression, confirms the idea that the problem is not due so much to environmental factors as to internal factors.

      The treatment of choice is the use of antidepressants, with tricyclics appearing to work best in endogenous or melancholic depression. This type of antidepressant is characterized by act by inhibiting the reuptake of serotonin and norepinephrine in the brain, in a nonspecific way and affecting other hormones such as dopamine.

      Another treatment which appears to have great efficacy in endogenous depression is electroconvulsive therapy, in which a series of electrodes are placed on the patient’s head and then apply a series of electric shocks. Of course, this is an intervention that has nothing to do with the strong electric shocks used in psychiatric centers decades ago. Very weak and painless discharges are currently used.

      This therapy is highly effective in improving depressive symptoms. applies in cases where a rapid therapeutic response is required, Such as those associated with high suicidal ideation and depression accompanied by psychotic symptoms, or as an alternative to pharmacology when this type of treatment is not sufficiently effective.

      Although it has traditionally been viewed as an extremely aversive type of therapy, today it is carried out with discharges of controlled intensity and without pain (Since general anesthesia is previously applied) and safe (they are monitored and their vital signs are monitored).

      Fortunately, with these treatments, a large proportion of people with endogenous depression have a high level of improvement, most with a high rate of recovery.

      Bibliographical references:

      • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
      • Grosso, P. (2013). Antidepressants. University School of Medical Technology. University of the Republic of Paraguay.
      • Sants, JL; Garcia, LI; Calderon, MA; Sanz, LJ; of rivers, P .; Left, S .; Román, P .; Hernangómez, L .; Navas, E .; Lladre, A and Álvarez-Cienfuegos, L. (2012). Clinical Psychology. CEDE PIR preparation manual, 02. CEDE. Madrid.
      • Vallejo, J. and Leal, C. (2010). Treatise on psychiatry. Volume II. Ars Medical. Barcelona.
      • Welch, Calif. (2016). Electroconvulsive therapy. A: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Comprehensive clinical psychiatry at Massachusetts General Hospital. 2nd ed. Philadelphia, PA: Elsevier.

      Leave a Comment