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Endogenous depression: when unhappiness comes from within

Endogenous depression: when unhappiness comes from within

May 18, 2024

Mood disorders and especially depression are, after anxiety, the most frequent in clinical practice.

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

Although it is considered today that dividing the depression into these two groups is not reliable since external factors will always affect one way or another, if evidence has been found that there is a type of depression apparently caused by elements biological that has a particular cluster of symptoms. That is, it is considered true the presence of endogenous depressions, also called melancholic depression .

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Endogenous depression: distinctive characteristics and symptoms

As a general rule, when we talk about depression we usually refer to the disorder known as major depression. This disorder is characterized mainly by a sad and depressed mood , apathy and anhedonia and other multiple symptoms. These characteristics are generally shared by all depressed people.

But nevertheless, endogenous depression presents a series of characteristics that make it be considered a different subtype. In endogenous or melancholic depression the symptoms presented by the subjects tend to focus on vegetative and anhedonic elements. That is to say, they are symptoms linked to the lack of initiative, to inaction.

The main characteristic of this type of depressive disorder is a very marked anhedonia or lack of enjoyment when stimulated at a generalized level, together with a high passivity and lack of reactivity. Although anhedonia is also a frequent symptom in major depression, in endogenous depression it is much more marked. These individuals do not identify their mood as sad or depressed but experience a different sensation that they are not able to explain at all, feeling generally empty.

It is also common for them to present a certain psychomotor delay , in the form of slowing both physical and mental, and a certain internal agitation and irritability. And is that individuals with this disorder tend to feel a high level of anguish and guilt, being one of the types of depression that involves an increased risk of suicide. It is also common that they have sleep problems such as early awakenings.

Another element to keep in mind is that it usually appears with a seasonal pattern, being more frequent during the winter , and in general, depressive episodes tend to recur recurrently to a greater extent than in other types. In addition, there is usually a certain morning worsening of symptoms and mood.

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Some causes of internal origin

When we think of someone depressed, we usually have someone who, due to a painful event throughout their life or the lack of reinforcement in different vital domains, develops a pattern of negative thinking and behavior that causes the onset of depressive disorder. . It is a consideration shuffled by most theories that try to explain the origins of depression.

This is not the case of endogenous depression. While is true that indirectly the psychosocial aspects will affect the mental state of the individual , the person with melancholic depression does not have a serious difficulty nor is it generally little reinforced. In fact, it is common for this type of individuals to be found wrong, but do not know or have a reason. This among other elements causes the person to feel guilty, something that worsens the state of the subject and in fact is a frequent feature of this subtype of depression.

The main cause of this disorder is biological . Now, with biological does 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 be found more at the level of brain metabolism, speculating on the presence of genetic factors as a cause of the disorder. Thus, naturally the brain would have problems when properly segregating or using hormones such as serotonin.

Treating endogenous depression

Research has shown that patients with this type of depression present a good response to medical treatments . This fact, together with the lesser effect that placebo usually has in this type of depression, supports the idea that the problem is not due to environmental factors but rather to internal ones.

The treatment of choice is the use of antidepressants, being the tricyclics those that seem to work best in the case of endogenous or melancholic depression. This type of antidepressant is characterized by act by inhibiting the reuptake of serotonin and norepinephrine in the encephalon, in a non-specific way and that affects other hormones such as dopamine.

Another treatment that seems to have a high effectiveness in endogenous depression is electroconvulsive therapy, in which a series of electrodes are placed on the patient's head to subsequently apply a series of electrical discharges. Of course, this is an intervention that has nothing to do with the strong electrical discharges used in psychiatric centers decades ago. Currently, very low intensity, painless discharges are used.

This therapy has a high effectiveness in the improvement of depressive symptoms. Applies in cases where a rapid therapeutic response is necessary , as those associated with high suicidal ideation and depressions with psychotic symptoms, or as an alternative to pharmacology when this type of treatment is not effective enough.

Although it has traditionally been seen as a tremendously aversive type of therapy, nowadays it is done with controlled intensity discharges and in a painless way (since prior general anesthesia is 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 of them with a high rate of recovery.

Bibliographic 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.
  • Santos, J.L. ; García, L.I. ; Calderón, M.A. ; Sanz, L.J .; de los Ríos, P .; Left, S .; Román, P .; Hernangómez, L .; Navas, E .; Thief, A and Álvarez-Cienfuegos, L. (2012). Clinical psychology. CEDE Preparation Manual PIR, 02. CEDE. Madrid.
  • Vallejo, J. & Leal, C. (2010). Treaty of Psychiatry. Volume II. Ars Medical. Barcelona.
  • Welch, C.A. (2016). Electroconvulsive therapy In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier.

Is depression biological ? |Health NEWS (May 2024).

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