We’ve all heard of depression, but this mental health issue can fall into different categories depending on the severity and length of time it has persisted for. Here, we’re looking at Endogenous Depression; what it is, why it’s called ‘endogenous’, how it’s different from other types of depression, what causes it, how it’s treated, and much more.

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about depression, we’re here to help.

What is Endogenous Depression?

The term ‘Endogenous Depression’ is actually rarely used by medical professionals today. Instead, you might have heard this called Major Depressive Disorder (MDD), or on occasion, Clinical Depression. It is a mood disorder that can cause a persistent and intense low mood, which can have a negative impact on everything from behaviour to sleep to appetite to relationships. The specifics vary from person to person.

According to the World Health Organization, depression affects an estimated 5% of adults around the world, and in 2008, Major Depressive Disorder (MDD) was ranked third on the list of causes of the burden of disease worldwide. It is projected to rank first by 2030, so it’s safe to say depression is unfortunately an increasing issue.

"Endogenous depression is a term used to describe depression that happens supposedly without any external causes. The argument is it would be more linked to a genetic or biological predisposition whereas exogenous depression is a type of depression that is a response or reaction to an external event such as acute or chronic stress and trauma." - Dr Aura Goldman,  Chartered Psychologist 

What are the symptoms of Endogenous Depression?

Symptoms of Endogenous Depression vary from one individual to the next, but some of the main characteristics of this type of depression include:

• Persistent feelings of low mood or hopelessness
• Loss of interest in usual activities or hobbies
• Low sex drive
• Low self esteem
• Fatigue and lack of motivation
• Finding it difficult to focus and make decisions
• Sleep issues
• Loss of appetite or eating too much
• Desire to be alone or retreat from social activities
• Thoughts of suicide

Why call this type of depression ‘Endogenous’?

You might hear medical professionals categorising depression as either ‘endogenous’ or ‘exogenous’.

• Exogenous = “from without”. This means depression that comes from an external source, such as a stressful or traumatic event.
• Endogenous = “from within”. This means depression that does not come from an external circumstance, and doesn’t have an exact trigger event or root cause.

It is thought both types of depression require different treatments, so Endogenous Depression is often categorised as such to identify that this type of depression does not arise as the consequence of a trauma.

If your depression doesn’t seem to have an origin event, this does not mean you do not deserve the same treatment as someone who has gone through a traumatic event. There are treatment options to help every kind of depression.

What are the characteristics of other types of depression?

We all experience general feelings of melancholy and low mood from time to time, but depression can be quite different in that it can impact daily life in significant ways. Although they can be difficult to categorise, there are various types of depression with different symptoms and characteristics. These include:

• Seasonal Affective Disorder (SAD) — This is a period of depression most often experienced during the winter months due to lack of sufficient sunlight.
• Peripartum/Postpartum Depression — This is what some women feel in the weeks and months after childbirth. Although it can be hormone-related, this type of depression can be serious if left untreated.
• Dysthymia (also known as Persistent Depressive Disorder or Chronic Depression) — This is a mild but continuous depression that can last for 2 or more years.

Some less common types of depression to be aware of include:

• Psychotic Depression — This is a much more intense episode of depression that can sometimes lead to hallucinations.
• Manic Depression (also known as Bipolar Disorder) — This is a different condition from depression, but it is known to cause periods of extreme low mood.
• Reactive Depression (also known as Exogenous Depression) — This is a type of depression triggered by a traumatic event such as divorce or a death in the family.

How is Endogenous Depression identified over other types of depression?

Focusing on Endogenous Depression, which is categorised by an extended period of very low mood and some of the symptoms mentioned above, a medical professional would identify Endogenous Depression over other types by asking questions like:

• How long have you felt this way?
• What type of feelings are you experiencing?
• What other areas of life is it having an impact on?
• Has anything happened recently that may have led to this depression?
• Has anything happened in the past that may have led to this depression?
• Do you have suicidal thoughts?

If your depression is persistent, intense, and is having a negative impact on your daily life and relationships, then you may receive a diagnosis of Endogenous Depression. Many of the aforementioned types of depression are shorter-term, while Endogenous Depression is longer lasting.

What can cause Endogenous Depression?

There are many possible causes of depression, which include things like:

• Stress (this can affect brain chemistry and lower the ability to maintain mood stability)
• Certain medical conditions such as dementia, cancer and hyperthyroidism
• Other chronic health conditions (people with chronic health conditions are 80% more at risk of developing depression than the average person)
• Changes in hormones
• Genetics
• Alcohol or drug use
• Specific types of medications, including steroids
• Childhood abuse or another trauma

Sometimes depression can feel like it has no root cause, but this does not make it any less valid to discuss with your healthcare professional. Your access to treatment does not depend on the underlying cause (or lack thereof) of your depression.

How is Endogenous Depression treated?

Endogenous Depression can be managed with various treatment options including medications, psychotherapy and lifestyle changes. The most effective treatment appears to be a combination of both therapy and medication, rather than choosing one over the other.

Psychotherapy can include treatments like cognitive behavioural therapy (CBT) or interpersonal therapy to get to the root cause of your depression and anything underlying that might affect your ability to lift out of the low mood.

Medications are also effective in around 50-70% of patients, so you may be prescribed an antidepressant such as selective serotonin reuptake inhibitors (SSRIs). Some SSRIs you may be offered include things like Fluoxetine, Sertraline and Citalopram, or if they don’t work, tricyclic antidepressants (TCAs) such as Nortriptyline, Amitriptyline or Imipramine may be recommended.

Depending on your condition, symptoms and other health conditions, other medications may be advised instead, but the above are typically prescribed as a first step in tackling depression. Sometimes it takes a few tries to find the right medication and dosage for you, so don’t give up at the first hurdle; work together with your specialist to find what works best.

Does Endogenous Depression affect life expectancy?

Yes, Endogenous Depression can affect life expectancy, which is why it’s so important to address it early and never leave depression untreated. One study found depression was associated with a heightened risk of mortality. This can of course be due to suicide, but depression also puts additional stress on the body, which can release high levels of cortisol and change blood pressure, increasing heart attack risk.

What can someone with Endogenous Depression do themselves to help?

While professional help is always recommended for depression due to the long-term risks of leaving it untreated, there are things you can do at home to help improve your situation. Certain lifestyle changes can help, such as:

• Diet changes — Healthier food choices have been found to improve overall health and wellbeing, since studies show heavily processed foods are linked to depression.
• Avoiding alcohol and drugs — Both are nervous system depressants, so they are likely to make depression symptoms worse.
• Exercise — Getting mild to moderate exercise can boost endorphins, which in turn can improve low mood. Exercising may be the last thing you feel like doing, but even just a brisk walk can help kick-start the habit.
• Sleep — Whether you find yourself sleeping too much or not sleeping enough, implementing good sleep hygiene can help. This could mean going to bed and waking up at the same time each night, lowering your bedroom temperature, avoiding caffeine after midday, or anything else that will improve your sleep quality.

What to do if you think you may have Endogenous Depression

If you think you may have Endogenous Depression, keep in mind there is help available to improve depression symptoms and get you back to feeling like yourself. Despite feelings of hopelessness (a common symptom of depression), there are treatment options available and many ways to manage and recover from depression.

You can speak to your GP about this, or reach out to a specialist; Augmentive specialists can diagnose and treat using a mix of therapy and medication, and we offer a free 15 minute consultation to help guide you towards a specialist who can help with depression issues.

Please note: Augmentive is not an emergency mental health service, so if you are having suicidal thoughts you should call Samaritans on 116 123 or reach out to someone you trust for help.

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from private psychiatric assessments to helping you find a psychiatrist near you for support on your journey.

If you have a question about depression or think you may need advice and treatment, we’re here to assist on your journey. Our free 15 minute consultation can guide you to the most relevant specialists to answer your questions and discuss next steps.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.