Endogenous depression Is a type of depression that appears without the need for an environmental or circumstantial stimulus that causes an alteration in the person that translates into a depressive condition.
That is, a man or woman who experiences endogenous depression does not need things to go wrong, or have problems or difficulties in their lives. Can Presenting the depressive disorder without any apparent cause.
In this article we will talk about this type of depression, which usually presents with very severe symptoms, but can be treated effectively with Appropriate interventions.
Characteristics of endogenous depression
The endogenous depression refers to what was formerly known as melancholy, a term that refers to a permanent state of profound sadness and Intense
As we have been remarking, it is a disease that is caused by genetic causes that cause Metabolic alterations in brain Of the person who suffers it.
Thus, in these types of depressions do not involve factors referring to the way of being of the person, the things that he lives, or the management that Makes of his life and his emotions.
It can appear without the need for the person to have suffered traumatic experiences or created a way of being depressive.
Therefore, when the disease begins to manifest itself, the depressive person is unable to adapt, as before, his emotional reaction to Different situations of life, and feel sad and downcast without being able to identify why.
And the basic symptoms of endogenous melancholy are sadness and anguish. However, as we have seen happen with all the s Depressive syndrome, these two symptoms are not the only ones.
Symptoms of endogenous depression
1. Affective
Disorders of affection and humor were already considered by Kraepelin , The reference psychiatrist of the nineteenth century, as fundamental in the d Endogenous pressures. These are:
to. Quality other than habitual sadness
This quality other than humor is not easy to define. In fact, a person with endogenous depression is considered to be empty, anesthetized, or indifferent.
Thus, the sadness experienced in this type of depression refers, on the one hand, to a new emotion that has never been experienced, and for Other side, to the inability to express it.
In fact, the person with melancholic depression usually defines this quality other than habitual sadness as an internally uncontrollable fatigue, Permanent, constant, without relief, inexplicable and strange.
Therefore, the person with endogenous depression does not interpret their feelings as sadness or grief, but as a state that causes them discomfort and that Prevents living properly.
B. Inability to think
As we have said, the sadness experienced in endogenous depressions is not the typical depressive feeling easily identifiable by the patient.
It is a much stranger feeling, that the person who suffers it is not able to interpret and explain clearly.
Thus, the frequent description by endogenous depressive patients of their State of mind Is the inability to think, together with the Inability to see the future (or not notice the passage of time).
C. Anxiety and Irritability
Other important symptoms in this disease are hostility, irritability and anxiety .
These emotions are secondary to the feeling of strange and inexplicable sadness experienced by the patient.
If we put ourselves in context we could imagine the following:
You are a person without mood swings, you usually feel good or even happy, but one day you start to experience a new emotion that you It prevents enjoying things, experiencing positive feelings and remembering what happiness was.
In addition, you feel this new emotion as something that constantly fatigues you, that you can not control or endure, and that you do not know to explain what it is, Why you have it and what you can do to stop having it.
Hopefully, this strange emotion that makes you look bad and have a constant mood of depression, cause you Feelings of Anger and anxiety for being so.
In this way, the irritability, anxiety and even hostility experienced by many people with endogenous depression are justified by the Difficulty of coexisting with the new and strange feeling of sadness.
D. Anhedonia
Finally, many authors consider the Inability to experience pleasure With any activity as one of the main symptoms of depressions Endogenous.
2. Cognitive
Patients with endogenous depression often manifest inhibition and slowing of thinking. They find it hard to think, remember things and have many Difficulty concentrating .
In the same way, they often have their thoughts centered on their discomfort, and they find it very difficult to think and talk about other things.
However, all other cognitive functions are preserved (the person does not become dumb, only slower), and mental functioning Above is restored when the depressed state improves.
3. Motrices
The melancholic depression is always accompanied by inhibition or agitation, so these symptoms are main in the disease, since in other types Of depression many times there are no alterations in movement.
The most frequent is that the person is inhibited, it is difficult to walk and move, take short steps, drag the feet and take a long time to perform Actions or answer questions.
4. Somatic
People with endogenous depression usually feel fatigued, find themselves worse in the morning, lose their appetite, have dry mouth, suffer Digestive alterations, lose interest in sex and have problems of balance.
Likewise, they often have many problems to fall asleep and wake up earlier than usual.
5. Behavioral
Finally, unmotivated crying, decreased overall performance, tendency to isolation, and, in the most severe cases, The suicide attempts.
Course and forecast
The typical age of onset of the disease is between 30 and 40 years, and between 40 and 60 years.
Half of patients with a first depressive episode present a second in the next two years. When the second one has already been Chances of suffering a third increase up to 80-90%.
Likewise, 50% refer to the disease at 6 months, 80% at 2 years and 90% at 5 years. The chronicity rate is between 15-25% Conditioned largely by a poor therapeutic approach.
Treatment
Endogenous depressions are usually easily resolved if appropriate treatments are performed. However, in elderly patients, remission Of the depressive episode usually becomes more difficult.
Thus, the treatment of this disease is of vital importance since, despite being a severe mental disorder, it can be managed Appropriate treatment is given.
Due to the endogenous origin of the disease, the treatment is usually purely pharmacological, and psychotherapy tends to be more expendable than in Other mental illnesses.
The first-line treatment for this disease are Antidepressant psychotropic drugs Tricyclic compounds such as imipramine, or the Serotonin ecstasy and Noradrenaline (ISRN) such as duolxetine or venlafaxine.
In case of non-referral with these drugs, which must always be under prescription and medical follow-up, the treatment can be combined with Antidepressants, serotonin reuptake inhibitors (SSRIs), such as fluoxetine or citalompram.
In severe depressions electroconvulsive therapy (ECT) acquires special indication, which, despite the negative and eccentric impact it has Currently in society, has shown a very high efficiency.
In fact, ECT has been shown to be a treatment with 80-90% efficacy intervals in depressions with delusional ideas or intention Severe suicide, thus clearly outpacing the effectiveness of antidepressants in these cases.
Thus, endogenous depression is a severe and uncontrollable depressive syndrome for the person who suffers it, but fortunately it can be treated Effective way through psychotropic drugs or electroconvulsive therapy.
Differences between endogenous depression and major depression
Endogenous depression is a depressive syndrome that is characterized by having its origin in the biological or genetic part of the person.
However, it is not the only type of depression, as there are depressive pictures that appear as a reaction to different stressful events that may Happen in the life of a person, and therefore do not have a biological origin as the endogenous depression.
So before we get into the endogenous depression in detail, I would like to do a quick review of what depression is all about General, including both endogenous and non-endogenous depressions.
The Major depression Is a disorder of organized mood as an affective syndrome, and therefore has specific characteristics.
Normally, a depression refers to a marked alteration of mood, which runs with nuclear symptoms such as pathological sadness, Loss of interest or inability to experience pleasure.
However, in the depressions other affective, cognitive, somatic and behavioral symptoms appear.
In fact, to dictate that a person's condition refers to major depressive disorder, the following criteria must be met:
Five or more of the following symptoms are seen over a two-week period:
Depressed mood Most of the day, almost every day.
Loss of interest or ability to experience pleasure in all or almost all activities.
Significant weight loss without regimen or weight gain.
Insomnia or excessive sleep ( Hypersomnia ).
Stirring or slowing movements.
Feelings of worthlessness or guilt Excessive or inappropriate.
Decreased ability to think or concentrate.
Recurrent thoughts of death, suicidal thoughts or attempted suicide.
These symptoms cause discomfort and deterioration both social and occupational in the person.
The symptoms are not explained by the presence of a duel. For example, symptoms persist for more than 2 months after the loss of one to be loved.
These are the criteria that define major depressive disorder. As it is observed, the alteration of the mood and the pathological sadness are the Characteristics.
However, there must also be other types of symptoms: cognitive (difficulty concentrating or thoughts of death), somatic (insomnia or loss of Weight and appetite) and behavioral (agitation or motor slowdown).
This indicates that depression is not synonymous with sadness and that, therefore, being sad or depressed does not have to mean that it is Depressive or possessing a mental pathology.
In fact, depressive syndrome is considered to occur when a person does not have sufficient resources to cope with a particular situation, and is Unable to manage their sadness, their emotions and their activity for a long time.
However, this is not always so, and less so when we talk about endogenous depression.
Endogenous depression arises from within the individual, does not respond to events or situations in the environment. It does not even respond to personality and Way of facing the person's life.
Put another way: the endogenous depression can appear in a vital and enthusiastic person, who is not suffering a difficult moment in his life (like A divorce, a job dismissal or the death of a family member), and begin to experience sadness without knowing why.
Thus, the endogenous depression is a phenomenon very peculiar and very incapacitating for the person who suffers it.
References
- Barlow D. and Nathan, P. (2010) The Oxford Handbook of Clinical Psychology. Oxford University Press.
- Spent c Melancholia . In: Vallejo J, Gastó C. Affective Disorders: Anxiety and Depression . 2nd Edition. Masson. Barcelona, 2000.
- Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences / Clinical Psychiatry, 10th Edition (2007) Lippincott Williams & Wilkins.
- Urretavizcaya M, Pérez-Solà V. Clinic of depression. In: Vallejo J, Leal C. Treaty of Psychiatry. Volume II. Ars Médica. Barcelona, 2010.
- Vallejo J, Urretavizcaya M, Menchón JM. Acute and prolonged treatment of depressions. Treatment of resistant depressions. In: Vallejo J, Leal C. Treaty of Psychiatry . Volume II. Ars Médica. Barcelona, 2010.
- Vallejo J. Classification of affective disorders . In: Vallejo J, Gastó C. Affective Disorders: Anxiety and Depression . 2nd Edition. Masson. Barcelona, 2000.