What Is Endogenous Depression? Causes, Symptoms, and Treatment

Depression symptoms not caused by external factors may be endogenous depression.

Endogenous depression is a subtype of major depressive disorder (MDD), previously regarded as a separate diagnosis. Historically, mental health professionals distinguished between endogenous (internally driven) and exogenous (externally driven) depression. Modern diagnostic practices, however, no longer emphasize this distinction, focusing instead on the overall presentation of symptoms under the umbrella of MDD. Read on to learn more about the causes, symptoms, and treatments of endogenous depression

Causes of endogenous depression

Unlike exogenous depression, which is prompted by external events such as trauma, loss, or stress and aptly known as “reactive depression,” endogenous depression manifests without an identifiable cause. Symptoms often appear abruptly and seem unrelated to life circumstances, which is why it is sometimes referred to as “biologically based depression.”

The exact cause of any kind of depression is not fully understood, but it is believed to result from a complex interplay of the following factors:

• Genetic predisposition or a family history of depression
• Biological or neurochemical influences
• Psychological factors like low self-esteem or a tendency toward negative thinking can contribute
• Environmental factors like stressful life events, which may cause or exacerbate underlying vulnerabilities (depending on the kind of depression)

Symptoms of endogenous depression

Depression is a mood disorder generally characterized by prolonged and intense feelings of sadness or despair that disrupt daily functioning, affecting mood, behavior, and physical processes like sleep and appetite. Approximately 7% of adults in the United States experience MDD annually. 

Symptoms of endogenous depression are similar to those of MDD, but their sudden onset and lack of apparent triggers can set them apart. Common symptoms include:

• Persistent low mood, sadness, hopelessness, or feelings of emptiness
• Loss of interest or pleasure in activities once enjoyed, including hobbies or social interactions
• Chronic fatigue or low-energy
• Difficulty concentrating, thinking, or making decisions
• Sleep disturbances, such as insomnia or oversleeping
• Changes in appetite or weight (either loss or gain)
• Social withdrawal or isolation
• Physical symptoms like headaches, body aches, or digestive issues without a clear medical cause
• Suicidal thoughts or behaviors

Diagnosing endogenous depression

A depression diagnosis typically begins with an evaluation by a primary care provider or mental health professional. This process includes:

1. Medical history review: Discussing past medical conditions, current medications, and family history of mental health issues.
2. Symptom assessment: Determining when symptoms began and whether they were preceded by a stressful or traumatic event.
3. Screening tools: Questionnaires or diagnostic tests may be used to evaluate the severity of symptoms.
4. DSM criteria: The Diagnostic and Statistical Manual of Mental Disorders (DSM) requires at least two weeks of persistent depressed mood, depressive behavior, or loss of interest in daily activities for an MDD diagnosis. While earlier versions of the DSM distinguished endogenous depression, this is no longer the case.

As a reminder, endogenous depression is no longer a clinical diagnosis in and of itself, but may be used to describe depression with no obvious external causes. 

Is endogenous depression treatable?

In short, yes. The prognosis for endogenous depression is generally positive with appropriate treatment. Most people experience significant improvement within several weeks or months of starting treatment. Early intervention is critical, as untreated depression can persist for years, affecting overall quality of life.

Adherence to treatment plans, including medications and therapy, is essential when dealing with a mental health disorder. Abruptly discontinuing medications without medical supervision can lead to relapse or withdrawal symptoms.

Treatment options for endogenous depression

As mentioned, with proper care, most individuals with endogenous depression can achieve symptom relief and regain a fulfilling, productive life. Effective treatment for endogenous depression often involves a combination of medication, therapy, and lifestyle changes:

1. Medications

Here are some commonly prescribed depression medications:

• Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta) and venlafaxine (Effexor), which target multiple brain chemicals
• Tricyclic antidepressants (TCAs) like amitriptyline and nortriptyline, which used less frequently due to potential side effects 

Antidepressants typically take 4-6 weeks to show significant improvement, though some cases may require up to 12 weeks. Adjustments to medication or dosage may be needed based on individual responses.

2. Psychotherapy

Here are some popular kinds of therapy for depression:

• Cognitive-behavioral therapy (CBT), which helps individuals identify and challenge negative thought patterns, replacing them with healthier perspectives
• Interpersonal therapy (IPT), which focuses on improving relationships and addressing interpersonal issues that may contribute to depressive symptoms

3. Electroconvulsive therapy (ECT)

For severe or treatment-resistant cases, ECT may be considered. This procedure uses controlled electrical stimulation to alter brain chemistry, often leading to rapid symptom relief.

4. Lifestyle adjustments

In addition to therapy and medication, there are some common lifestyle adjustments that people can make to better cope with depression:

• Regular physical activity, such as walking, swimming, or yoga
• Reengaging in enjoyable activities, even if motivation is low
• Building a support system of friends and loved ones
• Meditation
• Maintaining a balanced diet rich in whole grains, lean proteins, and vegetables
• Establishing a consistent sleep routine

5. Support resources

Organizations like the National Alliance on Mental Illness (NAMI) provide education, peer support, and resources for individuals and families affected by depression.

Also, in extreme cases, depression may cause suicidal ideation. If you or someone you know is in crisis or experiencing suicidal ideation, call or text the Suicide and Crisis Lifeline at 988 or visit 988Lifeline.org.

How Charlie Health Can Help With Endogenous Depression

If you or a loved one are struggling with endogenous depression, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for dealing with serious mental health conditions, including endogenous depression. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, managing endogenous depression is possible. Fill out the form below or give us a call to start healing today.