Endogenous depression: when unhappiness comes from within.

A type of depression whose causes are more internal and biological than environmental and the result of the environment.

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

Being a problem that greatly affects psychological and emotional well-being and can be extremely 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 the one that divides is the one that divides into endogenous and reactive depression, depending on whether its cause is internal or external..

Although it is currently considered unreliable to divide depression into these two groups, since external factors will always affect it in one way or another, evidence has been found that there is a type of depression apparently caused by biological elements that has a particular grouping of symptoms. That is to say, it is considered certain the presence of endogenous depressions, also called melancholic type depression..

Endogenous depression: characteristics and distinctive 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 moodThe main features of this disorder are a sad and depressed mood, abulia and anhedonia, and a number of other symptoms. These characteristics are generally shared by all depressed people.

However, endogenous depression has a number of characteristics that make it a distinct subtype. that make it be considered a distinct 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 lack of initiative, to inaction.

The main characteristic of this type of depressive disorder is a very marked anhedonia or lack of anhedonia or lack of enjoyment in the face of stimulation at a generalized level, together with a high passivity and lack of reactivity. 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 fully explain, usually feeling empty.

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

Another element to take into account is that it usually presents with a seasonal pattern, being more frequent during the winterIn general, depressive episodes tend to recur more frequently than in other typologies. In addition, there is usually a certain morning worsening of symptoms and mood.

Some causes of internal origin

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

This is not the case with endogenous depression. While it is true that psychosocial aspects will indirectly affect the individual's mental state, the person with melancholic depression will be more likely to suffer from depression.The person with melancholic depression does not have a serious difficulty, nor is he/she generally under-reinforced. In fact, it is frequent that this type of individual is unwell, but does not know or have a reason. This, among other elements, causes the person to feel guilty, which worsens the subject's state and in fact is a frequent characteristic of this subtype of depression.

The main cause of this disorder is biological.. Now, 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 is more likely to be found at the level of brain metabolism, speculating on the presence of genetic factors as the cause of the disorder. Thus, the brain would naturally have problems in secreting or correctly using hormones such as serotonin.

Treating endogenous depression

Research has shown that patients with this type of depression have a good response to endogenous have 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 so much due to environmental factors as to internal ones.

The treatment of choice is the use of antidepressants, with tricyclics seeming to work best in the case of endogenous or melancholic depression. This type of Antidepressant is characterized by the following characteristics inhibiting the reuptake of serotonin and norepinephrine in the brain, in the in the brain, in a non-specific manner and affecting other hormones such as dopamine.

Another treatment that seems to be highly effective in endogenous depression is electroconvulsive therapy, in which a series of electrodes are placed on the patient's head and then a series of electric shocks are applied. However, this is an intervention that has nothing to do with the strong electric shocks used in psychiatric centers decades ago. Currently, very low intensity, painless shocks are used.

This therapy has a high effectiveness in the improvement of depressive symptoms. It is applied in cases in which a rapid therapeutic response is needed, such as those associatedIt is applied in cases where a rapid therapeutic response is necessary, such 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 sufficiently effective.

Although it has traditionally been seen as a tremendously aversive type of therapy, nowadays it is performed with shocks of controlled intensity and in a painless way (since it is previously (since general anesthesia is applied beforehand) and safe (they are monitored and their vital signs are watched).

Fortunately, with these treatments, a large number of people with endogenous depression show a high level of improvement, most of them having a high rate of recovery.