Endogenous depression

Updated 12 months ago on April 03, 2023

Endogenous depression is an endogenous psychological disorder characterized by a depressed, depressed mental state, decreased mood, motor inhibition (or motor excitement) and slowed thinking, caused by "internal" causes. Some researchers believe that the underlying cause of the problem is a disorder of metabolic processes in the brain, that is, impaired formation of serotonin and noradrenaline or biogenic amines. However, there is no scientific evidence that sufferers of endogenous depression suffer from "serotonin deficiency" or "chemical imbalance in the brain." The diagnosis of endogenous depression is made by psychiatrists without any biological tests to detect abnormal metabolic processes in the brain, but only on the basis of the patient's complaints and/or observation of their behavior.

Endogenous depression is thought to occur without the presence of external circumstances and influence from outside, independent of past or present events in the life of the individual. No favorable moments - positive news, pleasant events, activities that normally bring pleasure - have little or no effect on a person's mood and well-being. Individuals suffering from endogenous depression are usually not characterized by tearfulness, but they are completely consumed by distressing ideas of self-criticism, self-blaming and self-deprecation. It is with these facts in mind that psychiatrists distinguish endogenous depression from psychogenic disorder and diagnose it accordingly.

In ICD-9, endogenous depression was code 296.19 ("unspecified endogenous depression"). ICD-10 no longer uses the term "endogenous depression", but its actual equivalents are highlighted among the different types of depression and its gradations in severity: F33.2 - recurrent depressive disorder, current episode of severe depression without psychotic symptoms, F33.3 - recurrent depressive disorder, current episode of severe depression with psychotic symptoms, and F33.38 - other recurrent depressive disorder, current episode of severe depression with other psychotic symptoms.

This disorder is characterized by periodic relapses (exacerbations), which can occur independently, without an apparent external cause. Endogenous depression can be bipolar (the depressive phase of bipolar affective disorder) or unipolar.

  • decreased mood (hypothymia);
  • Motor lethargy (or motor excitement);
  • a depressed, wistful mood;
  • irrational anxiety;
  • slowed speed of thinking;
  • depersonalization;
  • decreased appetite;
  • sleep disturbance;
  • suicidal tendencies.

A symptom close to hypothymia is an unbearable feeling of longing, mental pain, which for patients is equivalent to physical suffering. Sometimes people suffering from depression even show that longing "sits" behind their sternum or in the area of the head and neck. At the same time, patients clearly distinguish the feeling of longing from symptoms of internal diseases, such as the heart. Longing can also affect one's perception of the world - everything around seems gray and unreal.

Diurnal fluctuations of the condition are characteristic, with peak deterioration in the morning.

In describing the symptoms of endogenous depression, it is impossible not to mention anhedonia - a decrease or complete loss of the ability to feel pleasure. Sometimes it is so pronounced that patients are bothered by a painful sensation of the absence of any desires or feelings.

In endogenous depression, patients perform all actions extremely slowly. Sometimes, against the background of motor lethargy, excitement may arise, during which the person may injure himself or herself or commit suicide.

Anxiety in endogenous depression manifests itself differently depending on the severity of the disorder - there can be a sense of the imminence of a catastrophic event, vegetative symptoms, agitation (motor agitation), etc. Moreover, patients frequently cannot differentiate a condition of panic anxiety and melancholy since these sensations merge and are characterized by stagnant pathological affects.

An important indicator for the diagnosis of endogenous depression is a pronounced mental retardation: slowing down the rate of thinking, the rate of speech (in some cases, there can be acceleration of the rate of speech). Patients take a long time to process the information they receive; they need considerably more time than in the norm to formulate their answers and state their thoughts. Persons suffering from the disorder note that their thoughts and decisions have become illogical, inconsistent and arise slowly, with an enormous effort of will. In contrast to asthenic conditions, a slowing of the rate of speech is observed throughout the dialogue with the patient. The decrease in activity is also constant and unchanging - patients describe a feeling of fatigue, lack of strength and energy, and rapid fatigability, which do not disappear even after prolonged rest.

In depersonalization, the emotional component of mental processes is lost or reduced. This refers not only to the classic symptoms of mental anesthesia: loss of feelings for loved ones, absence of emotional perception of the environment, nature, works of art, etc., but also to depersonalization of thinking, memory, somatopsychic depersonalization. Such patients' thoughts pass away without leaving a trace, there is no sense of their completeness as they proceed without emotional accompaniment, they are faceless; memory is not impaired, but there is no sense of recognition; previous experiences, images, thoughts are dull, as if erased, so it seems that there is nothing in memory.

Disorders of the digestive system

Decreased appetite and digestive system disorders: lack of appetite or, conversely, excessive appetite, nausea, weight loss or gain.

There can be difficulty falling asleep, restless sleep, early awakening, and a lack of feeling of recovery after sleep.

To avoid such negative consequences, not only timely treatment is necessary, but also the support of loved ones.

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