Endogenous and Exogenous Depression

Endogenous Depression
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Psychiatrists and researchers once categorized depression using a pair of terms derived from Latin: endogenous (meaning "from within”) and exogenous ("from without").

These names were intended to indicate whether someone’s depression came from internal causes (such as genetics) or external causes (like a stressful or traumatic event).

The old belief was that the distinction was necessary and that each type of depression needed different treatment. Over the last few decades, however, research has not provided sufficient evidence in support of this theory.

Today, depression formerly referred to as “endogenous” is known as major depressive disorder (MDD). The current philosophy is that the same types of treatment can be used for MDD whether it is endogenous or exogenous.

However, it can still be helpful for health care and mental health professionals to note the differences between endogenous and exogenous causes of major depression when helping people understand the condition. 

Symptoms

There is considerable overlap in depression symptoms from one type to another. A key difference (particularly when discussing endogenous or exogenous types) can be the cause or trigger for an episode of depression rather than specific symptoms.

symptoms-of-depression
Illustration by Joshua Seong. © Verywell, 2018.

Endogenous Depression

Symptoms of endogenous depression include feelings of sadness, worthlessness, guilt, and an inability to enjoy normally pleasurable things. You may also notice changes in your appetite, sleep patterns, and energy levels. 

If you have endogenous depression, the world may seem like a dark and sad place because that's how you feel within yourself.

Exogenous Depression

Exogenous depression can look and feel much like endogenous depression. The difference is that these symptoms come on after something happens in a person's life. For example, a person may feel persistently sad after the death of a loved one or struggle with guilt and feelings of worthlessness after losing their job.

Exogenous depression can make the world seem dark and sad because of what's happening around you rather than in you.

Another difference is that people with exogenous depression don't always have the physical symptoms of depression, like having trouble sleeping or change in appetite, common in other forms of the condition.

Causes

Whether depression is endogenous or exogenous, it’s almost always triggered by a life stressor. In someone who is prone to depression due to a genetic or biochemical predisposition, a significant change, life event, or trauma can serve as a trigger that causes them to develop symptoms. 

Endogenous Depression

People with endogenous depression often feel that their symptoms occur “for no reason”—at least in the sense that there is no apparent external cause. Instead, the cause is thought to be biochemical and/or genetic.

For example, a person with a family history of mental illness may be more likely to develop depression.

Exogenous Depression

Exogenous (or reactive) depression is triggered by an outside stressor such as the loss of a loved one, getting divorced, or losing your job. People who experience or witness a traumatic event may develop depression as a direct result of that exposure. 

While someone with endogenous depression had an underlying predisposition that was triggered, exogenous causes can lead to symptoms of depression in someone who doesn’t have a predisposition. 

Treatment

In 2012, a study published in the journal Molecular Psychiatry suggested that the root cause of exogenous and endogenous depression could be found in different pathways in the brain. 

However, researchers have yet to prove that the two types respond differently to specific treatments for depression, such as medication. 

Though they are instigated in different ways, both exogenous and endogenous depression ultimately lead to a biochemical imbalance in the brain. Therefore, a treatment that addresses an imbalance can be used for either type. 

The first-line treatment for depression of either type is usually antidepressant medication. Drugs from a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) are often the first choice, as they are consistently effective and well-tolerated.

Medications are often paired with psychotherapy, which is more effective for some people than using only one of the treatments for depression.

People with severe or treatment-resistant depression may need other interventions to effectively manage their symptoms, such as antipsychotic medications and/or electroconvulsive therapy (ECT).

The unique qualities of all types of depression are still being researched. As new information is learned and discovered, in the future, treatments may emerge that can help manage various forms of depression in different or more targeted ways.

For now, it’s best to discuss your symptoms, family health history, and risk factors with your doctor or a mental health professional to determine the best treatment.

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