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Endogenous Depression

Depressions Endogenous

Endogenous depression is caused by biological factors or genetic predisposition rather than an outside stimulus, as opposed to its reactive equivalent. It encompasses a potential for significant morbidity by influencing the outcomes of other, unrelated medical conditions or even self-inflicted injury, and mortality, usually by suicide. Furthermore, endogenous depression may cause patient alienation from peers and substance abuse. However, symptoms can be reduced by appropriate medication.


Presentation

Patients suffering from endogenous depression may conceal psychiatric symptoms and may address a general physician instead of a psychiatrist with somatic complaints [1] [2] [3] like headaches, muscle aches, numbness or abdominal distress, for fear of being diagnosed with a mental illness, that would cast a stigma on them. They may also genuinely believe physical symptoms are the cause of their low mood and dysphoria, not the other way around [4] [5] [6]. Aside from the symptoms enumerated above, affected individuals exhibit anhedonia, irritability, persistent sadness or sense of worthlessness, asthenia, isolation, eating disorders leading to weight changes, lack of motivation, insomnia, and difficulty in concentrating and memorizing new information. Disinterest in sexual activities is also noticed. Patients may find it difficult to impose their opinion, express strong feelings and cope with casual activities. They are often insecure and feel helpless. Perceived quality of life decreases, for the individual and his or her caregivers. Agitation or lethargy or swings between these two states are also frequently encountered. In more advanced stages, hallucinations and suicidal ideation arise, in parallel with social isolation. Patients may also provoke self-injury. Depression may also be a symptom of other psychiatric diseases, such as schizophrenia. When associated with psychosis, depression may also signalize bipolar affective disorder, substance abuse or organic brain syndrome. The prognosis of associated illnesses is two times worse in a depressed patient.

Symptoms may vary among age groups. Even preschool children may be affected [7] [8]. Children of all ages more often present with irritability or decline in school grades or even marasmus [9], whereas elders more often have confusion and somatic signs as dominant findings.

Fatigue
  • The person could appear anxious, have a change in sleeping patterns, a change in eating habits, show fatigue, have low self-esteem and even sudden mood changes.[depressivedisorder.blogspot.com]
  • I have thought this and I think this link shows it, but adrenal fatigue/dysfunction is probably a more accurate diagnosis than depression is but for some reason adrenal fatigue is seen more of as a sham. food for thought. A.B.[forums.phoenixrising.me]
  • Its symptoms include difficulty falling asleep, disturbed sleeping patterns, body aches and prolonged fatigue. Depression that is not endogenous is classified as reactive.[wisegeek.com]
  • He or she may usually appear anxious, undergo few changes in sleeping patterns, show fatigue, face changes in normal eating habits and with sudden mood changes, he/she may also start losing self confidence.[std-gov.org]
Weight Loss
  • The apparently complex influence of weight loss on prolactin response to serotonergic challenge remains to be clarified as well as the role played by the bioavailability of the challenge drug and its metabolite.[ncbi.nlm.nih.gov]
  • It is generally accepted that endogenous depression includes marked vegetative changes, such as loss of appetite, loss of weight, loss of sleep, psychomotor retardation or agitation, marked guilt, and loss of pleasure.[link.springer.com]
  • Symbols Support WR Privacy Policy Forums Suggestions endogenous depression Psychiatry a severe form of depression usually characterized by insomnia, weight loss, and inability to experience pleasure, thought to be of internal origin and not influenced[wordreference.com]
  • It is often identified with a specific symptom complex—psychomotor retardation, early morning awakening, weight loss, excessive guilt, and lack of reactivity to the environment—that is roughly equivalent to the symptoms of major depressive disorder. neurotic[medical-dictionary.thefreedictionary.com]
  • “A patient who has psychomotor retardation, hypersomnia, and gaining weight is scored as having identical symptoms as another who is agitated, sleeping badly, and has weight loss,” Goldberg wrote.[theatlantic.com]
Family History of Depression
  • A significant association was found between positive DST results and a positive family history of depression. These results support other evidence for use of a positive DST result as an external validating criterion for ED.[deepblue.lib.umich.edu]
  • Patients with endogenous depression often are more likely to have a positive family history of disorders and fewer psychosocial and environmental factors that cause their symptoms. [12] A family history of depression and perceived poor intimate relationships[en.wikipedia.org]
  • It is believed that patients with a family history of depression may be more responsive to certain antidepressant drugs that have been previously used to cure other members in the family.[healthguideinfo.com]
  • Risk Factors for Endogenous Depression Since it is generally attributed to genetics, a family history of depression is considered to be the key risk factor.[embracingdepression.org]
Crying
  • Antidepressants can get an endogenous patient into a fit of rage (I destroyed my bedroom while on medication) and CBT increased the apathy/crying cycle.[wisegeek.com]
  • They increasingly sleep later, have difficulty waking up, cry for unknown reasons, and complain of physical ailments like headaches.[sites.google.com]
  • When they confront loss, women are more reinforced for passivity and crying, while men are more reinforced for anger or indifference (Weissman and Paykel, 1974).[social-anxiety-treatment-cure.weebly.com]
  • Impact on your Thoughts: Lack of concentration Forgetfulness Inability to make spontaneous decisions Pessimistic attitude Guilt Self pity Thoughts of self destruction Impact on your Behavior: Apathy Cry often Prefer to stay away from social situations[depressivedisorder.blogspot.com]
  • Impact on Behaviour: You may find the affected person crying most of the times. He/she will start moving far away from common social situations. Decay in sex drive. In some cases, person may also have least interest in personal grooming.[std-gov.org]
Weight Gain
  • Anticholinergic effects, weight gain and orthostatic hypotension were more frequent in the clomipramine group. No biological treatment-related changes were observed.[ncbi.nlm.nih.gov]
  • TCAs may cause drowsiness, dizziness, and weight gain. Carefully read the information provided by the pharmacy and speak to your doctor if you have any concerns.[healthline.com]
  • In most of the cases, TCA leads to weight gain, dizziness and person may also face drowsiness. In case if you face any of these symptoms while using these medications then it is necessary to move to the doctor and find right solution for that.[std-gov.org]
  • Depression-induced inactivity can also contribute to weight gain. If a person experiences a change in body weight of more than five percent in a month, medical attention is necessary, according to London.[livestrong.com]
Overeating
  • A case is reported of a 29-yr-old female with attacks of aphasia/dysphasia over a period of several months which lasted days to weeks accompanied by a dysphoric state.[ncbi.nlm.nih.gov]
  • Improvements occurred over time but differences between treatments were never statistically significant. Dizziness, tremor and anticholinergic symptoms were significantly more frequent with clomipramine.[ncbi.nlm.nih.gov]
  • The results clearly favour moclobemide over tranylcypromine for both efficacy and tolerance in the treatment of endogenous depression.[ncbi.nlm.nih.gov]
  • The ROC analysis indicated that the DSI offers no advantage over the standard DST, regardless of which criterion values are used to define cortisol nonsuppression.[ncbi.nlm.nih.gov]
  • Assessment in this study was made difficult by concomitant treatment with benzodiazepines and/or mild neuroleptics in both groups, but the results of efficacy and tolerance clearly favour moclobemide over desipramine in the treatment of endogenous depression[ncbi.nlm.nih.gov]
Loss of Appetite
  • It is generally accepted that endogenous depression includes marked vegetative changes, such as loss of appetite, loss of weight, loss of sleep, psychomotor retardation or agitation, marked guilt, and loss of pleasure.[link.springer.com]
  • Symptoms of Endogenous Depression Patients who have been diagnosed with Endogenous Depression will often have many of these symptoms: Low mood Hallucinations Loss of appetite or change in eating habits Inability to experience pleasure Insomnia or difficulty[embracingdepression.org]
  • […] of appetite or overeating Your primary care provider or mental health professional can diagnose MDD.[healthline.com]
  • Its symptoms are much the same as depression brought on by trauma, and they include sudden and violent mood swings, fatigue, loss of appetite, low self-esteem, a tendency to withdraw from social activity and insomnia.[psychcentral.com]
Constipation
  • In the zimeldine group, increased sweating and headache were more pronounced, while the amitriptyline patients more often reported dry mouth and constipation. Body weight was not significantly changed by either treatment.[ncbi.nlm.nih.gov]
Low Self-Esteem
  • Along with the speech and mental retardation, such people is exacerbated by a sense of guilt, of remorse in combination with low self-esteem.[healthrxmeds.com]
  • Like most forms of depression, the symptoms can be enhanced by behavioral factors such as low self-esteem, chronic physical illnesses, and high stress to name just a few.[embracingdepression.org]
  • The person could appear anxious, have a change in sleeping patterns, a change in eating habits, show fatigue, have low self-esteem and even sudden mood changes.[depressivedisorder.blogspot.com]
  • Shame,guilt,and low self-esteem can result from the mistaken belief that to express pain is a sign of character weakness,but these feelings are in fact symptoms of the illness.[mentalhealthforum.net]
Anhedonia
  • Endogenous depression is characterized by feelings of guilt and worthlessness and anhedonia. Anhedonia is the inability to derive pleasure from once pleasurable activities such as exercise, hobbies, or sex.[7cups.com]
  • ., anhedonia, psychomotor agitation or retardation, diurnal mood variation with increased severity in the morning, early morning awakening and insomnia in the middle of the night, weight loss, self-reproach or guilt, and lack of reactivity to one's environment[medical-dictionary.thefreedictionary.com]
  • Many depression patients exhibit anhedonia, for example, but many others don’t.[theatlantic.com]
Psychomotor Retardation
  • Keywords Psychomotor Retardation Depressive Illness Global Rating Scale Research Diagnostic Criterion Placebo Response Rate These keywords were added by machine and not by the authors.[link.springer.com]
  • To obtain more reliable measures the scores for the various symptoms were added together to form a total score, which was then divided into a depression score and a retardation score, presumably measuring mainly depressive mood and psychomotor retardation[ncbi.nlm.nih.gov]
  • It is often identified with a specific symptom complex—psychomotor retardation, early morning awakening, weight loss, excessive guilt, and lack of reactivity to the environment—that is roughly equivalent to the symptoms of major depressive disorder. neurotic[medical-dictionary.thefreedictionary.com]
  • “A patient who has psychomotor retardation, hypersomnia, and gaining weight is scored as having identical symptoms as another who is agitated, sleeping badly, and has weight loss,” Goldberg wrote.[theatlantic.com]
Feeling of Worthlessness
  • Self-destructive behavior is a manifestation of the patient's feeling of worthlessness and loss of self esteem.[medical-dictionary.thefreedictionary.com]
  • […] of worthlessness Each patient will have a different set of symptoms with different severity level for each, but if an individual has had several of these symptoms for an extended period of time – usually two weeks or longer – they may be suffering from[embracingdepression.org]
  • Impact on Feelings: Person starts having a feeling of worthlessness. It may show irritability with time. Intolerable mood swings with temper outburst conditions. Great decay in motivation level. Person may feel tired all the time.[std-gov.org]
Suicidal Ideation
  • The suicidal ideation from the Mirtazapine was the final straw for me, and I felt that I could no longer pursue this path.[drugs-forum.com]
Insomnia
  • Some of the typical characteristic features of depression endogenous include insomnia , sleeplessness , depleting energy levels, inability to focus or poor concentration levels, problems remembering and memorizing, and lack of interest in any form of[all-on-depression-help.com]
  • Symbols Support WR Privacy Policy Forums Suggestions endogenous depression Psychiatry a severe form of depression usually characterized by insomnia, weight loss, and inability to experience pleasure, thought to be of internal origin and not influenced[wordreference.com]
  • If the patient has been suffering from depression related insomnia, the addition of antidepressants can assist them in getting a full nights rest. Further treatment often entails Cognitive Behavior Therapy.[embracingdepression.org]
  • […] and features occurring in the absence of external precipitants and believed to have a biologic origin (e.g., anhedonia, psychomotor agitation or retardation, diurnal mood variation with increased severity in the morning, early morning awakening and insomnia[medical-dictionary.thefreedictionary.com]
  • Examples of SSRIs include: paroxetine (Paxil) fluoxetine (Prozac) sertraline (Zoloft) escitalopram (Lexapro) citalopram (Celexa) SSRIs may cause headaches, nausea, and insomnia at first.[healthline.com]
Sleep Disturbance
  • Overall, there was little support for the prediction of a difference in short- or long-term outcome between patients with and without EEG sleep disturbances.[ncbi.nlm.nih.gov]
  • Only "sleep disturbances" on the Hamilton Rating Scale for Depression (HRS) showed significant (P less than 0.05) improvement with amitriptyline. Only small differences in the frequency of side effects were seen.[ncbi.nlm.nih.gov]
  • disturbance, and mood swings which may hinder social relationships.[en.wikipedia.org]
  • These same people often experience sleep disturbances, which can exacerbate feelings of fatigue and grogginess.[livestrong.com]
Apathy
  • Antidepressants can get an endogenous patient into a fit of rage (I destroyed my bedroom while on medication) and CBT increased the apathy/crying cycle.[wisegeek.com]
  • Impact on your Thoughts: Lack of concentration Forgetfulness Inability to make spontaneous decisions Pessimistic attitude Guilt Self pity Thoughts of self destruction Impact on your Behavior: Apathy Cry often Prefer to stay away from social situations[depressivedisorder.blogspot.com]
  • Aggression is easier and quicker to be observed than apathy; therefore endogenous depression is a more complicated type of depression.[treat-depression.com]
Aphasia
  • A case is reported of a 29-yr-old female with attacks of aphasia/dysphasia over a period of several months which lasted days to weeks accompanied by a dysphoric state.[ncbi.nlm.nih.gov]
Sexual Dysfunction
  • Drug treatment of depression - even using the newer SSRIs - still results in unwanted side effects, such as the sexual dysfunction that affects 60% of patients. There are potential lethal interactions between SSRI and MAOI drugs.[books.google.de]

Workup

There is no specific physical trait that helps diagnose endogenous depression aside from the fact that the physician may notice decreased hygiene, decreased movement and reactivity or agitation. However, infection, hypothyroidism, Cushing's syndrome, Addison's disease, hypopituitarism and a number of tumors and neurologic organic disorders may cause endogenous depression and must be eliminated by physical examination and laboratory workup. Blood tests should include a complete blood cell count, blood alcohol and vitamin B12 levels, toxicology screening, thyroid-stimulating hormone levels, liver, and kidney function tests. Dexamethasone suppression test and cosyntropin stimulation test can overrule Cushing's syndrome and Addison's disease.

When a neurologic substrate is suspected based on the presence of neurologic deficits, imaging modalities such as computer tomography, magnetic resonance imaging, positron emission tomography and single-photon emission computed tomography scanning may prove useful; the latter demonstrating regional perfusion deficits in affected patients [10] [11].

Several depression tests exist. Some are based on patient's understanding of depression [12], some describe and inquire about symptoms [13]. Depression scales, such as Zung self-rating depression scale, geriatric depression scale, patient health questionnaire, Beck depression inventory, center for epidemiologic studies-depression scale or Hamilton depression rating scale should be used. They are self-applied or the last one should be carried out in a clinical setting.

Treatment

  • The rating was performed before treatment, one week after the fourth treatment (a treatment pause was then made) and one week after the completed series.[ncbi.nlm.nih.gov]
  • Although there are now considerable data attesting to the efficacy of several forms of treatment for depression, there is surprisingly little information to guide the selection of the treatment most likely to benefit a given patient.[ncbi.nlm.nih.gov]
  • One patient on moclobemide and 5 on desipramine stopped treatment prematurely because of poor tolerance; no patients stopped treatment because of lack of efficacy.[ncbi.nlm.nih.gov]
  • Treatment [ edit ] Individuals suffering from endogenous depression require treatment plans that focus on the internal, cognitive thought processes since internal stressors are the root of somatic symptoms.[en.wikipedia.org]
  • These patients were prospectively assessed for subsequent response to antidepressant treatment or placebo. Previous studies of the effect of endogenous/melancholic depression on treatment response were also reviewed.[ncbi.nlm.nih.gov]

Prognosis

  • "The Incidence and Prognosis of Endogenous Depression" . British Medical Journal . 1 (4980): 1392–1397. doi : 10.1136/bmj.1.4980.1392 . ISSN 0007-1447 . PMC 1979411 . PMID 13316166 . Kramer, T (2002).[en.wikipedia.org]
  • The patients were referred to the three treatments at random and the groups may be regarded as having a similar prognosis (Table 2-5, 7).[ncbi.nlm.nih.gov]
  • Endogenous Depression information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis.[omicsonline.org]
  • Prognosis Like most other forms of depression, endogenous depression is completely treatable. Using psychotherapy or medication, the patient can completely alleviate their symptoms as long as they are willing to give it time to take effect.[embracingdepression.org]
  • Early signs of depression of this kind include pessimistic statements about one's illness and its prognosis, refusal to eat, diminished concern about personal appearance, and reluctance to make decisions.[medical-dictionary.thefreedictionary.com]

Etiology

  • The classification and diagnosis of depressive disorders are based on the symptoms, etiology and the course of the disease. Therefore we aim at a three-dimensional scheme of classification that takes into account all these variables.[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiology. In E. Paykel (Ed.), Handbook of affective disorders (pp. 111–129). New York: Guilford. Google Scholar Steiger, J. H. (1980). Tests for comparing elements of a correlation ma-trix. Psychological Bulleti n, 87, 245–251.[link.springer.com]
Sex distribution
Age distribution

Pathophysiology

  • Researchers have continued to identify the pathophysiological aspects of major depressive disorder, including alterations in various monoamine brain systems.[books.google.de]
  • The authors say 'This study investigated mitochondrial respiration in peripheral blood mononuclear cells (PBMCs), an established model to investigate the pathophysiology of depression.' which seems to me a pretty silly comment.[forums.phoenixrising.me]

Prevention

  • As preventative measures, pharmaceuticals such as SSRI's and antidepressants may also be utilized to avoid further development or progression to Major Depressive Disorder. [14] There have been few treatments targeted specifically toward Endogenous Depression[en.wikipedia.org]
  • Over time, scientists have discovered that these three nutrients can prevent depression or reduce symptoms if they are taken together. Future bouts of depression may be able to be prevented by adopting a healthy lifestyle.[embracingdepression.org]
  • If you think someone is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.[healthline.com]
  • Endogenous Depression information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis.[omicsonline.org]

References

Article

  1. Wittchen H, Lieb R, Wunderlich U, et al. Comorbidity in primary care: presentation and consequences. J Clin Psychiatry. 1999;60(7):29–36.
  2. O’Connor D, Rosewarne R, Bruce A. Depression in primary care. 1: Elderly patients’ disclosure of depressive symptoms to their doctors. Int Psychogeriatr. 2001;13(3):359–365.
  3. Tylee A, Gandhi P. The importance of somatic symptoms in depression in primary care. Prim Care Companion J Clin Psychiatry. 2005;7:167–176.
  4. Herran A, Vazquez-Barquero J, Dunn G. Recognition of depression and anxiety in primary care. Patients’ attributional style is important factor. BMJ. 1999;318(7197):1558.
  5. Kessler D, Lloyd K, Lewis G, et al. Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. BMJ. 1999;318(7181):436–439.
  6. Kroenke K. Somatic symptoms and depression: a double hurt. Prim Care Companion J Clin Psychiatry. 2005;7:148–149.
  7. Sheikh R, Weller E, Weller R. Prepubertal depression: diagnostic and therapeutic dilemmas. Curr Psychiatry Rep. 2006;8(2):121-126.
  8. Katon W, Sullivan M, Walker E. Medical symptoms without identified pathology: relationship to psychiatric disorder, childhood and adult trauma, and personality traits. Ann Intern Med. 2001;134:917–925.
  9. Spitz R. Anaclitic depression: An inquiry into the genesis of psychiatric conditions in early childhood. Psychoanal Stud Child. 1946;2:313-342.
  10. Tutus A, Kibar M, Sofuoglu S, et al. A technetium-99m hexamethylpropylene amine oxime brain single-photon emission tomography study in adolescent patients with major depressive disorder. Eur J Nucl Med. 1998;25(6):601-606.
  11. Maeng J, In K, Dong W. Brain single photon emission computed tomography findings in depressive pseudodementia patients. Af Dis. 2002;69(1-3):159-166.
  12. Mitchell A, Coyne J. Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies. Br J Gen Pract. 2007;57(535):144-151.
  13. Arroll B, Khin N, Kerse N. Screening for depression in primary care with two verbally asked questions: cross sectional study. BMJ. 2003;327(7424):1144-1146.

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Last updated: 2018-06-22 02:03