Endogenous depression is a mental disorder, the classic signs of which are:
- Depressed, sad mood;
- Motor and mental retardation;
- Irrational anxiety;
- Slow thinking speed;
- Decreased appetite;
- Sleep disturbance;
- Suicidal tendencies.
The state of the persons suffering from this disorder are characterized as depressed with a hopeless, oppressive melancholy. Although patients separate their feelings from the natural sadness and sadness, they can not explain what specific differences are endowed with the emotions they experience. Symptoms of the disease-pronounced and intense in strength manifestations, it has a strong painful effect on patients, forcing a radical change in the usual way of life.
Anxiety in endogenous depression manifests itself depending on the severity of the disorder in different ways: from the sense of inevitability of a catastrophic event with vegetative symptoms to agitation-anxiety numbness, reaching a state of complete stupor. Moreover, patients often can not distinguish between the state of panic anxiety and debilitating anguish, since these feelings merge together with the disease and they are characterized by stagnant pathological affects.
Endogenous depression occurs without the presence of external circumstances and outside influence, not depending on what happened or the present events in the life of the individual. No favorable moments: positive news, pleasant events, activities that bring normal pleasure, do not affect the mood and well-being of the person. People suffering from endogenous depression are not characterized by crying, but they are completely absorbed in the painful ideas of self-criticism, self-blame and self-abasement. That is, given these facts, the experts distinguish a disease from a psychogenic disorder and are diagnosed with endogenous depression.
A feature of endogenous depression, occurring in a mild form, is the daily cycle of mood changes, when after waking up in the morning, a person feels the maximum peak of a sad mood, while in the evening the feeling is slightly softened. In severe form of the disease there is a syndrome of” perversion of the daily rhythm”, when in the afternoon there is a noticeable decrease in mood, increased anxiety.
An important indicator for the diagnosis of endogenous depression is a pronounced mental retardation: slowing down the speed of thinking, the pace of speech. Sick for a long time to comprehend the information received, they require a much longer time than normal to formulate their answers and to describe the arisen thought. Persons suffering from the disorder note that their thoughts and decisions have become illogical, inconsistent, arise slowly with a tremendous effort of will. In contrast to asthenic States, the slowdown in the rate of speech is observed throughout the dialogue with the patient. Constant and constant is the decrease in motor activity-patients describe feelings of fatigue, lack of strength and energy, fatigue, which do not disappear even after a long rest.
Even in the presence of all these manifestations, endogenous depression often remains without due attention, most patients do not consider themselves sick and, accordingly, do not apply to a psychotherapist in a timely manner. This is due to the fact that in this disorder there are no visible external causes, there are almost always no bodily ailments, somatic manifestations are rare and non – intensive.
“Dreary” depression can be both an independent mental illness, and can act as one of the phases in the course of bipolar disorder (manic-depressive psychosis).
The leading place in the formation of prerequisites for endogenous depression belongs to the internal hereditary-genetic, biochemical and organ-somatic factors, that is, the main reason for the occurrence of the disorder lies in the individual characteristics of the human body. In most patients with this diagnosis, hereditary severity of various mental disorders is recorded. Very rarely, the onset of the disease is provoked by a strong negative or positive stress factor, but quite quickly the connection of low mood with a stressful event is lost.
Endogenous depression is classified as a severe depressive disorder with no psychotic symptoms. Despite the severe course of the disease, these diseases are attributed to the predicted favorable, as amenable to successful treatment with drugs (antidepressants).
The complexity of the treatment of this disorder is the absence of a real problem, as it is not clear what to fight and what should be corrected. Endogenous depression is associated with a high risk of suicide, and thoughts of suicide do not depend on the severity of the disorder.
Causes of endogenous depression
This disease belongs to the so-called predisposition disease, since the main factor in the presence of predisposition to the occurrence of the disorder is genetic heredity. The transfer of” inherited ” adaptive resources of the body and the feature of the regulation of the level of mediators: serotonin, norepinephrine, dopamine. When genetic pathology is a shortage of these chemicals controls mood. Despite this hereditary predisposition, a person staying in a favorable psycho-emotional environment may not suffer from depressive disorders.
Also, the lack of a number of important chemicals in the body can be provoked by the peculiarities of the diet, natural age-related changes. Thus, the lack of amino acids L-Tryptophan, L-Tyrosine, L-Glycine and L-Glutamine significantly reduces the body’s resistance to stress factors and is a factor in the inevitable development of depressive disorders.
The trigger for the development of endogenous depression can be external factors such as:
- the traumatic event,
- chronic somatic diseases,
- pathology of the Central nervous system,
- taking some medications.
Subsequently, a secondary depressive episode can occur independently, without external influence.
A typical endogenous depression is represented by a triad of Kremelin-a classic triad of the main symptoms: depressed mood, slow thinking, motor retardation.
- The leading symptom and specific feature of this disorder is Hypo – MIA-pathological vital depression. Such a protopathic nature of longing is inseparable from the physical sensations experienced by patients and brings the strongest bodily suffering. Many people suffering from the disorder can accurately localize their feelings in a certain area (usually in the chest, head, neck). Moreover, patients clearly differentiate the sensation of pain, characteristic of somatic diseases and experiences associated with real causes.
- Typical primary symptom acts and ideational (mental) braking. Even being in an emergency, extremely responsible situation, the patient is not able to quickly make the necessary decision, willpower accelerating the thought process.
- With endogenous depression, motor retardation looks characteristic: the patient forms a kind of facial expression, the so-called “face of melancholy”, giving an expression characteristic of elderly people. Often, motor braking reaches the maximum degree of numbness, when the patient is in a depressed stupor. Occasionally, against the background of complete retardation, patients experience a sudden, unexplained and uncontrolled attack of despair, accompanied by intense motor excitation, up to the probability of self-harm.
- With a depressive episode, the phenomena of depersonalization and anhedony often appear. Many patients note the appearance of a painful sensation, in which there are no emotions and desires and there is a sense of change in their own “I”. Often there is a derealization of what is happening: patients perceive what is happening unreal, dark, faded, there is a feeling of slowing down time.
Although expressed depressed mood may be accompanied by secondary (affectogenimap) symptoms – delusions, depression, in patients suffering from endogenous depression, there is a prevailing belief in his guilt, insignificance, hopelessness of the future. This disorder brings to public attention the most important human fears: concerns about the healing of the body, salvation of the soul, material goods. These primary fears form the typical delusional symptoms: hypochondriacal ideas, ideas of sin, ideas of self-accusation and self-abasement.
In severe involutional melancholia is clearly manifested stereotypical anxiety-delusional syndrome: depressed mood, morose state of alarming agitation, fear, verbal illusions, delusions conviction. Without adequate treatment is the formation of irrational phobic anxiety with continuing anxiety, constant agitated state and manifest a variety of manifestations of delusional experiences in the form of inevitability of punishment and death, hypochondriac moods, ideas of suicide. Typical hypochondriacal delusions stands particularly imaginative whimsicality, absurdity and irrationality of the content.
As a rule, having reached its peak, endogenous depression provokes the formation of a mental defect called “depressive weakness“, which is characterized by a decrease in mental and motor activity, constant depression of mood, decrease in emotional and sensitive resonance, a variety of violations in the intellectual sphere.
Melancholy depression affects the supply of human vitality and energy, and awareness of this fact causes the person the most concern. The vital symptoms include:
- Excessive fatigue;
- Severe apathy;
- Inability to carry out volitional efforts in the usual volume;
- Sleep disorders: too early awakening, alternating with problems falling asleep;
- Appetite disorders and disorders of the digestive system: lack of appetite or, conversely, excessive appetite, constipation, nausea, weight loss or weight gain;
- Problems with concentration;
- Pain of somatovegetative nature: “pressing” or “squeezing” pain in the chest, neck, head;
- Lack of sex drive, loss of libido, inability to reach orgasm;
- A sense of irrational fear, panic attacks;
- Mood swings depending on the time of day.
For this disorder is characterized by a decrease in response to events, detachment from the surrounding reality, the immunity of information from the outside. In the physiological aspect, the decrease in reactivity is manifested in the absence of appropriate reactions after taking standard doses of drugs.
Treatment of endogenous depression
The basis of treatment of endogenous depression is the use of drug therapy. In this disease, antidepressants are usually used. The choice and dosage of the drug occurs on an individual basis, taking into account the personal characteristics of the patient and based on the presence and severity of symptoms.
Against the background of drug therapy, there is a gradual disappearance of symptoms. After 2-3 weeks from the start of taking antidepressants, motor and mental retardation decreases, while depressed mood, delusional formations and suicidal thoughts/attempts are still preserved. Therefore, the use of antidepressants should be carried out until the complete disappearance of all manifestations of the disease, since the sudden cessation of treatment is fraught with deterioration of the patient’s condition and a return to a deeper depressive state.
Along with antidepressants for the treatment and prevention of endogenous depression is used that group of drug. Long, continuous use of these drugs helps to stabilize mood and prevents the emergence of new depressive episodes.
Psychotherapy is carried out only as a secondary addition to drug therapy. Modern psychotherapeutic techniques help to identify and eliminate the true cause of the disorder, to form a new model of response to stressful situations, to correct personal assessment. However, without the help of antidepressants, it is impossible to restore the metabolism and concentration of neurotransmitters impaired in endogenous depression.
Persons predisposed to this mental disorder, it is necessary to periodically carry out preventive measures, to avoid excessive mental stress, to observe the regime of work and rest, not to abuse alcoholic beverages, to adhere to a healthy diet.