Mood Disorder

Endogenous depression is a mood disorder characterized, among other things, by marked sadness, hopelessness and apathy. But the cause of endogenous depression is different from that of reactive depression. In the latter there is no external triggering situation, but it is due to internal or psychobiological factors.

It is caused by a structural change in the biochemistry of the brain, whereas in reactive depression there is an obvious connection between the triggering situation and the onset of the disease. Therefore, the triggering cause is the central core of depression.

Since there are no recognisable external causes, it can be difficult for the environment and the patient to understand the disease. An imbalance in the chemistry of our brain is enough to plunge us into deep sadness, which not even we understand, but which we cannot counteract without help.

The chemistry behind depression

Endogenous depression is characterised by a significantly reduced serotonin level, as is the case with exogenous depression, but in this case it is not determined by external factors but occurs naturally. In the case of this type of depression, there is a high genetic component, although this “only” increases, but does not decide, the likelihood of developing depression. There are several suspicions that different neurotransmitters are associated with depression.

The theory based on norepinephrine states that depression is due to a functional lack of norepinephrine in the cerebral synapses. One of the evidence supporting this theory is that sleep deprivation, especially REM sleep, has antidepressant effects, and this is due to an increase in the sensitivity of the norepinephrine receptors.

Serotonin plays a very important role in controlling our body’s balance and thus regulates excessive activation. The deficit of this neurotransmitter, accompanied by a functional deficit of the catecholamines, can lead to depression.

Typical symptoms of depression

In depression there are different symptoms and not everyone suffers from the same, but the typical symptomatology of depression is the following:

Symptoms affecting the state of mind: Sadness is the quintessence of depression. Irritability, a feeling of emptiness or nervousness can also occur. Positive feelings are less and less felt.

Symptoms affecting drive and behaviour: General introverted state leading to apathy, indifference and anhedonia.

Cognitive symptoms: Memory performance, attention and concentration decrease. In addition, perception is altered by low self-esteem, overtaxing and loss of self-esteem.

Physical symptoms: Sleep problems such as insomnia or sleep addiction are common symptoms, as are fatigue, loss of appetite, listlessness and reduced sexual desire.

Interpersonal symptoms: Interpersonal relationships become less and less until the person becomes completely isolated at some point.

Although these symptoms can occur in all types of severe depression, there are some differences in the way the symptoms manifest themselves and especially in their intensity. Severe depression, whether reactive or endogenous, renders the patient unable to act and makes social relationships and work performance more difficult, although the symptoms of endogenous depression are usually even more severe.

Typical Symptoms of Endogenous Depression

Even though both types of depression (reactive and endogenous depression) have largely the same symptoms, there are still differences. Endogenous depression has greater vegetative symptoms, such as tachycardia.

The symptoms are more severe and suicidal thoughts are more likely than in other species. In addition, in most cases it is possible to detect seasonal variations in symptoms and early signs of them.

A more intense, overpowering, disproportionate and pervasive sadness is spreading. In addition, the sadness is accompanied by a pronounced anhedonia, or equivalent, the inability to feel joy. There is a loss of reactivity and it is not possible for the affected person to react emotionally to important positive events.

The endogenous sadness is not changeable by itself despite efforts. Since there is no identifiable cause on which a therapy can concentrate, medication is the first treatment method. The good news about this type of depression is that it responds very well to antidepressants.

Dispute over children’s disease DMDD

They are prone to severe rage outbursts and are extremely irritable, but also distressed and depressed: A mental disorder in children has now been redefined in the Psychiatrist Manual. Critics, however, fear that DMDD could become a fashion diagnosis.

From one moment to the next they boil with rage. They beat around themselves, banging on people or objects. At least every other day anger breaks out of these children unsustainably, at home, at school or when they are out with their parents. Between the outbursts of rage they are very irritable, but they also seem sad, closed and depressed. The consequences: Problems at school, few friends.

Children who have it this way are not in the usual early childhood phase of defiance. They are too old for this and their disasters are too serious. Psychiatrists have a new name for the severe mood swings: DMDD – an abbreviation that stands for Disruptive Mood Dysregulation Disorder.

It is obvious that the children are not well. What exactly is the problem behind it, however, is controversial. “Many a psychiatrist diagnoses a severe form of ADHD with accompanying depressive disorder,” reports the child psychiatrist Florian Daniel Zepf from the University Hospital Aachen. Others, on the other hand, noted a disturbance of social behaviour or an additional emotional disturbance.

In the USA, most children have been diagnosed with bipolar disorder. This refers to an episodic alternation between pathological elation and depression. In January 2008 alone, more scientific articles on bipolar disorder in children were published than in the years between 1986 and 1996 combined,” writes Zepf and his colleague Martin Holtmann from the University of Bochum in the “Textbook of Child and Adolescent Mental Health.

The psychiatrists faced a problem: “Actually, children with these severe mood swings do not fit clearly into one of the previous categories,” says Zepf. This also complicates appropriate treatment.

Clarity through new diagnosis?

The new diagnosis DMDD was therefore introduced in order to create more clarity and contain the bipolar epidemic in the USA. This severe mood disorder will be officially included in the new edition of the catalogue for mental disorders, the DSM-5, from May 2013.

But for many doctors and psychologists, the new diagnosis causes abdominal pain. DMDD has only been under discussion for seven years – and has hardly been researched to date. It usually takes many years and hundreds of studies for a mental illness to be included as an official diagnosis in the handbook.

For example, the binge eating disorder was only included in the newly published manual after many years of additional research, while Internet addiction did not make it into the DSM-5. DMDD, on the other hand, lacks studies, so that questions remain unanswered: Do the criteria in practice only include sick children? And do all child psychiatrists interpret the criteria identically?

“This will be the epidemic number four among children – after ADHD, the Asperger syndrome and the bipolar disorder”, the psychiatrist Allen Frances alerted his colleagues in the specialist medium “Psychiatric Times”. Allen is the biggest critic of the DSM-5. He himself was in charge of the predecessor, the DSM-4, but he considers many of the contents of the new edition to be arbitrary.

Instead of containing the epidemic of bipolar diagnoses, the DSM committee is creating another fashionable disease,” he writes. Instead, the new diagnosis would wrongly classify even more children as ill and give them too many drugs.