What’s the difference between endogenous depression and exogenous depression (aka reactive depression)?

Endogenous Depression Results


An endogenous depression is there regardless of events in the outside world, although they can definitely exacerbate it. An exogenous depression is caused by adverse life events, environmental factors (nasty weather does it to some extent for most of us, for example) and has nothing to do with neurochemistry. The term “reactive depression” is perhaps more telling, in the sense that it helps one to put one’s finger on the main difficulty endogenous depression sufferers have to deal with in their relationships with the people around them.

Why reactive depression sufferers have it easy compared to endogenous depression sufferers.

People who don’t suffer from mood disorders only know that which they’ve experienced themselves and since their moods are, in the vast majority of cases, influenced by things happening to them and/or certain things in their environment, they can’t conceive of the concept that someone might be depressed independently of or indeed despite external events and environmental influences. To them, someone suffering from a depression on a balmy, sunny day, after they’ve just left their fulfilling, prestigious and well-paying job to go home to a beautiful and open-minded spouse via a bar where everyone knows their name and a short stop at their lover’s place (who, incidentally, is as physically attractive as he or she is unassuming) is beyond comprehension – after all, he or she is depressed ‘for no reason’. According to them, the sufferer just needs to get his or head ‘right’ – realize how good he or she has it and voila – problem solved, no more depression, because how can anyone ever be depressed about having such a fairy-tale life? To them, depression for ‘no reason’ (in fact, there is a reason, it just isn’t either identifiable, tangible or corrigible in the outside world they share with the sufferer) is no depression at all, it isn’t valid and the sufferer’s very real suffering isn’t real at all.

All types of depression are tough and I wouldn’t wish any of them on anyone. It isn’t a competition either, in the style of ‘my depression is worse than your depression‘. With that said, as difficult as it is to deal with the mess in your own head, its even more difficult to deal with the lack of support from those around us (if we’re lucky) and active disdain and derision for our weak-mindedness (if we’re not). Reactive depression sufferers can usually count on others to say ‘give the guy a break, his wife has just left him, his house has burnt down together with his incredible collection of rare bonsai trees his grandfather, whom he loved dearly, had brought back from Japan to be passed down through generations as a family heirloom and he now lives under a bridge with an ugly, old woman and has to suck stones for money’, which will usually grant them all kinds of leeway in social settings, but the best an endogenous depression sufferer can hope for is ‘leave that guy alone, he’s a moody so-and-so’.

How to explain that you don’t have reactive depression and what that means.

What I’ve found helpful is to draw parallels with an experience non-sufferers may have had. In a not particularly sunny climate, light seasonal depressions are quite common. The lack of sunlight in the winter causes a vitamin D deficiency, which in turn (it is thought) negatively affects a person’s baseline sense of well-being. How severe this is depends on each person’s individual sensitivity, but it is common enough to be noticed. Ask them to remember what the difference between the last gloomy day of the winter and the first really sunny day of the spring was in terms of how they felt; now explain to them that for you, it isn’t as simple as a sunny day or a vitamin D supplement.

Depression-related quote of the day.

It isn’t cheerful or helpful this time, but it underscores what I’ve written above:

Depression can seem worse than terminal cancer, because most cancer patients feel loved and they have hope and self-esteem.
- David Burns

Can’t leave it at that, can we, so here goes:

Curiosity endows the people who have it with a generosity in argument and a serenity in their own mode of life which springs from their cheerful willingness to let life take the form it will.
- Alistair Cooke

What Is Endogenous Depression?

What is endogenous depression then? (the boring part)

The term “endogenous” comes from the Greek “endo“,meaning roughly “from within”, and “gen“, meaning “producing”.  If we put it all together, an endogenous depression  - properly fully termed endogenous major depressive disorder or mood disorder, endogenous clinical depression - simply means that the depression is caused by factors internal to the organism rather than external factors such as life events, trauma or environmental influences. This is juxtaposed with an exogenous depression (also termed reactive depression), which is brought on by one or more of the external factors listed above. The difference between the two will be the subject of an upcoming article. (You can now read the article “Differences Between Endogenous and Exogenous/Reactive Depression“.)

Endogenous depression is, briefly speaking, caused by dysregulation of one or more systems involving neurotransmitters which are responsible for, among others, euphoria, sense of well-being and energy. It is believed to be a genetic, hereditary condition in most cases. Read Causes Of Endogenous Depression if you’d like more detailed, if boring to some, information.

What is endogenous depression like really?

Endogenous Depression Painting

Endogenous depression through the eyes of a symbolist painter

For a sufferer, it means being a slave to neurotransmitter production and reuptake in his or her brain. No matter how great the weather, how beautiful the surroundings or how pleasant, friendly and cheerful people around him or her are, the sufferer can feel subdued, groggy and emotionless or conversely irritable and anxious. What makes things worse is that those wonderful people can’t understand why the sufferer is carrying on in such an unsociable, grumpy manner when there’s every reason in the world to be jolly and enjoy life. Humans are social animals and as such find it difficult to sustain a good mood if one of the members of the group is behaving in such an abnormal way. Not knowing the reasons for such behaviour on the part of the sufferer and attributing it, at least subconsciously, to his or her contrarian nature or inability to place the well-being of the group ahead of his or her own, many members of the group are likely to exhibit overt signs of displeasure in various forms, none of which are easy to deal with for the sufferer and which invariably make the situation worse. Others will react by attempting to uncover the reasons behind the sufferer’s bad mood, either by asking him or her things like “what’s wrong” and assuring him or her that “you can talk to me”, ad infinitum, or by doing random things to remove perceived impediments to the sufferer’s being happy, the list of which is of course arrived at through infuriatingly inappropriate guesswork. The sufferer will often think “If my problem weren’t in my head, there’s no way this would have been it – do you even know me?”.

It’s a feeling of being trapped inside your own head – willing yourself to feel better so your friends and family can have a good time, wishing and hoping beyond hope that relief will come and no one will realize just how badly the sufferer is capable of functioning in society. Of course, relief doesn’t come and both the irritating fussing over the ‘grumpy’ sufferer by some and the disapproving looks from the rest make matters even worse. Saying “don’t mind me, I’m just under the weather today, it’s nothing to do with you guys or anything, really” doesn’t help one iota and you wish you could say what’s really wrong, but you can’t – because you don’t know yourself, can’t find the words or can’t live with the stigma.

Read Endogenous Depression Signs And Symptoms for more, as this deserves its own article (one I can write on a better day than today).

Depression-related quote of the day.

I don’t mean to be a Pollyanna, but whenever I’ve felt helpless in a battle with my own brain and despaired at the futility of fighting my own body, I’ve come back to this:

“If you don’t like something, change it; if you can’t change it, change the way you think about it.”

- Mary Engelbreit

The new way I choose to think about my predicament is different each time, but I distinctly remember one from childhood. My mother’s colleagues, after hearing me play several Chopin preludes, couldn’t believe that a 7 year old boy could understand enough about the depths of sadness, melancholy and hopelessness to play them in the manner I did. I felt a certain hint of satisfaction at thinking that I’ve plumbed the depths of despair no adult in the room has, enabling me to make music, rather than just elicit sound from my instrument.