Causes and Treatment of Endogenous Depression Endogenous depression, a subtype of major depressive disorder (MDD), is primarily rooted in internal biological and genetic factors rather than external life events. This type of depression can be particularly challenging because it arises from deep-seated neurochemical imbalances in the brain. Managing endogenous depression often requires a well-thought-out pharmacological approach, as it heavily relies on correcting these internal dysfunctions through medication. Causes of Endogenous Depression Endogenous depression is associated with several internal factors that contribute to its onset and persistence: 1. Genetic Predisposition - Hereditary Influence: A significant factor in endogenous depression is genetics. Individuals with a family history of depression are at a higher risk of developing the condition. Genetic variations affecting neurotransmitter systems, particularly those related to serotonin, dopamine, and norepinephrine, are believed to increase susceptibility to endogenous depression. 2. Neurochemical Imbalance - Neurotransmitter Dysfunction: A hallmark of endogenous depression is the imbalance in neurotransmitters, the brain's chemical messengers. Specifically, serotonin, norepinephrine, and dopamine are the primary neurotransmitters involved in mood regulation. Deficiencies or dysfunctional signaling in these pathways are strongly linked to the development of depressive symptoms such as persistent sadness, anhedonia (loss of interest in activities), and cognitive impairments. 3. Endocrine Factors - Hormonal Imbalances: Hormonal dysfunctions, particularly involving the hypothalamic-pituitary-adrenal (HPA) axis, play a crucial role in endogenous depression. Elevated cortisol levels, often seen in individuals with depression, indicate an overactive stress response. Additionally, thyroid dysfunction, particularly hypothyroidism, can contribute to the onset of depressive symptoms by disrupting normal neurochemical processes. 4. Brain Structure and Function - Neuroanatomical Changes: Studies have shown structural and functional abnormalities in brain regions such as the hippocampus and prefrontal cortex in individuals with endogenous depression. These areas are critical for regulating emotions and cognitive functions, and changes in their size or activity can predispose a person to depression. 5. Biological Rhythms - Circadian Rhythms: Disruptions in the body’s circadian rhythm, which governs the sleep-wake cycle, are closely linked to endogenous depression. Individuals with this condition often experience sleep disturbances, such as insomnia or hypersomnia, which can worsen depressive symptoms. Dysregulation of melatonin, a hormone that regulates sleep, further exacerbates these issues. Treatment of Endogenous Depression The treatment of endogenous depression is predominantly pharmacological, aiming to correct the underlying neurochemical imbalances that contribute to the disorder. The choice of medication depends on several factors, including the severity of symptoms, the patient's response to previous treatments, and the presence of any co-occurring conditions. 1. Antidepressants - Selective Serotonin Reuptake Inhibitors ( SSRIs ): - SSRIs are often the first-line treatment for endogenous depression due to their favorable side effect profile and efficacy. They work by blocking the reabsorption (reuptake) of serotonin into neurons, making more serotonin available in the brain, which helps elevate mood. - Fluoxetine (Prodep, Flunil) - Sertraline (Serlift, Zosert) - Escitalopram (Nexito, Cipralex) - Serotonin-Norepinephrine Reuptake Inhibitors ( SNRIs ): - SNRIs target both serotonin and norepinephrine, providing a broader effect on neurotransmitter levels. They are particularly useful for patients who do not respond adequately to SSRIs or who have significant fatigue and lack of energy as part of their depression. - Venlafaxine (Venlift, Veniz) - Duloxetine (Duzela, Duloxin) - Tricyclic Antidepressants ( TCAs ): - TCAs are an older class of antidepressants that inhibit the reuptake of both serotonin and norepinephrine. They are effective but tend to have more side effects, such as dry mouth, sedation, and weight gain. TCAs are often used when SSRIs and SNRIs are not effective. - Amitriptyline (Tryptomer, Amitone) - Nortriptyline (Noritop, Nortrip) - Atypical Antidepressants: - These medications do not fit neatly into the other categories and are often used when standard treatments are ineffective or not well tolerated. They work through various mechanisms, such as enhancing dopamine and norepinephrine activity. - Bupropion (Wellbutrin, Zyban) - Mirtazapine (Mirtaz, Remeron) Get the Best treatment of depression with Dr Shariq Qureshi - Best psychiatrist in Jaipur for depression treatment.