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Psychiatrists and researchers oncecategorized depressionusing a pair of terms derived from Latin: endogenous (meaning “from within”) and exogenous (“from without”). These names were intended to indicate whether someone’s depression came from internal causes (such as genetics) or external causes (like a stressful or traumatic event).
The old belief was that the distinction was necessary and that each type of depression had to be treated differently.Today, depression formerly referred to as “endogenous” is known asmajor depressive disorder(MDD). The current philosophy is that the same types of treatment can be used for MDD whether it is “endogenous or exogenous.”
It can still sometimes be helpful for healthcare and mental health professionals to note the concept of endogenous and exogenous causes of major depression when helping people understand the condition.
This article discusses the symptoms, causes, and treatments for endogenous vs. exogenous depression. If you are experiencing symptoms of depression, talk to your doctor or mental health professional to get an appropriate diagnosis and treatment.
The Most Common Types of Depression
There is considerable overlap indepression symptomsfrom one type to another. A key difference (particularly when discussing endogenous or exogenous types) can be the cause or trigger for an episode of depression rather than specific symptoms.
Verywell / Joshua Seong
Endogenous Depression
Symptoms of endogenous depression includefeelings of sadness,worthlessness, guilt, and an inability to enjoy normally pleasurable things. You may also notice changes in your appetite, sleep patterns, and energy levels.
If you have endogenous depression, the world may seem like a dark and sad place because that’s how you feel within yourself.
Exogenous Depression
Exogenous depression can look and feel much like endogenous depression.The difference is that thesesymptoms come on after something happensin a person’s life. For example, a person may feel persistently sad after the death of a loved one or struggle with guilt and feelings of worthlessness after losing their job.
Exogenous depression can make the world seem dark and sad because of what’s happeningaround yourather thanin you.
Another difference is that people with exogenous depression don’t always have thephysical symptoms of depression, like havingtrouble sleepingor change in appetite, which is common in other forms of the condition.
EndogenousSymptoms are not tied to an identifiable causeSymptoms seem to arise from withinOften involves physical symptomsExogenousSymptoms are tied to external eventsMimics situational depressionDoes not always have physical symptoms
EndogenousSymptoms are not tied to an identifiable causeSymptoms seem to arise from withinOften involves physical symptoms
Symptoms are not tied to an identifiable cause
Symptoms seem to arise from within
Often involves physical symptoms
ExogenousSymptoms are tied to external eventsMimics situational depressionDoes not always have physical symptoms
Symptoms are tied to external events
Mimics situational depression
Does not always have physical symptoms
How Genetics Plays a Role in Depression
People with endogenous depression often feel that their symptoms occur “for no reason”—at least in the sense that there is no apparentexternalcause. Instead, the cause is thought to be biochemical and/or genetic. For example, a person with a family history of mental illness may be more likely to develop depression.
Can You Be Depressed for “No Reason?”
While someone with endogenous depression had an underlying predisposition that was triggered, exogenous causes can lead to symptoms of depression in someone who doesn’t have a predisposition.
How Life Stressors Can Lead to Depression
Medical and mental health professionals use a specific set of criteria to diagnose depression. These guidelines are found in the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” (DSM-5). Your primary care doctor may evaluate you for depression in the office, but they might also want you to see someone who specializes in diagnosing and treating mental illness, such as apsychiatrist.
The process of beingdiagnosed with depressionusually involves several key components. It often begins with you being asked questions about:
Your doctor may also perform a physical exam and administer lab tests to rule out any medical conditions that might be contributing to your symptoms.
One of the most important questions you will be asked is whether you have ever hadsuicidal thoughtsor attempted suicide—a potential consequence of untreated depression.
If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.
If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see ourNational Helpline Database.
Major depressive disorder(MDD) is diagnosed when someone has experienced intense sadness and/or loss of interest in their usual activitiesplusseveral other symptoms of depression (such as trouble sleeping, change in appetite or weight, and difficulty concentrating) forat least two weeks.
Sometimes, yourdiagnosis might change. If you don’t respond well to a treatment that usually works for depression, for instance, your doctor might want to reevaluate your symptoms to see if you have another mental illness, such asbipolar disorder.
RecapIn order to diagnoseany form of depression, your doctor or mental health professional will ask questions, conduct lab tests, and may perform a physical exam. Having the correct diagnosis will make it much more likely that you will find an effective treatment.
Recap
In order to diagnoseany form of depression, your doctor or mental health professional will ask questions, conduct lab tests, and may perform a physical exam. Having the correct diagnosis will make it much more likely that you will find an effective treatment.
How Depression Is Diagnosed
Once a diagnosis is established, the providers in charge of your care will begin working on a treatment plan. Keep in mind that the most effective treatment for you won’t necessarily be the same as what works for someone else with depression, and you may need to try more than one treatment.
In 2012, a study published in the journalMolecular Psychiatrysuggested that the root cause of exogenous and endogenous depression could be found in different pathways in the brain.However, researchers have yet to prove that the two types respond differently to specific treatments for depression, such as medication.
Though they are instigated in different ways, both exogenous and endogenous depression ultimately lead to abiochemical imbalance in the brain. Therefore, a treatment that addresses an imbalance can be used for either type.
Medication
The first-line treatment for depression of either type is usually antidepressant medication.Drugs from a class of antidepressants calledselective serotonin reuptake inhibitors(SSRIs) are often the first choice, as they are consistently effective and well-tolerated.
Psychotherapy
Medications are often paired withpsychotherapy, which is more effective for some people than using only an antidepressant.Cognitive behavioral therapy(CBT) is one type of therapy that is often utilized to treat depression, but other types of therapy may be used includingdialectical behavior therapy(DBT),interpersonal therapy(IPT), andpsychodynamic therapy.
Other Treatments
People with severe ortreatment-resistant depressionmay need other interventions to effectively manage their symptoms, such as antipsychotic medications and/orelectroconvulsive therapy(ECT).
The unique qualities of all types of depression are still being researched. As new information is learned and discovered, in the future, treatments may emerge that can help manage various forms of depression in different or more targeted ways.
For now, it’s best to discuss your symptoms, family health history, and risk factors with your doctor or amental health professionalto determine the best treatment.
Depression can affect anybody at any point during their life. While it cannot always be prevented, there are steps that you can take to help reduce the risk of developing endogenous depression.
Lifestyle modifications that may lower your risk of depression include eating a healthy diet, getting regular physical exercise, and getting adequate sleep. Having a strong social support network is also important.
While you cannot always avoid the difficult life events that cause exogenous depression, there are strategies that you can utilize to improve your ability to cope with stress. Caring for yourself and seeking support from friends and family can be helpful when you are dealing with a challenge. Stress management techniques such as deep breathing, mindfulness, yoga, and meditation can also improve your ability to manage stress.
Summary
While mental health professionals used to make a distinction between endogenous vs. exogenous depression, symptoms of depression are now diagnosed using criteria in the DSM-5. A person’s diagnosis will depend on the nature, extent, severity, and duration of their depressive symptoms.
Endogenous depression seems to arise from within, where exogenous depression is linked to specific external events. Regardless of the cause, depression is generally treated with medication, therapy, or a combination of the two. Lifestyle factors including exercise, diet, sleep, and social support may also influence depression risk factors and affectresiliencefollowing stressful events.
A Word From Verywell
If you are experiencing symptoms of depression, it is important to take steps to get help, regardless of whether those symptoms seem to be endogenous vs. exogenous. A healthcare practitioner or mental health professional can assess your symptoms, make and appropriate diagnosis, and recommend treatments to help you start feeling better.
5 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kahn E.Endogenous and exogenous depressions.Postgrad Med. 1954;16(4):330-3. doi:10.1080/00325481.1954.11711694Malki K, Keers R, Tosto MG, et al.The endogenous and reactive depression subtypes revisited: Integrative animal and human studies implicate multiple distinct molecular mechanisms underlying major depressive disorder.BMC Med. 2014;12:73. doi:10.1186/1741-7015-12-73National Institute of Mental Health.Depression.Andrus BM, Blizinsky K, Vedell PT, et al.Gene expression patterns in the hippocampus and amygdala of endogenous depression and chronic stress models.Mol Psychiatry. 2012;17(1):49-61. doi:10.1038/mp.2010.119Muñoz RF, Beardslee WR, Leykin Y.Major depression can be prevented.Am Psychol. 2012;67(4):285-295. doi:10.1037/a0027666
5 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kahn E.Endogenous and exogenous depressions.Postgrad Med. 1954;16(4):330-3. doi:10.1080/00325481.1954.11711694Malki K, Keers R, Tosto MG, et al.The endogenous and reactive depression subtypes revisited: Integrative animal and human studies implicate multiple distinct molecular mechanisms underlying major depressive disorder.BMC Med. 2014;12:73. doi:10.1186/1741-7015-12-73National Institute of Mental Health.Depression.Andrus BM, Blizinsky K, Vedell PT, et al.Gene expression patterns in the hippocampus and amygdala of endogenous depression and chronic stress models.Mol Psychiatry. 2012;17(1):49-61. doi:10.1038/mp.2010.119Muñoz RF, Beardslee WR, Leykin Y.Major depression can be prevented.Am Psychol. 2012;67(4):285-295. doi:10.1037/a0027666
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kahn E.Endogenous and exogenous depressions.Postgrad Med. 1954;16(4):330-3. doi:10.1080/00325481.1954.11711694Malki K, Keers R, Tosto MG, et al.The endogenous and reactive depression subtypes revisited: Integrative animal and human studies implicate multiple distinct molecular mechanisms underlying major depressive disorder.BMC Med. 2014;12:73. doi:10.1186/1741-7015-12-73National Institute of Mental Health.Depression.Andrus BM, Blizinsky K, Vedell PT, et al.Gene expression patterns in the hippocampus and amygdala of endogenous depression and chronic stress models.Mol Psychiatry. 2012;17(1):49-61. doi:10.1038/mp.2010.119Muñoz RF, Beardslee WR, Leykin Y.Major depression can be prevented.Am Psychol. 2012;67(4):285-295. doi:10.1037/a0027666
Kahn E.Endogenous and exogenous depressions.Postgrad Med. 1954;16(4):330-3. doi:10.1080/00325481.1954.11711694
Malki K, Keers R, Tosto MG, et al.The endogenous and reactive depression subtypes revisited: Integrative animal and human studies implicate multiple distinct molecular mechanisms underlying major depressive disorder.BMC Med. 2014;12:73. doi:10.1186/1741-7015-12-73
National Institute of Mental Health.Depression.
Andrus BM, Blizinsky K, Vedell PT, et al.Gene expression patterns in the hippocampus and amygdala of endogenous depression and chronic stress models.Mol Psychiatry. 2012;17(1):49-61. doi:10.1038/mp.2010.119
Muñoz RF, Beardslee WR, Leykin Y.Major depression can be prevented.Am Psychol. 2012;67(4):285-295. doi:10.1037/a0027666
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