Endogenous depression - basics, symptoms, treatment and curing

What is Endogenous Depression?

In most cases, a person who appears to suffer from a type of depression will often have a reason for it. In other words, the depression has been brought on or encouraged by an event, or something has happened to that individual, either in their youth or adulthood, that they have not been able to deal with. There are, however, cases where the individual does not seem to have a reason for their depression. They show all the symptoms of depression, but there just not seems to be any apparent cause for it. This is when the patient would probably be diagnosed with endogenous depression.

Endogenous means 'coming from within' and such depression were thought to be due to biochemical changes within the body, although there is still very little understanding of what triggered them.

Note that the way in which depressive illness is classified has been changed recently. In practice this is really only of interest to statistician and researchers, but you may know of someone, a friend or relative perhaps, who was given a particular diagnosis under the old system and wonder how that relates to a diagnosis that someone receives now. Until very recently, depression was classified as either reactive or endogenous. Reactive depression was believed to have been caused by a particular event in a person's life. In other words, the sufferer became depressed as a reaction to things that had happened, such as redundancy, bereavement, serious illness, etc.

Endogenous depression is a term, which is also used to describe those patients who do not respond to medication.

Symptoms

A person who suffers from endogenous depression will often exhibit similar symptoms as someone suffering from any other type of depression. The person could appear anxious, have a change in sleeping patterns, a change in eating habits, show fatigue, have low self-esteem and even sudden mood changes.

The symptoms of endogenous depression range from mild to more severe and not all patients exhibit the same symptoms. If the patient is suffering from an underlying health concern or any accompanying mental health illness, the symptoms may become more severe in nature. Like most other forms of depression the symptoms of endogenous depression are classified into 4 distinct categories.

Impact on your Thoughts:

• Lack of concentration


• Forgetfulness


• Inability to make spontaneous decisions


• Pessimistic attitude


• Guilt


• Self pity


• Thoughts of self destruction

Impact on your Behavior:

• Apathy


• Cry often


• Prefer to stay away from social situations


• Little to no sex drive


• Lack of personal grooming (in severe cases)


• Disinterest in work and routine activities

Impact on your Feelings:

• Feel tired all day


• Lack of motivation


• Occasional temper outbursts


• Irritability


• Worthlessness

Impact on your Physical Well Being:

• Prolonged fatigue


• Difficulty falling asleep


• Disturbed sleep patterns


• Experience bodily aches

If you do experience any or all of these symptoms, consider getting medical help at the earliest in order to initiate treatment and speed up recovery. Since there are different treatment options available, discuss all of them with your doctor to find out which one is best suited to your unique needs.

Causes

Since endogenous depression is a genetic mood disorder, patients predisposed to this form of depression generally develop the condition when the chemical imbalances in the brain become more severe. Stress along with other traumatic circumstances can also influence the onset of this condition but in most cases the patient will not be able to associate any particular event with the advent of the disorder. Endogenous depression can affect people of all age groups and most patients realize that they’re suffering from the disorder only after the symptoms are manifested.

Treatment

How is endogenous depression treated? Endogenous depression can be also called as biochemical depression. It tends to run in families, as in genetic factors, and is generated by brain chemistry and imbalances of serotonin (it’s one of the "feel good" hormones that helps us to sleep) or other neurotransmitters. Most of anti-depressant medications prescribed currently are chemicals that maintain or improve serotonin levels. Even the natural approach that utilizes diet, herbs, and amino acids is geared toward raising serotonin levels.

Often though, with endogenous depression, the sufferer has difficulty controlling depressive thoughts and as such, in this situation a very specific form of counseling, CBT or Cognitive Behavioral Therapy, is also indicated.

There are also certain food items and natural supplements which would be useful in alleviating endogenous depression, such as omega-3 fatty acids found in fish, vitamin B compounds, and folic acid found in broccoli, asparagus, and spinach. Research reports have indicated that increasing the intake of all three compounds is extremely effective in reducing the condition and / or preventing depression from setting in. Regular intake of salmon and other fish that are a rich source of omega-3 fatty acids has been found to relieve the symptoms of depression.

Self-Help

Self help for endogenous depression may seem like an unrealistic objective when you have absolutely no interest in anyone or anything outside the black hole you find yourself in. That is why you need to have someone who will call you every day. It can be a close friend or family member. That is the first self help for endogenous depression tip. A tiny first step in keeping a supportive relationship alive and well…

The second self help for endogenous depression tip is to make a list of all the things that you liked or even still like doing and which give you pleasure. This can range from food, music, a movie, a hot bath, a long walk or even playing with a dog or cat. If you can aim to do one or two of these things every day, that is a great start.

The third self help for endogenous depression tip is not to underestimate the power of exercise. Scientists now are absolutely certain that any form of exercise has such a beneficial effect on our mood (and also on our body) that it can sometimes even replace anti-depressants. If you are stressed out or just totally down, exercise can really lift your mood and get those endorphins going which in turn raise your serotonin levels. It is no accident that endorphins are called 'happy chemicals’. Brisk walking for thirty minutes a few times a week can do the trick if you have no will power to face the gym and all that goes with it.

Summary

Like any other type of depression, endogenous depression is treatable. While treatments may not seem to work at first, they will over time. It is important for anyone who wishes to work through their depression to be open and honest with their therapist so that the therapist can have a clear understanding about what the patient needs. With the proper information, the therapist can be sure to choose the right medication and/or other treatments that would best work in the patient’s favor. Depression is not something to ignore or shy away from getting help for. If anyone thinks they might be suffering from depression, they need to consult a therapist so they can get the help they need.

Untreated, this mental condition can cause severe problems for the affected person and his or her loved ones. Several cases of untreated endogenous depression result in suicide, mainly because afflicted persons feel depressed for no particular reason and ultimately feel totally helpless and hopeless; they then finally contemplate ending their lives.

It is extremely important for family members to ensure that persons suffering from depression endogenous get proper professional help. Family and friends should also ensure that persons suffering from depression are encouraged to engage in activities which keep them occupied and interacting with people. If possible, affected persons should also try and enroll into an exercise routine, as well as yoga and meditation. These will help calm and relax them on a long-term basis.

Sources and Additional Information:

http://trusted.md/blog/completecounseling/2008/09/05/what_is_endogenous_depression

http://www.depression-guide.com/endogenous-depression.htm

http://www.wrongdiagnosis.com/e/endogenous_depression/intro.htm

http://www.brighthub.com/mental-health/depression-mood/articles/82754.aspx

http://www.all-on-depression-help.com/endogenous-depression.html

http://www.selfgrowth.com/articles/what_is_endogenous_depression_and_how_do_you_treat_it

Dance and Movement Therapy for Depression

Dance therapy has been used to treat mental and physical disabilities and illnesses in the United States since the 1940s. It is recognized by many major organizations as a legitimate form of treatment despite the scarcity of scientific studies that explore its effects. At the very least, it is known that dance/movement therapy will "provide exercise, improve mobility and muscle coordination...reduce muscle tension...improve self-awareness, self-confidence, and interpersonal interaction, and [act as] an outlet for communicating feelings," according to the American Cancer Society.

What is Dance and Movement Therapy?

In this type of therapy, a dance therapist helps a group of people to express themselves in movement. Expressing feelings in this way is supposed to improve mood.

Dance/movement therapy, as a creative art therapy, is rooted in the expressive nature of dance itself. Dance is the most fundamental of the arts, involving a direct expression and experience of oneself through the body. It is a basic form of authentic communication, and as such it is an especially effective medium for therapy. Based in the belief that the body, the mind and the spirit are interconnected, dance/movement therapy is defined by the American Dance Therapy Association as "the psychotherapeutic use of movement as a process that furthers the emotional, cognitive, social and physical integration of the individual."

History

Dance therapy, as it is currently defined, began in the U.K. and spread to the United States in the 1940s.

Dance/movement therapy as an organized profession was born in psychiatric hospitals such as St. Elizabeth's in Washington, D.C., in the 1940s and Camarillo State Hospital in California in the 1920s. Students of the early pioneers of the field in those hospitals and other settings started the Dance Therapy Association in 1966. I was trained in that model, which was developed from the work of Marian Chace, a Denishawn dancer who started dance therapy at St. Elizabeth's Hospital and Chestnut Lodge.

Dance therapists noted progress and outcomes in the nursing logs in terms of expanded range of affect and motion, increased interpersonal communication skills, and group dynamics. Dance therapists no longer work primarily in psychiatric settings but now function in medical hospitals, wellness settings, workplaces, and spas. In these settings, they bring their unique healing combination of body, symbol, energetics, resiliency, and recovery. 

Basics

Dance therapy is founded on the idea that the mind and body are inseparable. At its most basic level, dance is a form of exercise, providing mobility, flexibility and strength. Exercise increases neurotransmitters in the brain called endorphins, which encourage happiness and contentedness, curing symptoms of depressive patients. Total body movements enhance the circulatory, respiratory, skeletal and muscular systems, according to the American Cancer Society. Furthermore, the ACS notes that dance therapy helps patients "develop a nonverbal language that offers information about what is going on in their bodies," improving their communication with themselves and others, decreasing isolation and providing a sense of hope for the future.

Uses

A qualified dance therapist will observe a patient's natural movement and decide upon an appropriate program for their particular needs. Therapy sessions may occur individually or in groups. The American Dance Therapy Association holds classes at nursing homes, daycare centers, hospitals and educational settings, among others. Dance therapy has reportedly assisted people with learning disabilities, eating disorders and autism, as written in Levy's book "Dance/Movement Therapy: A Healing Art." Dance therapy is said to help a patient develop organizational skills, help improve body image issues and expand cognitive abilities. Because dance therapy operates on the belief that the mind and body are linked, it seeks to heal emotional and physical illness simultaneously. Depressive patients are encouraged to find freedom from debilitating emotions in their movements.

Considerations

The American Cancer Society notes that "few scientific studies have been done to evaluate the effects of dance therapy on health, prevention, and recovery from illness." Dance therapy should be pursued under the supervision of a primary care physician and should be part of a holistic health and wellness plan, regardless of a person's diagnosis.

Recognition

Dance therapy is now practiced all over the world. This expressive therapy is recognized by the Health Care Financing Administration of the Department of Health and Human Services, the Administration on Aging and the Office of Alternative Medicine of the National Institute of Health. All dance therapists working for the ADTA must have a master's degree and a minimum of 700 supervised hours of clinical training.

You do not like dancing?

The common misconception is that you need to be a skilled dancer to practice dance therapy. Absolutely wrong! It is not about learning new moves and getting on the dance floor to show off. It is all about getting alone with your body and mind. Even if you do not need dance therapy on a clinical level, you can practice self-growth dance techniques to help you reach a blissful state of freedom and emotional relief. Learn to let go completely and surrender to your body's needs. Authentic Movement and Contact Improvisation are two powerful, expressive dance techniques.

Authentic movement is a personal growth tool to help you tune into your body. Authentic Movement creates a space for the development of a process through spontaneous movement. As a practice, it integrates many traditions: therapy and meditation, individual and community process, ritual and improvisation. Everyone can benefit from Authentic Movement.

Contact improvisation is another self-growth dance technique in which physical contact with another human being provides exploration through movement improvisation. Contact Improvisation is one of the most well-known forms of postmodern dance. To physically touch another person in an expressive, uninhibited way can be a powerful way to release repressed feelings.

“I love the feeling of using something I really believe and know is good for me,” Given said when discussing her calling as a dance therapist. “It is very rewarding having a tool to share with others.”

Quick facts

• As defined by the American Dance Therapy Association, "Dance/Movement Therapy is the psychotherapeutic use of movement as a process which furthers the emotional, social, cognitive, and physical integration of the individual."


• Dance/movement therapy emerged as a distinct profession in the 1940's.


• The American Dance Therapy Association was formed in 1966. It maintains a code of ethics and has established standards for professional practice, education and training.


• There are approximately 1203 dance/movement therapists in 46 states and 29 foreign countries.


• Dance/movement therapy is an effective treatment for people with developmental, medical, social, physical and psychological impairments.


• Dance/movement therapy is practiced in mental health rehabilitation, medical, educational, forensic, nursing homes, day care, disease prevention and health promotion programs.


• Dance/movement therapy is used with people of all ages, races, and ethnic backgrounds in individual, couples, family, and group therapy formats.


• Entry into the profession of dance/movement therapy is at the Master's level. The title "Dance Therapists Registered" (DTR) is granted to entry level dance/movement therapists who have a master's degree which includes 700 hundred hours of supervised clinical internship. The advanced level of registry, "Academy of Dance Therapists", (ADTR) is awarded only after DTR's have completed 3,640 hours of supervised clinical work in an agency, institution or special school, with additional supervision from an ADTR.

Gratitude Dance

Sources and Additional Information:

http://www.ehow.com/about_6556906_dance-therapy-depression.html

http://www.healthyplace.com/alternative-mental-health/depression-alternative/dance-and-movement-therapy-for-depression/menu-id-55/

http://www.the-bright-side.org/site/thebrightside/content.php?type=1&section_id=893&id=1144

http://www.ileneserlin.com/dance_movement_therapy.pdf

http://www.examiner.com/dance-in-nashville/dance-therapy-the-art-of-healing-through-expression

Seasonal Affective Disorder: Winter Depression

Seasonal affective disorder is a pattern of major depressive episodes that occur and remit with changes in seasons. The most recognized form of seasonal affective disorder, "winter depression," is characterized by recurrent episodes of depression, hypersomnia, augmented appetite with carbohydrate craving, and weight gain that begin in the autumn and continue through the winter months. Physicians have many options for treating seasonal affective disorder. While questions regarding the validity of seasonal affective disorder as a syndrome and the mechanism of action of light therapy continue to be investigated, the established effectiveness of light therapy in patients with winter depression supports the usefulness of assessment for this seasonal pattern and consideration of light therapy as an option in addition to existing treatment choices.

What is SAD?

Throughout the centuries, poets have described a sense of sadness, loss and lethargy which can accompany the shortening days of fall and winter. Many cultures and religions have winter festivals associated with candles or fire. Many of us notice tiredness, a bit of weight gain, difficulty getting out of bed and bouts of "the blues" as fall turns to winter.



However some people experience an exaggerated form of these symptoms. Their depression and lack of energy become debilitating. Work and relationships suffer. This condition, known as Seasonal Affective Disorder (SAD) may affect over 10 million Americans while the milder, "Winter Blues" may affect a larger number of individuals.



The typical symptoms of SAD include depression, lack of energy, increased need for sleep, a craving for sweets and weight gain. Symptoms begin in the fall, peak in the winter and usually resolve in the spring. Some individuals experience great bursts of energy and creativity in the spring or early summer. Susceptible individuals who work in buildings without windows may experience SAD-type symptoms at any time of year. Some people with SAD have mild or occasionally severe periods of mania during the spring or summer. If the symptoms are mild, no treatment may be necessary. If they are problematic, then a mood stabilizer such as Lithium might be considered. There is a smaller group of individuals who suffer from summer depression.



SAD is recognized in the DSM-IV (The American Psychiatric Association's diagnostic manual) as a subtype of major depressive episode. The classic major depression involves decreased appetite, decreased sleep, and often, poor appetite and weight loss. It has long been recognized that some depressed individuals had a "atypical depression" with increased sleep and appetite along with decreased energy. Some, but not all of these atypical individuals also had a seasonal pattern. Some people with winter depression also have mild or occasionally severe manic mood swings in the spring and summer. If these episodes are severe, the individual might be diagnosed with Bipolar Disorder.

What are the patterns of SAD?

Symptoms of winter SAD usually begin in October or November and subside in March or April. Some patients begin to slump as early as August, while others remain well until January. Regardless of the time of onset, most patients don’t feel fully back to normal until early May. Depressions are usually mild to moderate, but they can be severe. Very few patients with SAD have required hospitalization, and even fewer have been treated with electroconvulsive therapy.

The usual characteristics of recurrent winter depression include oversleeping, daytime fatigue, carbohydrate craving and weight gain, although a patient does not necessarily show these symptoms. Additionally, there are the usual features of depression, especially decreased sexual interest, lethargy, hopelessness, suicidal thoughts, lack of interest in normal activities, and social withdrawal.

Light therapy, described below, is now considered the first-line treatment intervention, and if properly dosed can produce relief within days. Antidepressants may also help, and if necessary can be used in conjunction with light.

In about 1/10^th of cases, annual relapse occurs in the summer rather than winter, possibly in response to high heat and humidity. During that period, the depression is more likely to be characterized by insomnia, decreased appetite, weight loss, and agitation or anxiety. Patients with such "reverse SAD" often find relief with summer trips to cooler climates in the north. Generally, normal air conditioning is not sufficient to relieve this depression, and an antidepressant may be needed.

In still fewer cases, a patient may experience both winter and summer depressions, while feeling fine each fall and spring, around the equinoxes.

The most common characteristic of people with winter SAD is their reaction to changes in environmental light. Patients living at different latitudes note that their winter depressions are longer and more profound the farther north they live. Patients with SAD also report that their depression worsens or reappears whenever the weather is overcast at any time of the year, or if their indoor lighting is decreased.

SAD is often misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections.

Epidemiology of SAD

Surveys estimate that 4 to 6 percent of the general population experience winter depression, and another 10 to 20 percent have subsyndromal features. Women with SAD outnumber men four to one. The average age of onset is approximately 23 years of age. The risk of SAD appears to decrease with age. Pilot studies of childhood cases of SAD suggest a prevalence rate between 1.7 and 5.5 percent in children between the ages of nine and 19 years.

For every individual with full blown SAD, there are many more with milder "Winter Blues." The incidence of SAD increases with increasing latitude up to a point, but does not continue increasing all the way to the poles. There seems to be interplay between an individual's innate vulnerability and her degree of light exposure. For instance, one person might feel fine all year in Maryland but develop SAD when she moves to Toronto. Another individual may be symptomatic in Baltimore, but have few symptoms in Miami. Some individuals who work long hours inside office buildings with few windows may experience symptoms all year round. Some very sensitive individuals may note changes in mood during long stretches of cloudy weather.

How is SAD diagnosed?

It can sometimes be hard to tell the difference between non-seasonal depression and SAD, because many of the symptoms are the same. To diagnose SAD, your doctor will want to know if:

• You have been depressed during the same season and have gotten better when the seasons changed for at least 2 years in a row.


• You have symptoms that often occur with SAD, such as being very hungry (especially craving carbohydrates), gaining weight, and sleeping more than usual.


• A close relative-a parent, brother, or sister-has had SAD.

How SAD it treated?

Doctors often prescribe light therapy to treat SAD. There are two types of light therapy:

• Bright light treatment. For this treatment, you sit in front of a "light box" for half an hour or longer, usually in the morning.


• Dawn simulation. For this treatment, a dim light goes on in the morning while you sleep, and it gets brighter over time, like a sunrise.

Light therapy works well for most people with SAD, and it is easy to use. You may start to feel better within a week or so after you start light therapy. But you need to stick with it and use it every day until the season changes. If you don't, your depression could come back.

Other treatments that may help include:

• Antidepressants. These medicines can improve the balance of brain chemicals that affect mood.


• Counseling. Some types of counseling, such as cognitive-behavioral therapy, can help you learn more about SAD and how to manage your symptoms.

If your doctor prescribes antidepressants, be sure you take them the way you are told to. Do not stop taking them just because you feel better. This could cause side effects or make your depression worse. When you are ready to stop, your doctor can help you slowly reduce the dose to prevent problems.

You may feel better if you get regular exercise. Being active during the daytime, especially first thing in the morning, may help you have more energy and feel less depressed. Moderate exercise such as walking, riding a stationary bike, or swimming is a good way to get started.

Theories about how light affect mood and sleep

In 1984, a psychiatrist at NIMH, Norman Rosenthal, published a paper on the use of bright light therapy in patients with this disorder. Since then, a large number of well-designed studies have confirmed and refined these findings. Researchers are still investigating mode by which bright light can lift depression or reset a sleep cycle. One theory is that an area of the brain, near the visual pathway, the suprachiasmatic nucleus responds to light by sending out a signal to suppress the secretion of a hormone called melatonin. Brain studies suggest that there is impairment serotonin function in neurons leading to the suprachiasmatic nucleus.



Initial theories suggested a pathway from the retina to the suprachiasmatic nucleus. However some recent research indicated that bright light applied to the back of an individual's knee could shift human circadian rhythms. (Daily sleep-wake cycle) This suggests that the bloodstream, not just the neurons of the visual pathways, might mediate the biological clock.



How the Light Box is used

Before embarking on a course of light treatment, it is best to have a complete psychiatric evaluation. Sometimes a medical illness or another psychiatric condition can masquerade as depression. Discuss various treatment alternatives with your doctor. Light therapy does take time, and regular use. Like exercise, not everyone who would benefit from it will actually do it on a regular basis. Your doctor will discuss the various types of light boxes or visors available. The time spent in front of the light is related to the intensity of the light source and the distance one sits from the light. The light devices cost about $250 to $500 and often are not covered by insurance. I will often lend out a box for a month so that the individual can see whether it helps before purchasing a box.



Some individuals who use a 10,000-lux box may only need 30 minutes of daily light treatment. However, the amount of light needed varies widely from individual to individual. The light treatment is most often done in the morning, but studies have suggested that either morning or evening light can help SAD. Some people may get insomnia when they use the light in the evening. Initially, researchers felt that one needed full spectrum light. Now, studies suggest that regular fluorescent lights will work as well. UV (ultraviolet) light can damage eyes and skin, so it must be filtered out. It is best to buy a commercially built light box to be sure of the exact amount of light and to be sure that there are no isolated "hot spots" which could damage eyes. Many people still prefer full spectrum (minus UV) light because it is closest to natural lighting.



The individual measures the distance from her face to the light source. This measurement is important, and should be repeated daily for several days and occasionally after that. The light needs to strike one's eyes, but one does not need to look directly into the light source. It is fine to occasionally glance directly into the light. Many people read a book or eat breakfast while using the lights. Sitting still for 30 minutes to several hours is not an option for some people. For these people, the light visor is an option. Others are able to take one of the compact light boxes to work and use it for several hours. It is best to use the light source in an uninterrupted time block, but it can be helpful even with some interruptions.



Long term treatment compliance is often more difficult than one might initially anticipate. This is an important reason to have a professional monitoring. Having to account for your regular use (or the lack thereof) is a powerful motivator. It is also helpful to have an outside objective individual to help monitor your response to the treatment.



Since one of the symptoms of SAD can be difficulty awakening in the morning, some find it helpful to have the light turn on just before they are supposed to wake up. Some individuals like to use a Dawn Simulator. This is a bright light that is programmed to gradually increase its intensity such that it reaches its full intensity a set period before the individual is scheduled to awaken. Although it is less gentle, some people will put their light box beside their bed and hook it up to a timer set to turn on shortly before awakening.



Some people like to use full spectrum light bulbs for everyday household use. There is no evidence that these low intensity bulbs affect mood or sleep phase. Your plant light will not cure your SAD. Your 10,000-lux light however, may be nice for some of your plants.

Side Effects of Light therapy

 Potential side effects of light therapy are rare and most often include jitteriness, a feeling of eyestrain and headache. Light therapy, like antidepressant medications, occasionally will cause someone to switch into a manic state. There has been debate on whether there might be long term retinal effects, but none have been documented when lights with proper screening of UV wavelengths are used. Individuals taking certain medications such as Lithium, tricyclic antidepressants, and neuroleptics and individuals with conditions such as diabetes or retinal degeneration should be monitored by an ophthalmologist. Because this form of treatment is fairly new, many doctors recommend a baseline eye exam and annual monitoring.

Sources and Additional Information:

http://www.aafp.org/afp/980315ap/saeed.html

http://www.ncpamd.com/seasonal.htm

http://www.nami.org/Content/ContentGroups/Helpline1/Seasonal_Affective_Disorder_(SAD).htm

http://www.webmd.com/depression/tc/seasonal-affective-disorder-sad-topic-overview

http://www.medicinenet.com/seasonal_affective_disorder_sad/article.htm