Endogenous vs. Exogenous Depression: What Are the Differences?

Psychiatrists and researchers once categorized depression using 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 as major 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.

Symptoms

There is considerable overlap in depression symptoms from 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.

Endogenous Depression

Symptoms of endogenous depression include feelings 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. 

Exogenous Depression

Exogenous depression can look and feel much like endogenous depression. The difference is that these symptoms come on after something happens in 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.

Another difference is that people with exogenous depression don't always have the physical symptoms of depression, like having trouble sleeping or change in appetite, which is common in other forms of the condition.

Causes

Whether depression is endogenous or exogenous, it’s almost always triggered by a life stressor. In someone who is prone to depression due to a genetic or biochemical predisposition, a significant change, life event, or trauma can serve as a trigger that causes them to develop symptoms. 

Endogenous Depression

People with endogenous depression often feel that their symptoms occur “for no reason”—at least in the sense that there is no apparent external cause. 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.

Exogenous Depression

Exogenous (or reactive) depression is triggered by an outside stressor such as the loss of a loved one, getting divorced, or losing your job. People who experience or witness a traumatic event may develop depression as a direct result of that exposure. 

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. 

Diagnosis

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 a psychiatrist. 

The process of being diagnosed with depression usually involves several key components. It often begins with you being asked questions about:

• How you feel physically and emotionally
• What your day-to-day life is like
• Whether anyone in your family has a mental health condition 
• What your diet and lifestyle, and social activities are like
• What you do for work
• Whether you take any medications that you take or substances

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 had suicidal thoughts or attempted suicide—a potential consequence of untreated depression. 

Major depressive disorder (MDD) is diagnosed when someone has experienced intense sadness and/or loss of interest in their usual activities plus several other symptoms of depression (such as trouble sleeping, change in appetite or weight, and difficulty concentrating) for at least two weeks.

Sometimes, your diagnosis 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 as bipolar disorder.

Treatment

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 journal Molecular Psychiatry suggested 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 a biochemical 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 called selective serotonin reuptake inhibitors (SSRIs) are often the first choice, as they are consistently effective and well-tolerated.

Psychotherapy

Medications are often paired with psychotherapy, 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 including dialectical behavior therapy (DBT), interpersonal therapy (IPT), and psychodynamic therapy.

Other Treatments

People with severe or treatment-resistant depression may need other interventions to effectively manage their symptoms, such as antipsychotic medications and/or electroconvulsive therapy (ECT).

For now, it’s best to discuss your symptoms, family health history, and risk factors with your doctor or a mental health professional to determine the best treatment.

Prevention

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 affect resilience following 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.