Understanding jargon

Bridget wrote:She keeps telling me (via email - she lives a long way from me) that her psych. says she is "endogenous" - she says it as if to say "that's it - nothing can be done". Dr has taken her off some of her medication because it was causing high blood pressure and put her on "citalopram". Aparently this is causing problems. This is all jargon to me, but I wish I could understand. I'm assuming 'endogenous' means it is coming from within and not being triggered by an external situation.

Hi, Bridget:

The distinction between endogenous and exogenous depression is somewhat out of favor these days - but "endogenous depression" refers to depression that is not solely reactive to external triggers.

Although this is an oversimplification and not entirely accurate, for the moment assume that major depression is the result of an insufficient supply of the neurotransmitter serotonin. Now, sometimes that insufficiency can result from chronic sleep deprivation or disruption, chronic anxiety or stress, prolonged grief or bereavement, etc., etc. These would be considered external (exogenous) events that are triggering the depression by reducing serotonin levels. Modern antidepressants (SSRI = selective serotonin reuptake inhibitors) act to increase serotonin levels and in many cases a patient who takes these medications for several months or a year or two is able to discontinue them and maintain the gains made with the medication for long periods of time or even for the rest of his or her life.

Other patients seem to have a physiological inability to maintain sufficient levels of serotonin even in the absence of external stressors or triggers. These individuals would correspond to the "endogenous" type of depression. It does NOT mean that in such patients there are not external triggers NOR that the patient cannot benefit from psychotherapy, and it definitely does not mean that "nothing can be done". It simply means that for apparently physiological (or at least non-psycholopgical) reasons, that individual exhibits a chronic vulnerability to depression.

Of course, the causes of depression are a lot more complex than a deficiency in serotonin - the example is given simply to illustrate the endogenous-exogenous distinction.

Many thanks for your helpful explanation!