Exogenous versus Endogenous Depression and Natural Solutions

[This article was previously published in Natural Nutmeg, December 2014 issue.]


Depression is an unfortunate common denominator that affects so many people worldwide. In 2012, the National Institute of Mental Health listed that approximately 16 million adult Americans experienced at least one major depressive episode in the prior year. The Centers for Disease Control (CDC) listed approximately 9% of American adults having depression. In fact, according to the CDC, depression is the major cause of disability in our country between the ages of 15 and 44. And the rate of depression in our country and globally is rising according to the World Health Organization.


There are many reasons for why someone feels depression. Some of these reasons relate to external factors such as emotional, mental or physical trauma. Other reasons may relate to weather or stress. Even still, a person may feel depression because of an internal body issue. A helpful way to understand depression is to consider whether the origin of the depression is exogenous (from outside the body) or endogenous (from within the body). Exogenous depression is triggered by traumatic life events. Endogenous depression is commonly referred to as chemical in origin or associated with some imbalance in the body.


Endogenous versus Exogenous Depression

Commonly, persons with exogenous depression are recommended to use psychotherapy as a tool for healing. This involves spending time with a psychotherapist or counselor on a regular basis discussing traumas and stressors in your life and history. The value of this type of therapy is extensive. We have all felt alone at times in our life. Having someone to ‘talk to’ at these difficult times can be incredibly supportive and helpful.


Endogenous depression typically refers to persons that have chemical imbalances or imbalances of other body systems. A person may suffer from endogenous depression because of reduced levels of serotonin in the brain. Serotonin is a neurotransmitter (chemical in the brain) that modulates how we feel. Many of the ever popular anti-depressant drugs such as Prozac are called SSRI’s or selective serotonin re-uptake inhibitor, which means that they help to increase levels of serotonin in the body. Another cause of endogenous depression could be physical trauma to the head such as a concussion. Concussion injuries can injure certain parts of the brain that are involved in how we behave and how we express our emotions and thoughts. These types of injuries can contribute to depression as well as other types of behavioral disorders.


The Body-Mind Connection

When we think of depression, particularly endogenous depression, the concept of the body-mind connection can be considered. In Traditional Chinese Medicine, a vast body of knowledge stemming from thousands of years of wisdom and learning, there is knowingness that our emotions and our body’s vital organs are intimately related. For example, when we experience anger, there is a connection to our liver. When we experience fear, there is a connection to our kidneys. When we experience grief, there is a relationship with our lungs. When emotions remain unresolved or repressed, the energy of these emotions can create disharmony or imbalance in that organ and can lead to impairment of these vital organs.


In Body Wisdom, a book written by Sharon Giammatteo, PhD, the body-mind connection is illustrated through a series of hand connections that can be incorporated into a self-care program to facilitate emotional healing. By incorporating a visualization process and meditation, these hands-on exercises can be helpful in reducing body symptoms associated with ‘repressed’ emotions that can contribute to depression.


Nutritional Wellness and the ‘Brain in the Gut’

At first glance, the ‘brain in the gut’ may sound like a bad sci-fi movie title—the attack of the mini-brains that feed off the gut! Well, in fact, the concept of the ‘brain in the gut’ is quite real and vital to our learning of the body and how we can attain optimal mental and physical health. What is it?! As we discussed earlier in this article, serotonin is an important neurotransmitter in the modulation of mood. Though serotonin is a neuro-chemical and may be thought of as primarily functioning in the brain, this is actually not the case. Over 90% of serotonin in our body is produced in our gut. In fact, gut bacteria more recently referred to as the ‘microbiome’, can alter brain chemistry, including the function of serotonin. If there is an imbalance of gut bacteria in our body, it can affect how we feel. If we have ‘leaky gut syndrome’ which means that the lining of our digestive tract is damaged or weak, it can affect how we feel. Leaky gut syndrome can be caused by toxicity and inflammation.


How can we improve our digestive health, strengthen the lining of our gut, and ‘feel better’? Gut toxicity is very common today and is generally associated with inflammation. A great way to decrease toxicity in the body and simultaneously reduce inflammation is to implement an anti-inflammatory lifestyle. By markedly reducing inflammatory foods as well as diminishing our exposure to toxic elements, we can promote greater health.


What is an anti-inflammatory lifestyle? Essentially, an anti-inflammatory lifestyle is comprised of several important aspects:

1. Anti-inflammatory diet: This means that we limit foods that are inflammatory or can contribute to greater inflammation in the body. Examples of inflammatory foods include:

A. Grain: Especially, ‘gluten’ founds in wheat, rye, barley and often oats

B. Refined sugar: For example, high fructose corn syrup, white sugar, brown sugar, aspartame and NutraSweet

C. Processed foods and preservatives, including partially hydrogenated oils or ‘trans-fats’

D. GMO or genetically modified foods: Commonly, soy and corn in our country is GMO.

E. Processed dairy: Dairy is often mucous-producing and can contribute to congestion. Attempting a dairy elimination diet by eliminating dairy 100% for 3 months and assessing the benefits symptomatically can be a helpful tool. If dairy is a staple in the diet, making sure that the source is natural is ideal.

F. Processed dairy: Dairy is often mucous-producing and can contribute to congestion. Attempting a dairy elimination diet by eliminating dairy 100% for 3 months and assessing the benefits symptomatically can be a helpful tool. If dairy is a staple in the diet, making sure that the source is natural is ideal.

2. Note: An anti-inflammatory diet can be challenging in the sense that there are many restricted foods. However, the benefits short-term and long-term are tremendous. The easiest way to consider this type of diet is by thinking of the foods you can eat rather then the foods that you cannot eat. Foods that are good to eat and actively help to combat inflammation include:

A. Water (not a food but definitely vital!)

B. Vegetables: Combination of diverse vegetables that are raw and cooked is ideal.

C. Fruit: Fruit is an important component of a healthy diet. Fruit is comprised of multiple nutrients and enzymes that can promote greater health and combat inflammation. When trying to lose weight, it is important to limit fruit to 2 servings per day but those servings are particularly helpful and tasty!

D. Natural protein: For those that are not vegetarians, eating ‘natural’ meats is important to gain optimal protein to build a healthy body.

E. Nuts: Nuts can be a very good source of ‘healthy fats’. An exception to this is peanuts. Peanuts are highly processed and can be very inflammatory. A great substitute for peanut butter is ‘Sunbutter’ (made out of sunflower seeds).

3. In addition to eating an anti-inflammatory diet, there are ways to reduce our exposure to environmental toxins:

A. Replace synthetic cleaners and detergents in your home with natural versions.

B. Replace your body products with ‘natural’ versions.

C. Buy produce that is organic or natural and free of pesticides and growth hormones.


By decreasing inflammatory foods and exposure to toxins, we can promote greater health in our body by encouraging a healthier gut and immune system. When we don’t feel good, it is difficult to feel positive. As our gut becomes healthier, our outlook improves. In addition to changing our foods and lifestyle, there are additional tools that can help in promoting greater health of our body.


Integrative Manual Therapy (IMT)

Most of us know that good nutrition can help lead us towards optimal health and many of the above listed strategies can help to reduce inflammation throughout our digestive tract and thereby change the way we ‘feel’. But when the gut is weak, having other tools can be helpful to promote healthier functioning of our digestive tract. One such tool is Integrative Manual Therapy (IMT). IMT is a hands-on approach to healing. IMT Therapists (often physical therapists, occupational therapists, massage therapists, chiropractors, and body workers) use their hands to help reduce restrictions in the muscles and soft tissues of our abdomen. IMT can help to promote normal circulation to the tissues of the gut as well as drainage from these tissues to promote healthier elimination of toxins.


Our body’s ability to protect itself is remarkable. When there is an organ or tissue in the body that is compromised because of toxicity or a general weakness in the tissue, then our body will attempt to limit movement of that organ and around the organ to protect it from further compromise. In this scenario, the joints in the region can become compressed, the muscles can go into spasm, and the soft tissues or fascia in the region can tighten. Often, this lack of mobility and tension creates pain and stiffness, while underlying this process is a protective mode that is maintaining our ability to function.


By using IMT, gentle hands-on treatment can be focused on correcting the alignment problem, reducing the compression and tension in the region, and promoting normal circulation and drainage at the gut, thereby, helping to strengthen the tissues. When there is more movement in the body, there is a greater capacity for drainage of toxins.


Integrative Manual Therapy is an advanced form of manual therapy that can get to the heart of the problem by localizing underlying toxicity and inflammation that may be a root cause. By incorporating a program of IMT to treat the underlying dysfunction, an anti-inflammatory lifestyle along with psychotherapy, a long term answer can be reached.


Depression can stem from a variety of causes. There are multiple tools that can be used to help with depression. Sometimes, medication is necessary, even for a short time to help a person move forward. At times, the traditional medical approach can be substituted with a more holistic path. Often, a combination of supportive therapies is most helpful in reaching a place of optimal mental health.