A case of a depressed patient who attempted suicide during intensive Naikan

Abstract

  A 33-year-old male developed marked depressive symptoms due to an increase in workload. He was admitted to our hospital because he had a suicidal idea. Drug therapy for depression was performed, but no remission was observed. One month administration, intensive Naikan therapy was introduced. However, during the night of the first day of Naikan, he attempted suicide by a drug overdose. The factors associated with this attempt may have been persisting depressive symptoms at the introduction of Naikan therapy, poor motivation of this therapy, and the therapist's attitude lacking flexibility. In Naikan therapy for patients with depression, the risk of suicide should be adequately evaluated by not only the assessment of depressive symptoms but also comprehensive assessment of the life history, family background, personality tendency, and coexisting psychiatric disorders. Therapists should avoid the hasty introduction of Naikan and continue to provide support to patients until depressive symptoms become relatively stable, and signs of motivation appear.