title: [Two cases of depressive disorder after pacemaker implantation].
abstract: We report 2 patients who showed psychological symptoms after pacemaker implantation. Pacemaker syndrome was excluded, and a diagnosis of depressive disorder not otherwise specified was made in both patients. Patient 1 complained of discomfort early after pacemaker implantation but became unaware of the pacemaker after 1 year. However, after 3 years, lack of activity, general fatigue, and unaccountable sensations developed. These symptoms improved with symbiosis with the pacemaker. Patient 2 developed many complications after pacemaker implantation. Therefore, he was markedly aware of the pacemaker as not-self and wanted to remove it. One month after implantation, unaccountable sensations and irritations began to occur. He did not return to work, and the symptoms improved with progression of "mourning for the loss of the perfection of the own body". In both patients, their symptoms improved after "acceptance that their own body depended on the pacemaker" and "symbiosis with the pacemaker as not-self", not complete integration of the pacemaker. Therefore, the psychological process after pacemaker implantation consisted of the establishment of "mourning for the loss of the perfection of the own body" and "symbiosis with not-self". In these patients, this process was impaired, causing depressive symptoms. This process resembled the integration process in patients undergoing dialysis or renal transplantation. As, compared with renal transplantation, it is more difficult to integrate the pacemaker to the own body, so, it seems better to aim for "symbiosis with the pacemaker" to promote the adjustment process. To promote the adjustment process and decrease depression, support after understanding of this psychological process is needed.
authors.affiliation: Department of Psychiatry, Kyushu Kousei Nenkin Hospital.
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D003866:Depressive Disorder / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000523:psychology*; D010342:Patient Acceptance of Health Care