title: Intractable depression successfully treated with a combination of autogenic training and high-dose antidepressant in department of otorhinolaryngology: a case report.
abstract: BACKGROUND
  Patients suffering from ear discomfort are commonly encountered in the department of otolaryngology. If various clinical examinations do not reveal any objective findings, then the patients are referred to the department of internal medicine or psychiatry. Psychotherapy is recommended in some cases. This paper describes the successful administration of autogenic training in a patient suffering from ear discomfort due to major depression.
  
  
  METHODS
  We present a case of intractable depression that was successfully treated with a combination of psychotherapy, administered by a clinical psychologist, and high-dose antidepressant. The patient was a 36-year-old female with hearing discomfort in her left ear. In 2003, she experienced insomnia and an appetite loss, and her condition was diagnosed as major depression along with an avoidant personality disorder. Her depression has not been improved with antidepressant treatment for 3 years in department of psychosomatic medicine. She was referred to our department because of ear discomfort in her left ear. There was no abnormality in her physical examinations. She wanted to be treated in department of otorhinolaryngology. We increased the dose of fluvoxamine maleate up to 200 mg/day, and introduced cognitive therapy and autogenic training by a clinical psychologist. Eventually, her depressive state as well as the hearing complaint was markedly alleviated.
  
  
  CONCLUSIONS
  Autogenic training can be a viable and acceptable treatment option for patients who fail to respond to other therapies. This case emphasizes the importance of autogenic training as a method to control physical symptom of depression.
authors.affiliation: Department of Otorhinolaryngology, Hino Municipal Hospital, Tamadaira 4-3-1, Hino-shi, Tokyo 191-0062, Japan. amifumi@bc5.so-net.ne.jp
authors.forename: Fumiyuki
authors.initials: F
authors.lastname: Goto
authors.forename: Kimiko
authors.initials: K
authors.lastname: Nakai
authors.forename: Masato
authors.initials: M
authors.lastname: Murakami
authors.forename: Kaoru
authors.initials: K
authors.lastname: Ogawa