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	13. Treatment of Depressive Psychosis By Takahiro Tanaka, M.D., Head Ph. vsician, Chofu Hospital, Chofu City I.    INTRODUCTION In 1973, I had the chance to report on organic germanium, the carboxyethyl sesquioxide of germanium developed by Dr. Kazuhiko Asai, used in the treatment of diseases in general.     Since then, I have observed many cases which has enabled me to verify the efficacy of organic germanium in a variety of diseases, of which I refer in this report in particular to cases of depressive psychosis. On occasions, I am afraid, some statements may not convey the full meaning since I am an internist and thus less knowledgeable about psychopath.     The number of patients suffering from depressive psychosis, including those with manic depressive psychosis, whom I had the chance to attend during the eight years since 1970 and who are covered in this report, amounts to only seven or eight.  Furthermore, only five of these were treated with organic germanium for periods long enough to justify reporting.   Under these circumstances, it may be presumptuous of me to make this report, but, being an internist who has only very few antidepressants at his disposal, and thus having no alternative but to use organic germanium for treatment, has allowed me to evaluate objectively the efficacy of the compound in specific diseases. II.  CASES Case I (reported previously, female, 27 years old): In 1971, when still a university coed, she suffered from depressive psychosis following appendectomy. It was four days after the occurrence of the symptoms that I saw her. The patient's eyes appeared vacant and were full of tears, typical symptoms of depressive psychosis. Administration of 80 mg organic germanium per day was advised. Within two days, the patient's  eyes became alert, the appearance of vacancy and  misery being dispelled. Another two days later, her complexion had returned to normal and hardly any speech impediment remained.  Ten days later the patient accompanied by her mother went for a three hours train ride to attend the annual examination at her university.     In this case, the total dosage of organic germanium taken during the days of treatment was 2 g, i.e., 80 mg per day, after which administration was discontinued. Two to three times during the said period Diazepam was also given. A dose of 5 mg of this was given before bedtime because she complained of difficulty in going to sleep.  Seven years have now passed without a recurrence of the observed symptoms. Case 2 (male, 38 years old): On January 16, 1975 the patient experienced a second seizure of depressive psychosis. It was one week later that a member of his family came to consult  me; at that time he was an outpatient at a psychiatrist's office. At the next visit I noticed his vacant eyes and his Jack of  speech: he was under the influence of  Tofranil.  According to the psychiatrist it would take about two months for him to recover from this boUt. I prescribed organic germanium, 100 mg twice a day, to be taken in the morning and in the evening. A week  later, although he still complained of intense languor, his eyes appeared much brighter. He was instructed to reduce the Tofranil dosage to half the present amount. Two weeks later, his eyes had returned almost to normal, and after another month he returned to work. He continued the intake of organic germanium for nearly one year. Although three years since the onset of the second seizure have elapsed, no sign of a recurrence has been observed. Case 3 (reported previously, female, 58 years old): Since 1968, she has had repeated periods of depressive psychosis at intervals of six  months. While in the beginning these lasted for up to three month, each recurrence worsened her condition, until it reached the point of attempted suicide in 1970. At that time she began organic germanium treatment. She had been suffering from persistent insomnia and had been taking 10 mg doses of Diazepam when unable to sleep. Being pampered and stubborn, she very often spurned her family's advice of taking the drug, thus being awake all night. germanium.     Since no data were available as to the use of organic in the treatment of depressive psychosis, I was not sure whether giving it in this particular case would produce any results. Within two to three days after beginning the intake of  10 mg twice a day, mornings and evenings, the persistent insomnia had lifted, while the symptoms of depressive psychosis had almost vanished. The  intake was continued for another three years. It is now almost eight years since the last bout. No problems have been observed since then. Case 4 (female, 69 years old). She has a history of  30. Years' depressive psychosis. The bouts would occur in a set pattern, the symptoms appearing with the advent of the cold season,  lasting through May and gradually disappearing towards the summer. She would continue to feel well till the onset of the next cold season.     Starting in November, 1973, she began taking organic germanium in a water solution (2 g dissolved in 500 ml water) that would last one month. The daily dose would consist of 70 mg in a divided dose, taken before meals in the morning and in the evening. The administration continued until the summer of 1976, during which period no further attack occurred.  In July 1976, probably because of a sense of relief of being freed from all the trouble, the patient discontinued the intake of the compound and continued to feel well all through the rest of that year. Then, in January, 1977, she had to undergo an operation on a cataract in her right eye, the consequence of which was a relapse into the former symptoms. In August, 1977, the patient resumed the intake of organic germanium, 100 mg per day.  Soon signs of improvement came visible and the patient was again able to sleep through the night. She is in good health today. Case 5 (female, 70 years old) . More than 30 years ago the patient began to suffer from  depressive psychosis, said to have started when she had to evacuate to the country.     In this case, a bout of the depressive state would last for three months, followed by' one month of well being before her condition would turn to a manic state for two months. This pattern would be followed by' quite normal behavior.  When I saw her, however, symptoms had become quite unsteady a depressive state today would be followed by a manic state tomorrow. Usually, the depressive state was dominant in January and February. It was on January 14, 1977 that she began a daily dose of 100 mg organic germanium. During January all went perfectly well. In February, mild symptoms were noted but subsided within about 10 days. All through March, April and May her well being continued, a state not felt for years. Confirmedly, she became less carrel with the prescribed intake, particularly since April, often skipping the intake for a day or two and, when going on a trip in May she forgot to take the powders with her. After her return the symptoms reappeared. Being stubborn, she refused to accept the advice of her family and her doctor. At last the administration was suspended.

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