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What can cause cancer patients to attempt suicide? Thiamine deficiency mimicking the symptoms of major depressive disorder

Published online by Cambridge University Press:  27 July 2023

Mayumi Ishida*
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Sho Sato
Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
Izumi Sato
Department of Clinical Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
Akira Yoshioka
Department of Medical Oncology and Palliative Care, Mitsubishi Kyoto Hospital, Kyoto, Japan
Nozomu Uchida
Department of General Medicine, Ogano Town Central Hospital, Saitama, Japan
Naoki Mizunuma
Tokyo Kagurazaka Law Office, Tokyo, Japan
Kosei Hasegawa
Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
Hideki Onishi
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Corresponding author: Mayumi Ishida; Email:



Thiamine deficiency (TD) presents with various physical and psychiatric symptoms, but no cases with depression-like symptoms have been reported.


We report a patient with cancer who appeared to attempt suicide as a consequence of depressive mood likely related to TD.


The patient was a 58-year-old woman diagnosed with recurrent endometrial cancer, with lung metastasis and pelvic dissemination. The patient apparently attempted suicide was referred to the psycho-oncology department.

At the time of the examination, major depressive disorder was suspected based on her mental symptoms, but when thiamine was administered intravenously in response to her poor dietary intake, her palpitations, dyspnea, anorexia, and insomnia improved, and her suicidal ideation disappeared at her reexamination 1 hour later after thiamine administration.

Significance of results

It is likely that the observed palpitations, dyspnea, anorexia, and insomnia, as well as the severe depression and the attempted suicide, which were thought to be physical symptoms associated with depression, were actually related to TD. Suicidal ideation and attempted suicide are conspicuous as psychiatric symptoms. However, in such cases, rather than simply starting treatment for depression, it is necessary to consider reversible TD as a cause of these symptoms and perform differential diagnosis to confirm the physical illness.

Case Report
© The Author(s), 2023. Published by Cambridge University Press.

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