NYT: Did Antidepressants Depress Japan?

[Guest guest]

This is a puff piece about SSRI marketing to Japan.

SSRi's are very damaging as some countries are just

now begining to admit. It is being posted to show to

what lengths that Big Pharma will go to make it's

sales pitch. They convince you that you have a " disease "

and that they just happen to have the solution too. Ka-ching.

 

There are a lot of inaccuracies here also. One being

that the suicide rate can be compared to western

nations to imply depression rates. A lot of suicides

in Japan have nothing to do with depression.

Historically, for a very long time, suicide (hara

kiri, seppuku )was a culturally acceptable/socially

mandated response to great errors which would bring

shame upon oneself or others. It is still culturally

acceptable as a carry over from the past. F.

 

 

 

 

 

> SSRI-Research

> Sun, 22 Aug 2004 11:34:15 -0400

> [sSRI-Research] NYT: Did Antidepressants

> Depress Japan?

>

> [-- perhaps the suicide rate will increase now

> that ssri's are hitting the market in Japan where

> the suicide rate is already very high....]

>

>

--------

>

> August 22, 2004

> Did Antidepressants Depress Japan?

> By KATHRYN SCHULZ

>

>

>

http://www.nytimes.com/2004/08/22/magazine/22DEPRESS.html?th= & pagewanted=print & p\

osition=

>

>

> f you had lived in Japan for the last five

> years, you would know by now that your kokoro is at

> risk of coming down with a cold. Your kokoro is not

> part of your respiratory system. It is not a member

> of your family. Its treatment lies well beyond the

> bailiwick of your average ear, nose and throat

> doctor. Your kokoro is your soul, and the notion

> that it can catch cold (kokoro no kaze) was

> introduced to Japan by the pharmaceutical industry

> to explain mild depression to a country that almost

> never discussed it.

>

> Talking about depression in Japanese has

> always been a fundamentally different undertaking

> than talking about it in English. In our language,

> the word for depression is remarkably versatile. It

> can describe dips in landscapes, economies or moods.

> It can refer to a devastating psychiatric condition

> or a fleeting response to the Cubs losing the

> pennant. It can be subdivided almost endlessly:

> major, minor, agitated, anxious, bipolar, unipolar,

> postpartum, premenstrual.

>

> But in Japanese, the word for depression

> (utsubyo) traditionally referred only to major or

> manic depressive disorders and was seldom heard

> outside psychiatric circles. To talk about feelings,

> people relied on the word ki or ''vital energy.'' A

> literal translation of Japanese synonyms for sorrow

> reads, to Westerners, like the kind of emotional

> troubles that might befall a kitchen sink: ki ga

> fusagu, sadness because your ki is blocked; ki ga

> omoi, sadness because your ki is sluggish; ki ga

> meiru, sadness because your ki is leaking.

>

> Inside every neologism lies a compact history

> of cultural change -- think McJobs, metrosexuals,

> the blogosphere. In Japan, the coining of kokoro no

> kaze marked a sea change in people's thinking about

> depression. That transformation was triggered by the

> pharmaceutical industry's other contribution to

> Japan in 1999: along with providing a catchy slogan

> for mild depression, the industry provided a cure:

> modern antidepressants. More than a decade ago,

> Peter Kramer chronicled the capacity of those drugs

> to reshape the cultural landscape in ''Listening to

> Prozac.'' But back then the culture they reshaped

> was the culture that had shaped them. Now, a huge

> campaign by the pharmaceutical industry is

> publicizing mild depression, which most Japanese

> didn't realize existed until recently. Japan has

> become a proving ground for what we stand to gain

> and lose by the global expansion of Western

> psychopharmacology.

>

> Certainly, Japan is a compelling candidate for

> a mental health makeover. Serious mental illness has

> long been inadequately addressed there. The suicide

> rate is more than twice that of the United States.

> The average hospitalization for mental illness lasts

> 390 days, compared with the American average of less

> than 10. Until recently, depression was regarded in

> much the same light as schizophrenia, and treatment

> was available almost exclusively in institutions.

> There was no such thing as ''mild'' depression. Talk

> therapy was rare (and remains so), and

> quasi-official policy dissuaded open discussion.

> ''The Ministry of Health considered 'depression' a

> bad word,'' Yukio Saito, who helped found Japan's

> national mental health hotline in 1971, said. For

> decades, Saito's requests to post hotline ads in

> public places were routinely denied.

>

> Last year, in a volte-face that reflects the

> shifting cultural tides of the last five years, the

> Ministry of Health launched a committee to help

> educate the public about depression. The actress

> Nana Kinomi talked publicly about her postmenopausal

> depression in 2000. Other celebrities followed suit.

> And last month, the Imperial Household Agency

> acknowledged that Crown Princess Masako is on

> antidepressants and in counseling for depression and

> an ''adjustment disorder.''

>

> Over the past five years, according to the

> Japanese Bookstore Association, 177 books about

> depression have been published, compared with a mere

> 27 from 1990 to 1995. Earlier this month, the

> country's most popular online bulletin board,

> Channel 2, carried 713 conversation threads about

> depression -- more than music (582) or food (691)

> and almost as many as romance (716).

>

> Depression has gone from bad word to buzzword.

> ''The media mention depression almost every week,''

> said Yutaka Ono, a psychiatrist and professor at

> Keio University and one of Japan's leading

> depression experts. People have even come to his

> office with newspaper in hand, he said, and asked if

> what they have is depression. Ono has been

> practicing for 25 years, but, he said, the number of

> patients who have consulted him about mild

> depression has surged in the last 4 or 5. Most

> Japanese epidemiological data doesn't differentiate

> between degrees of depression, but the Ministry of

> Mental Health and the leading psychiatrists with

> whom I spoke agree that mild depression accounts for

> the vast majority of new cases -- of which there are

> a staggering number. According to IMS Health, a

> company that tracks global health care and

> pharmaceutical information, depression-related

> doctor vists in Japan increased 46 percent from 1999

> to 2003.

>

> Disease rates typically increase because more

> people get sick or because diagnosis and reporting

> improve. But neither explanation fully accounts for

> the rise in mild depression in Japan. ''There's no

> question in my mind that severe clinical depression

> is a real disease,'' said Arthur Kleinman, a

> psychiatry professor, chairman of Harvard's

> anthropology department and co-editor of the

> definitive work ''Culture and Depression.'' ''I

> could take you all over the world, and you would

> have no difficulty recognizing severely depressed

> people in completely different settings. But mild

> depression is a totally different kettle of fish. It

> allows us to relabel as depression an enormous

> number of things.''

>

> As the idea of mild depression has gained

> traction in Japan, it may be that more people

> haven't gotten sick; they have simply come to define

> what's ailing them as a disease. Mild depression is

> not contagious, but it can be considered, in the

> root sense of the word, communicable -- and for the

> last five years, the pharmaceutical industry and the

> media have communicated one consistent message: your

> suffering might be a sickness. Your leaky vital

> energy, like your runny nose, might respond to

> drugs.

>

>

> Looking back, Naoya Mitake thinks he might

> have first experienced depression while in college.

> ''I was about to graduate, and my friends had all

> been hired by Japanese companies,'' he recalled. ''I

> couldn't imagine doing that, but I didn't know what

> else to do.'' He felt incompetent and worthless,

> unable to make decisions about his future. He might

> have been depressed back then, but, he said, ''the

> word never came to mind.''

>

> Mitake, now 39, steered clear of corporate

> Japan and instead became an associate professor of

> comparative politics at Komazawa University. In

> 2001, he consulted a doctor about his longstanding

> battles with insomnia and fatigue. The doctor

> prescribed antidepressants -- a common treatment for

> insomnia -- but Mitake's sleep didn't improve.

> (People on antidepressants frequently have to try

> different pills and dosages before finding an

> effective treatment.) Meanwhile, Mitake became

> increasingly anxious, frightened and sad. He stopped

> taking the first set of antidepressants, and his

> problems persisted. This time, he said, he knew he

> was ''extremely depressed.''

>

> Mitake is handsome, warm and articulate. He

> talked about his experiences with an appealing blend

> of curiosity and tranquillity, although the emotions

> he described were far from tranquil. ''I'd wake up

> in the middle of the night with this strange, strong

> anxiety,'' he remembered. ''I couldn't be alone. I

> felt too afraid. I couldn't teach my classes

> anymore.''

>

> Three months after his mood plummeted, he

> turned to antidepressants again and felt

> considerably better but not perfect. For almost two

> years, he cycled through various pills, with his

> melancholy waxing and waning. It wasn't until the

> summer of 2003, when he accidentally discovered a

> nonmedical treatment of his own, that his depression

> lifted.

>

> In the Diagnostic and Statistical Manual --

> the American Psychiatric Association's compendium of

> mental disorders -- depression is divided into

> discrete categories. In reality, though, there is no

> discernible line where moodiness crosses over into

> mild depression, or mild depression into severe.

> Moreover, mild depression does not feel mild to

> those who experience it. When I asked Mitake if his

> soul had a cold, he laughed, then paused and said he

> shouldn't have laughed. ''The phrase did some good.

> It changed people's perception and made depression

> easier to talk about.''

>

> In a country famous for its reticence, that is

> no small achievement -- especially since talking

> about depression is one effective way to treat it.

> But counseling is still rare in Japan; in books and

> speeches, Yutaka Ono has tried to encourage people

> to discuss their depression with a professional,

> but, he said, psychotherapy has been far slower to

> catch on than medication. The current idiom also has

> its limits: Mitake, for one, said he never uses the

> expression kokoro no kaze. ''Maybe for some people

> depression is like a cold,'' he said. ''If so, their

> colds are a lot worse than mine. Or my depression is

> a lot worse than theirs.''

>

> For 1,500 years of Japanese history, Buddhism

> has encouraged the acceptance of sadness and

> discouraged the pursuit of happiness -- a

> fundamental distinction between Western and Eastern

> attitudes. The first of Buddhism's four central

> precepts is: suffering exists. Because sickness and

> death are inevitable, resisting them brings more

> misery, not less. ''Nature shows us that life is

> sadness, that everything dies or ends,'' Hayao

> Kawai, a clinical psychologist who is now Japan's

> commissioner of cultural affairs, said. ''Our

> mythology repeats that; we do not have stories where

> anyone lives happily ever after.'' Happiness is

> nearly always fleeting in Japanese art and

> literature. That bittersweet aesthetic, known as

> aware, prizes melancholy as a sign of sensitivity.

>

> This traditional way of thinking about

> suffering helps to explain why mild depression was

> never considered a disease. ''Melancholia,

> sensitivity, fragility -- these are not negative

> things in a Japanese context,'' Tooru Takahashi, a

> psychiatrist who worked for Japan's National

> Institute of Mental Health for 30 years, explained.

> ''It never occurred to us that we should try to

> remove them, because it never occurred to us that

> they were bad.''

>

> The medical model of depression, by contrast,

> sees suffering as pathological and prescribes a pill

> in response. That outlook is partly pragmatic: call

> depression a disease and health insurance covers its

> treatment.

>

> Patient advocates also argue that

> reclassifying depression as a disease helps to

> diminish its stigma. But probably most important,

> the pharmaceutical industry has the financial

> incentive to recast moods as medical problems,

> creating what Kleinman calls ''a pharmacology of

> remorse and regret.'' It is, Kleinman said, ''one of

> the most powerful aspects of globalization, and

> Japan is at its leading edge.''

>

>

> In the late 1980's, Eli Lilly decided against

> selling Prozac in Japan after market research there

> revealed virtually no demand for antidepressants.

> Throughout the 90's, when Prozac and other selective

> serotonin reuptake inhibitors, or S.S.R.I.'s, were

> traveling the strange road from chemical compound to

> cultural phenomenon in the West, the drugs and the

> disease alike remained virtually unknown in Japan.

>

> Then, in 1999, a Japanese company, Meiji Seika

> Kaisha, began selling the S.S.R.I. Depromel. Meiji

> was among the first users of the phrase kokoro no

> kaze. The next year, GlaxoSmithKline -- maker of the

> antidepressant Paxil -- followed Meiji into the

> market. Koji Nakagawa, GlaxoSmithKline's product

> manager for Paxil, explained: ''When other

> pharmaceutical companies were giving up on

> developing antidepressants in Japan, we went ahead

> for a very simple reason: the successful marketing

> in the United States and Europe.''

>

> Direct-to-consumer drug advertising is illegal

> in Japan, so the company relied on educational

> campaigns targeting mild depression. As Nakagawa put

> it: ''People didn't know they were suffering from a

> disease. We felt it was important to reach out to

> them.'' So the company formulated a tripartite

> message: ''Depression is a disease that anyone can

> get. It can be cured by medicine. Early detection is

> important.''

>

> Like the Bush administration, GlaxoSmithKline

> has spent the last four years staying relentlessly

> on-message. Its 1,350 Paxil-promoting medical

> representatives visit selected doctors an average of

> twice a week. Awareness campaigns teach general

> practitioners and the public to recognize the

> following symptoms of depression (the translation is

> the company's): ''head feels heavy, cannot sleep,

> stiff shoulders, backache, tired and lazy, no

> appetite, not intrigued, feel depressed.''

>

> The psychiatrist Yutaka Ono advocates raising

> awareness about depression, but GlaxoSmithKline's

> marketing made him uncomfortable: ''They ran a very

> intense campaign about mild depression where a

> beautiful young lady comes out all smiles and says,

> 'I went to a doctor and now I'm happy.' You know,

> depression is not that easy. And if it is that easy,

> it might not be depression.''

>

> Whatever misgivings Ono and other doctors may

> have about the medicalization of mild depression, it

> has been a resounding financial success. As one

> psychiatrist, Kenji Kitanishi, noted wryly,

> ''Japanese psychiatry is in the bubble economy

> now.'' Between 1998 and 2003, sales of

> antidepressants in Japan quintupled, according to

> IMS Health. GlaxoSmithKline alone saw its sales of

> Paxil increase from $108 million in 2001 to $298

> million in 2003. According to the company, during

> one seven-month ad campaign it ran last year,

> 110,000 people in a population of 127 million

> consulted their doctors about depression.

>

> In late 2001, one of those people was Mitake.

> ''From the things I'd read, I knew about these

> chemicals in the brain, serotonin and so forth,''

> Mitake said. ''And I thought, O.K., this is a

> chemical phenomenon, so it needs to be cured by a

> chemical substance.'' In fact, no one understands

> the etiology of depression, and the role serotonin

> plays is ambiguous. Ask people with mild depression

> to explain its origins, and most will offer

> autobiography, not biochemistry: difficult families,

> dissolved relationships, demanding jobs. Japanese

> mental health specialists consistently cite the

> collapse of the bubble economy and disintegrating

> social structures as major factors in the nation's

> soaring depression rates.

>

> The idea that depression is a neurochemical

> malfunction dodges a fundamental chicken-and-egg

> problem. Screwy neurochemistry can cause depression,

> but depression can also wreak havoc on your

> neurochemistry. Likewise, research has shown brain

> chemistry can change in response to any number of

> interventions: medication, talk therapy, exercise,

> prayer. The question, then, isn't whether depression

> is a biochemical phenomenon; it is. So is the act of

> formulating a thought. So, in a sense, is sorrow.

> The question is, What do we gain, and what do we

> lose, by understanding the darker acts of our brains

> as diseases?

>

>

> One side effect of the antidepressants Mitake

> was taking was weight gain, so in August 2003 he

> went on a fasting retreat in the mountains. He

> thought he'd do some reading, but after the fourth

> day, he recounted: ''You can't even think. You just

> kind of lie there.'' Toward the end of his fast,

> Mitake went to a hot spring. ''There I was, totally

> naked with this breeze blowing and the sun shining,

> and suddenly I started to feel better,'' he

> recalled. Mitake credits the fast with ending his

> depression. ''It's like because I couldn't think for

> a while, the cycle just broke. All those negative

> feelings were gone.'' His depression hasn't

> returned, although on his doctor's advice, he

> continued to take antidepressants until last month.

>

> Mitake was quick to sound a cautionary note:

> ''I don't dare tell my friends with depression, 'Oh,

> you should go fast.' I tell them to find a good

> doctor and take medication as prescribed. I really

> believe the fast is what worked in my case, but I'd

> never recommend it as a cure.''

>

> Andrew Solomon, author of ''The Noonday

> Demon,'' champions antidepressants, but even he

> ultimately concludes that the best cure is the one

> you believe in. ''If you have cancer and try an

> exotic treatment and then think you are better, you

> may well be wrong,'' he writes. ''If you have

> depression and try an exotic treatment and think you

> are better, you are better.'' Yet the medicalization

> of depression makes it difficult to believe in any

> treatment but medicine. Rather than expanding

> options for care for those who suffer, the

> globalization of psychopharmacology may ultimately

> sow a monocrop of ideas about health and sickness.

>

> Writing about changing understandings of

> depression in other countries risks romanticizing

> suffering and other cultures. But not writing about

> them contributes to a kind of silence already

> evident in Japan. ''There is this almost invisible

> pressure that makes it difficult to freely raise

> questions,'' Saito, one of the founders of Japan's

> mental health hotline, noted. ''I find myself

> doubting whether medicalization is a good trend. But

> being in the position I'm in, needing some support

> from the medical system, I don't usually make

> comments like this.''

>

> Thomas Hardy once noted, ''What we gain by

> science is, after all, sadness.'' He meant the more

> we learn about nature, the crueler it seems and the

> less individual experience matters. The century

> since he wrote has seen stunning technological

> advances, but we haven't made much progress figuring

> out how to integrate science with other ways of

> understanding what it means to be human. These days,

> we may lose even sadness.

>

>

> Kathryn Schulz is a freelance writer and

> editor at large of Grist Magazine. She was a Spring

> 2004 Pew Fellow in international journalism.

>

>

> Copyright 2004 The New York Times Company

>

>

> [Non-text portions of this message have been

> removed]