Filmmaker Mike Mills used to think that Japan was a land where the social stigma associated with mental illness kept thousands of sufferers unseen, unheard and untreated.

But then on a recent visit, a Japanese friend unashamedly popped an antidepressant in front of him. Mills realized that the perception of mental illness had changed dramatically and that he wanted to make a movie about it.

Since then, he has dedicated himself to completing “Does Your Soul Have A Cold?” The documentary chronicles the lives of five Japanese men and women who use antidepressants to alleviate symptoms associated with clinical depression.

Mills found his friend’s attitude toward depression was partly due to a surge in advertising by pharmaceutical firms beginning in the late 1990s to change the way Japanese identify and treat mental illness.

The film is about “exporting American definitions of depression and the use of antidepressants to the ancient culture of Japan,” according to the film’s production company, IFC TV.

However, instead of explaining how the Western approach to clinical depression has led to increased consumption of antidepressants, the film relies on the actions and words of its subjects, along with information about the drug industry, to tell a story about depression and antidepressants in contemporary Japan.

Drug company Meiji Seika Kaisha Ltd. began selling Depromel, a selective serotonin reuptake inhibitor, or SSRI, believed to help stabilize mood by boosting levels of serotonin in the brain, in 1999.

Since then, sales of antidepressants in Japan have quintupled, according to statistics from IMS Health, a company that tracks global health-care information for pharmaceutical companies.

Japan, where the suicide rate of more than 30,000 a year is well above the average of other industrialized countries, has proven to be fertile ground for selling antidepressants with catchy advertising campaigns that compare, for example, serious mental illness with the common cold. Last year, sales of antidepressants in Japan exceeded 90 billion yen, IMS reports.

“Does Your Soul Have A Cold?” (the title comes from the advertising slogan used by British pharmaceutical company GlaxoSmithKline) introduces viewers to sufferers with varying degrees of depression who all take antidepressants. Only two of the five participants are undergoing psychotherapy or counseling in addition to drug treatment, and one man, whose depression has led to a condition known as “hikikomori,” a state in which the sufferer is unable to leave home, insists on downing his medication with large amounts of alcohol.

Mills paints a bleak picture of Japanese mental health by contrasting gray images of a rainy, overcrowded Tokyo with the distraught lives of these people. One young woman admits, “I’m happiest when I’m asleep because I don’t have to think about wanting to die.”

In a brief interview after the film was screened recently at the Los Angeles Film Festival, Mills commented, “GlaxoSmithKline has done a lot to educate about depression (in Japan). It’s just weird when someone feels so bad and then a drug company like GlaxoSmithKline tries to make a profit off of them.”

But for Michael Fetters, a physician and director of the Japanese Family Health System with the University of Michigan, anything that helps to facilitate the treatment of depression is positive.

“Depression is a very significant problem in Japan right now and the tools for treating depression there are very limited,” Fetters, who sees more than 7,000 Japanese patients living in Michigan every year, said in a phone interview.

Fetters faces a challenge when his Michigan-based patients visit or return permanently to Japan.

“It has been extremely difficult for us to help patients find psychotherapy and counseling in Japan for their depression,” Fetters said. “We’re not just talking about drugs — treatment needs to be multifaceted.”

Although Fetters said he realizes pharmaceutical firms’ desire to tap into the “huge market for SSRIs in Japan,” he warned about underplaying the severity of depression for the sake of an ad campaign. “If we are equating depression to a cold, then marketing has gotten out of control,” he said.

The film, Mills said, neither condones nor disapproves of the use of antidepressants in treating depression. However, the filmmaker does admit to one specific intention: “I hope the movie helps people suffering from depression in Japan realize that they are not alone and that they are not invisible.”

“Does Your Soul Have A Cold?” is not currently set to screen in Japan, but Mills said “the project will not be complete” until it is seen by Japanese audiences.

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