Commentary / Japan

Reducing the burden of depression in Japan

by Cesar Chelala

Contributing Writer

Depression is widespread, largely undiagnosed and rarely treated in Japan. Until the late 1990s, depression was largely ignored outside the psychiatric profession. Depression has been described as “kokoro no kaze” (“a cold of the soul”) and only recently it is being accepted in Japan as a medical condition that shouldn’t provoke shame in those suffering from it. In Japan, it is estimated that 1 in 5 people will experience some form of depression during their lifetime.

Depression is a state of low mood that can affect a person’s thoughts, behavior, feelings and sense of well-being. Its symptoms include sadness, inactivity, difficulty in thinking and concentration, and altered appetite and sleep. Many depressed people have feelings of dejection and hopelessness that may drive them to suicide.

Depression can manifest at any age. It can begin during childhood or later. As happens also among adults, girls are more likely to experience depression than boys. Among women, 1 in 7 experiences postpartum depression; about half of them start experiencing symptoms during pregnancy.

Clinical depression among the elderly is also common. Among the elderly, depression is frequently confused with the effects of other illnesses. Studies in nursing homes of elderly patients with physical illnesses show that depression substantially increases the risk of dying from those illnesses.

In most cases, depression can be treated. The U.S. Food and Drug Administration’s recent approval of the drug esketamine is a significant advance in the treatment of depression. It is particularly effective for those who have been resistant to conventional treatment, or who are at imminent risk of suicide. Esketamine is a rapid-acting antidepressant whose medical use was started in 1997. On Feb. 12, an independent panel of experts recommended that the FDA approve the use of esketamine, as long as it is administered in a clinical setting to ensure patient safety. Esketamine may bring relief to patients in Japan, where clinical trials of the drug are now taking place.

Depression has been called a “democratic disease” because it affects people across all social and economic strata. The World Health Organization estimates that more than 300 million people were affected by depression worldwide in 2015, equivalent to 4.4 percent of the world’s population.

Depression is widespread in Japan but largely neglected. One of the reasons for this neglect is the feeling of shame associated with mental health issues. Many who suffer from depression think there is something wrong with them, rather than that they suffer from a medical condition that can be treated. In most cases, people resort to gaman, the will to endure.

Depression is also a major contributor to suicide. According to the WHO, almost 90 percent of people who attempt suicide suffer from depression. There are approximately 800,000 suicides globally every year. In Japan, although the total number of suicides has diminished in recent years, the high number of suicides among children is an ongoing cause for concern.

Aside from the effects on health and on people’s well-being, depression exacts a heavy economic toll on individuals, families, and society as a whole. The London School of Economics has estimated that the economic cost of depression is over $14 billion annually in Japan. That includes decreased productivity, medical expenses and indirect medical costs.

It remains necessary to raise awareness of depression in the general population of Japan, through massive health communication campaigns, alerting on the seriousness of the untreated cases and about the possibility now of addressing the problem effectively. As depression is on the rise globally, the approval of a drug to treat cases resistant to treatment is a reason for hope.

Cesar Chelala is a medical doctor, an international public health consultant and the winner of several journalism awards.