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Depression in Japan

The New York Times Magazine (free registration required. Bugmenot is your friend.) is running a fascinating article about depression in Japan. I’ve always found it interesting how much culture affects us as humans.

“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.

The way the Japanese view depression has had to change dramatically in order for—what we in the West may consider—standard treatment practices to not only become available but to become desired.

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.

Some may see this as a positive, citing the over-prescription of antidepressants here in the States, but considering that Japan has a suicide rate nearly double that of the U.S., I’m not so sure.

I was very interested in the story of Naoya Mitake, the “human interest” portion of this story. Mitake experienced long-term, persistent symptoms that are all too familiar to someone suffering from depression: insomnia, fatigue, anxiety, feelings of worthlessness. What is really great about his story is that it’s not “I took Prozac® and now I’m perfect!”, but that he found his own path to recovery. He did take antidepressants, but was able to take himself off them after an experience he had following a 30-day fast.

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.

This is not to say that fasting for 30 days will cure depression in everyone, but Mitake was able to find the core of his problems and fixed them from within.

In my own struggles with depression I’ve found that my own introspection and reflection have been as helpful, if not more, than antidepressants. And I can’t stress enough the importance of seeing a psychologist (talk therapist) while taking antidepressants. Having a safe place to vent about all of my problems every week is a great help. Sometimes I don’t have a lot to talk about, but most of the time (and especially recently) I’m going a mile a minute. I also take medication for anxiety and I’ve found that having an opportunity to just spill my guts about everything that is weighing on me is more affective than the pills. But when you work 40+ hours a week, such opportunities don’t come up so often.

Dealing with depression is a long battle, and one that you have to fight every day. I have to be aware every day so that I don’t slip back down to where I was less than two months ago. But the important thing to remember is that you are not alone, no matter how strongly you feel to the contrary. I am blessed to have family and friends who care a great deal for me and have been instrumental in my current recovery. And for them I will be forever grateful.