Depression

Treatment of depression in Japan

Depression, or major depressive disorder (MDD) is a medical condition which characterizes in consistent loss of interest in life, low mood and self-esteem. Japanese government estimates that around 1.200.000 people in Japan suffer from this mental disorder, but as far not all of them ask for professional help, the actual number might be significantly more (厚生労働省. 平成30年版厚生労働白書. 2019; https://www.mhlw.go.jp/toukei_hakusho/hakusho/). The variety of symptoms makes finding out the right diagnosis and prescribing adequate medicines for depression quite complicated. Following symptoms are the most common:

• Feeling sad, hopeless, lonely for a long period of time,
• Inability to feel joy or satisfaction,
• Not feeling better when receiving support from family or friends,
• Irritation, anger or tearfulness upon unimportant matters,
• Consistent tiredness and lack of energy,
• Sleeping disturbances, including both insomnia and sleepiness,
• Eating disorders, including lack of appetite and excessive uncontrolled eating,
• Lack of concentration, memory troubles, troubled or slow thinking,
• Anxiety,
• Suicidal thoughts or attempts, thinking of death,
• Unexplained physical pain or disorders.

Symptoms may also vary upon age and gender, for example, older people with depression may have symptoms similar to dementia, like forgetfulness or slow movements.

Treatment of the depression is a complex process, depending on the disease cause, progression level and patient’s desire to participate in certain activities. For earlier stages of major depressive disorder, the most effective ways to treat the disease are taking psychotherapy and changing lifestyles, like doing regular exercises, going for walks, following healthy diet and maintaining good sleep. However, as the disorder progresses, some chemical reactions in the brain make the recovery extremely difficult. In this case, the consulting doctor should help to treat the most adequate medicines for treatment of the depression.

Which medicines for depression should I choose?

Antidepressants mainly work on postsynaptic and presynaptic receptors in the brain. Selective serotonin reuptake inhibitors limit reabsorption of serotonin in the presynaptic cell, increasing its free extracellular level. Norepinephrine or noradrenaline reuptake inhibitors work in the similar way for norepinephrine and epinephrine, increasing adrenergic neurotransmission. Some of the medicines affect all the receptors listed. Also, there are tricyclic antidepressants targeting dopamine receptors and some medicine with mild opioid-like actions. The doctor in charge should help the patient to choose the adequate treatment according to disease, age and symptoms. Many of Japanese medicines for depression have their own unique features to be considered.

• Cymbalta capsules are effective for the treatment of not only major depressive states, but also for various anxiety disorders and neurological pains,
• Effexor capsules’ active ingredient binds to a broad spectrum of brain receptors, so usually this medicine can be used even for patients who don’t respond to other antidepressants,
• Fluvoxamine maleate tablets help to treat Internet addiction and social phobia,
• Trazodone tablets improve insomnia symptoms,
• Sertraline tables are effective for the treatment of fear, avoidance and social phobia,
• Lexapro tablets are particularly good for long-term use in adults over certain age.

Also, Japanese doctor often use a natural remedy called Yokukansan for alleviating the mild depression symptoms without side effects. It helps to treat low mood, insomnia, irritability and early dementia as well, so it is a great option for elder patients.