Doctors doling out meds as mental health issues rise in Japan
The days of “grinning and bearing it” are fast coming to an end in Japan as increasing numbers of those suffering from depression and anxiety disorders are turning to medication rather than stoicism for a solution, as doctors, counselors and mental health specialists maintain that issues of depression and anxiety are becoming far more punctuated in Japanese society than in previous years.
But Japan has a long history of marginalizing those considered mentally ill and in 1900 the law required sufferers be isolated from society and confined to their own households. Perhaps more worryingly, historically, Japanese prisoners considered to be mentally ill were ordered to be executed.
Although the provisions for professional mental health care in Japan have come along in leaps and bounds in the past half century, they still trail far behind those of other developed nations, with the underlying cultural stigma that still surrounds mental illness here being one of the reasons for its sluggish development.
One sure-fire indicator of a nation’s faculty to deal with issues of mental illness — specifically those of an environmental rather than a genetic nature — both on a social and institutional level, is a country’s suicide rate.
The bursting of Japan’s economic bubble prompted an end to lifetime employment, and was blamed for the spike in suicides in the late 1990s from around 25,000 a year to around 32,000.
Depression, serious illness — particularly among the elderly — and debt have all been cited by psychiatrists in Japan as common causes of suicide.
Japan’s annual number of suicides has hit around the 30,000 mark since the late 1990s, making it one of the highest rates in the world. In 2007, the figure rose to 33,093, marking the second- highest number ever on record and forcing the government to take action, calling the issue a “national problem.”
The rates in Japan, when compared to other developed nations, are disproportionately high, a fact not gone unnoticed by the government who has vowed to reduce the numbers, and, while the figure has dipped in recent years, with the number of suicides in 2012 falling to 27,776, below 30,000 for the first time since 1997, the figure in 2013 was still a worrying 27,283, the National Police Agency said.
The primary causes of suicide, leading psychiatrists attest, are universal and are concerned with issues of despair brought on by tragedy or a personal sense of failure, and, clinical depression, which is caused by mental or emotional trauma or neurological factors.
Such is the scale of the problem in Japan, with suicide being the leading cause of deaths amongst people aged 20-49 and accounting for more than 30 percent of all deaths — five times that of the total deaths caused by road accidents — the government has pledged to cut the suicide rate by at least 20 percent over 10 years.
To this end, the Ministry of Health, Labor and Welfare here has been granted a 220 million U.S. dollar budget to augment and improve the nation’s scarce counseling services and tackle the problem of media, including books and websites, that romanticize and encourage at-risk people to enter into suicide pacts.
A number of additional programs have been proposed to help tackle the problem, including universal guidelines for the ” Management of Depression by Health Care Professionals and Public Servants,” and the “Mental Barrier-Free Declaration.” However, considering the annual suicide rate has only retreated marginally recently, a number of mental health specialists, as well as regular doctors, believe that proposed government dogma and doctrine is far too little, far too late and, in the short-term, an increase in qualified psychiatrists and pharmaceutical solutions are the only ways to stem the rising torrent of suicides.
According to the Japanese Society of Psychiatry and Neurology ( JSPN), the numbers of patients in Japan currently suffering from a psychiatric disorder are staggering and this doesn’t account for a massive “dark figure” of those who remain undiagnosed.
The JSPN figures show that 20 to 30 percent of outpatients and 30 to 40 percent of inpatients have a psychiatric disorder and although there are some 13,000 physicians in Japan practicing psychiatry, “we still feel this is not enough to meet the demands generated by the vast number of mental health issues present in society today.”
“In the last three years I’ve seen a drastic rise in the numbers of patients coming here due to anxiety and depression disorders,” a leading physician at Tokyo’s most prominent international clinic told Xinhua requesting anonymity.
“A lot of the time they come here as a last resort, particularly the Japanese who traditionally don’t look to doctors to help with mental issues — it’s a bit of a taboo here in Japan as people are taught to just endure such matters privately and without fuss or losing face, although this seems to be changing lately,” said the doctor, whose facility is affiliated with a famous medical institution in the United States.
She went on to say how she’d had a number of grown men weeping in her office saying that they felt suicide was the only option left for them and how that in such cases where a patient believed to have suicidal tendencies she had no choice but refer them to a specialist for ongoing combination therapy.
“Even we don’t have the resources here to deal with such cases and I have no way of knowing if such patients follow my referrals or not. In less serious cases, but where homeopathic or natural remedies and lifestyle changes such as exercise, meditation, healthy eating and herbal teas etc. don’t work, I’ll prescribe medication to help them with their issues,” the physician said.
“I’m not a psychiatrist, but I’ve worked in internal medicine for more than 10 years and never before have I had to prescribe as much anti-anxiety, anti-depressant and sleeping medication as I have had to recently. I’m sure that if it weren’t for the medication a number of my patients would’ve committed suicide,” she concluded.
A survey submitted to the Central Social Insurance Medical Council by the Ministry of Health, Labor and Welfare concurs that there has been a surge in the dispensing rate of generic drugs on a prescription basis, including a massive spike in the drugs used to treat anxiety and insomnia — a family of medication known as benzodiazepines.
Used on a short-term basis anti-anxiety and medications to combat issues of insomnia, often associated with anxiety disorders such as: alprazolam, chlordiazepoxide, diazepam and lorazepam — known more commonly as Xanax, Librium, Valium and Ativan respectively — can be very effective and are widely prescribed in Japan.
The drugs work by slowing down the central nervous system, relieving feelings of tension and nervousness. Medicines from the same family of drugs can also treat insomnia by shortening the time it takes to fall asleep as well as lengthening the sleeping time, according to pharmacologists.
In Japan, benzodiazepines such as Wypax, Meilax, Myslee and Lendormin are fast becoming household names, however there is, of course, a downside. Firstly, in the west, critical thought amongst specialists maintains that antidepressants are a safer way to treat general anxiety disorders (GAD) in the long-term, as the potential for addiction to benzodiazepines, due to its fast-acting, sedating, hypnotic and euphoric qualities, is extremely high and withdrawal from the drugs is well-documented as being more difficult than that of heroin withdrawal.
In general regular, local doctors in Japan, possibly due to cultural reasons, have a limited understanding of depression, its diagnosis and its treatment. Hence doctors are far more likely to prescribe a benzodiazepine to treat immediate symptoms, rather than look for a long-term solution — the irony here being that the effects of long-term use of benzodiazepines can be far more devastating than the original condition that called for them.
Slowly but surely Japan is becoming a nation that will, sooner rather than later, share the world’s biggest drug problem, as Dr. Vernon Coleman in his book, “Life Without Tranquilizers,” explains.
“The biggest drug-addiction problem in the world doesn’t involve heroin, cocaine or marijuana. In fact, it doesn’t involve an illegal drug at all. The world’s biggest drug-addiction problem is posed by a group of drugs, the benzodiazepines, which are widely prescribed by doctors and taken by countless millions of perfectly ordinary people around the world… Drug-addiction experts claim that getting people off the benzodiazepines is more difficult than getting addicts off heroin…”
Source: Xinhua
Published: 26 Sep 2014
Category: Health alert, Top Story
