Here’s this week’s Media Mix, which is about the steep increase in the dispensing of psychoactive drugs in Japan. One of the more puzzling aspects of this issue is how far behind the curve government regulation is. Japan has a reputation for taking a long time when approving new drugs, but medications for mental, emotional, and behavioral disabilities are relatively unregulated, seemingly because psychiatry is not a field the government takes very seriously. One professor at a medical school admitted to the Asahi Shimbun that most Japanese physicians who go into psychiatry–and the number is on the rise–lack the proper training for diagnosis, and thus can be swayed more easily by pharmaceutical company salespeople. And because psychiatry is a young discipline in Japan, the latest trends tend to be stressed, such as drug treatments, which are basically “short-term” solutions, meaning they deal with the situation on a day-by-day basis. Psychoanalysis and counseling, on the other hand, address underlying causes, such as trauma and repression. Of course, there are many people with mental illnesses whose problems are deemed organic, and thus require chemical adjustments to help them get through the day. But what many of the older doctors interviewed by the media point out is that the dispensing of drugs has become automatic. Doctors have to monitor their patients’ reactions to these drugs and keep in mind that many are highly addictive. The leader of an organization of families of suicides told the Asahi that his group has lobbied the health ministry to carry out a survey of patients who may have experienced adverse reactions to their medications, but so far the ministry hasn’t. He points out that the government has launched a campaign to encourage people who think they are suffering from depression to seek treatment as early as possible, but at the same time the government does not caution these people with regard to the possible side effects of psychoactive drugs, since that’s usually the treatment they’ll encounter.
In a related story, the Yomiuri states rather bluntly that the huge increase in depression diagnoses is a direct function of “over-treatment.” In other words, since doctors have these tools, meaning these drugs, to treat depression they are actually more likely to diagnose it. Moreover, when making the diagnoses, they are very likely to use the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is produced by the American Psychiatric Association and has become controversial because of its perceived advocacy of drug treatment. Doctors simply tick off the symptons of depression in accordance with the DSM and then prescribe drugs without really taking into account the patient’s individual situation. Some drugs that are prescribed for psychiatric patients, such as anti-epileptics, anti-anxiety meds, and steroids, actually exacerbate depression, so monitoring is extremely important. A lawyers group working on cases involving drug side effects carried out a survey of doctors and a rep told the Yomiuri that most physicians don’t follow up on drug treatment, they just keep renewing the prescription as long as nothing really bad is evident. This mindset has become so prevalent that doctors will prescribe psychoactive drugs without even talking to a patient. On the NHK show, it was revealed that one doctor prescribed drugs to a two-year-old because his parents claimed the toddler had trouble sleeping. Obviously, 2 is too young for someone to have developed an emotional problem that could be treated through counseling. It’s difficult not to imagine that in this case it’s the parents who have the sleeping problem, not the child.