The Kirsch study published a few weeks ago has stirred much discussion of the placebo power of antidepressants (or is it the antidepressant power of placebos?); it's clear that the act of taking a pill that you expect to help you often does help you.
But can the availability of a pill meant for depression make you feel (or think of yourself as) depressed? That's the question behind another part of the drug debate, regarding whether the drug industry encourages us to medicalize ordinary experience.
In pondering these things I ran across this fascinating New York Times >article from 2004, "Did Antidepressants Depress Japan," about the introduction of the concept of depression in Japan beginning in the late 1990s. Before then, the article asserts, Japanese culture concerned itself little with depression outside of professional psychiatry and medicine. But when drug companies started pushing antidepressants beginning in 1999, a cultural awareness of depression grew -- and with it, the number of people who considered themselves depressed.
All arguments about the reality of severe depression aside, this says remarkable things about how cultures define -- and individuals experience (or not) -- a state of ill-being. The story is excerpted below the break, or read the whole thing here.
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.
Then, in 1999, a Japanese company, Meiji Seika Kaisha, began selling the S.S.R.I. Depromel. Meiji was among the first users of the phrase kokoro no kaze [common cold of the soul]. The next year, GlaxoSmithKline -- maker of the antidepressant Paxil -- followed Meiji into the market. Koji Nakagawa, GlaxoSmithKline's product manager for Paxil, explained: ''When other pharmaceutical companies were giving up on developing antidepressants in Japan, we went ahead for a very simple reason: the successful marketing in the United States and Europe.''
Direct-to-consumer drug advertising is illegal in Japan, so the company relied on educational campaigns targeting mild depression. As Nakagawa put it: ''People didn't know they were suffering from a disease. We felt it was important to reach out to them.'' So the company formulated a tripartite message: ''Depression is a disease that anyone can get. It can be cured by medicine. Early detection is important.''
Link to article 'Did Antidepressants Depress Japan?'.
neuroscience, medicine, public health, depression, Lilly, pharma
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I have gone through the entire article and it was nice .
Man, how can people not know they have a mental disease? That's a tough one. I guess the idea is that depression is more than ideation. Can I be depressed without having the belief that I am depressed? Yes, if depression is something other than a certain set of beliefs.
It seems that debates like this are fundamentally philosophy of mind debates. It's odd that some companies have a financial interest in the way that debate pans out.
The point is not that they had it and didn't know it (though that was probably the case with some), but that they redefined their condition after exposure to the ad campaigns. That's the question raised: Did they have a condition they didn't recognize, or did the ad campaign convince some that a more-or-less normal state is "depression"? Some of both, no doubt.
True, I just felt like changing the subject a little.
"It's odd that some companies have a financial interest in the way that debate pans out."
Mike, have you been living in our Western world in this century? Our entire Advertising system is geared towards changing our values and then our search for value. If that isn't a mind debate, I don't know what is. Millions of dollars can be made from telling someone they are lacking that which will make them happy, and then offering the "solution".
I strongly agree with the need for a different title. Though the article explains the situation well, at first I was expecting them to show how depression in Japan was manufactured by drug companies. This article is referenced in google by nearly only its title more than any other English article I saw on the topic of antidepressants in Japan, so it's more than a little misfortunate choice of words. Given the amount of suffering folks in Japan have had to endure by the 'gaman' spirit of not showing weakness, I'd hate for them to think now that there is great openness about depression that that was a mistake. My 12 years in Japan showed clearly the extent of folks affected by and often covering mental illness.