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Psychopharmacology in a Globalizing World: The Use of Antidepressants in Japan

McGill University

Despite the great popularity of selective serotonin-reuptake inhibitor (SSRI) antidepressants in North America and Europe, most of these medications have not yet been introduced in Japan. This reflects the difficulty in obtaining government approval for new drugs in Japan, as well as specific social and cultural issues. The majority of patients with depression or dysphoric mood in Japan are seen in specialty medical care, complain of physical symptoms, and are treated with anxiolytic medications. Sadness and depression may be given positive social meanings as yielding enhanced awareness of the transient nature of the world. This article explores the relevance for bioethics of cultural variations in the use of antidepressants at three different levels of analysis: (i) the varieties of depressive experience as they unfold in specific cultural worlds and value systems; (ii) the narrative construction of the self; and (iii) the political economic context of the pharmacological treatment of depression. The strong interconnections of values framed at one level with those at other levels means that there are likely to be unavoidable tradeoffs between different values or desirable short and long-term outcomes such as energy, efficiency, happiness, maturation, depth of personality, and responsiveness to social and moral predicaments. These tradeoffs challenge the assumption of universalism in biomedicine and raise questions about the consequences of our willingness to use medications to treat the myriad forms of distress that may signal fundamental problems with our way of life.

Key Words: affective disorder • culture • depression • bioethics • Japan • mood • psychopharmacology • Zen Buddhism

Transcultural Psychiatry, Vol. 39, No. 3, 295-322 (2002)
DOI: 10.1177/136346150203900302


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