Diagnostic and therapeutic issues of atypical depression in Japan

SummaryDepressive conditions such as treatment-resistant depression, persistent depression and chronic mild depression have recently been the subject of much interest in Japan. The term “atypical depression” is not in common use, however depressive states falling outside the “typical” categories of the major depressive disorders (MDD) can be discussed in terms of symptomatology, etiology, and response to treatment. The term “neurasthenia” which refers to a hypochondriacal disorder with or without physical illness, as well as to a subtype of neurosis (ICD-9, 300.5), is no longer extensively used. “Dysthymia” is classically employed to signify either a dysphoric state accompanied by mild depression and irritability, as defined by the German school, or a mild depressive personality disorder; it is currently used as an alternative to “neurotic depression” (ICD-9 300.4), or “dysthymic disorder” (DSM III-R). Recurrent brief depression is not yet a prevalent concept in Japan. Despite the observation of depression with hyperphagia and/or hypersomnia, these phenomena have not received a specific designation. Therapeutic approaches to depression include both non-drug modalities (psychotherapy, environmental modification, etc) and the standard drug regimens (antidepressants, anxiolytics, etc); clinical trials are currently underway with selective serotonin reuptake inhibitors which we expect to be effective in treatment-resistant depression. Plant-based traditional remedies are still widely employed in Japan, and several of these are described. Finally, we discuss the Morita therapy, a specifically Japanese modality for treatment of mild depression with obsessive-compulsive symptoms based upon the Zen philosophy. This approach involves an initial period of absolute bed-rest, followed by gradual resumption of work and social activities with support and counseling.