In Japan, depression was renamed “a cold of the soul” when the first SSRI arrived
Until the late 1990s the Japanese word for clinical depression carried a heavy stigma. After the first SSRI arrived in 1999, companies ran campaigns around a new phrase. Antidepressant sales rose six fold in eight years.
We have not finished checking this source. No judgement either way. how we score evidence
Caveat on this rating: This is an argument paper by a single author, not a study with a comparison group. Sales can rise because unmet need is finally met, because of marketing, or both, and the paper cannot separate them. The stigma it describes was real, and campaigns that reduce stigma have defenders in public health. The row reports what the paper documents, the phrase and the sales, and does not claim the people treated were not ill.
A condition can be introduced to a country the way a product is. Japan is the best documented case.
Significant findings
Hiroshi Ihara, a Japanese psychiatrist, set out the sequence in a 2012 journal paper. Until the late 1990s the public view of depression in Japan was "generally unfavorable", because of what the ordinary word for clinical depression, utsubyou, implied. The first SSRI reached the Japanese market in 1999. Drug companies then "initiated educational campaigns", and to help the drug's acceptance they coined a catchphrase: kokoro no kaze, which the paper translates as "a cold of the soul".
The paper gives the sales figures. Antidepressant sales in Japan went from 14.5 billion yen in 1998 to 87 billion yen in 2006, a six fold rise in eight years.
Ihara's objection is to the metaphor itself. A cold is mild, common and gone in a week. The phrase, he writes, "masked a critical difference between a cold and depression", and it hid how long treatment with these medicines usually lasts.
What this does not show
It does not show that the people who sought help were not unwell, or that the medicines did not help them. A campaign that lowers stigma can bring real suffering into care. Japan has long had a high suicide rate, and part of the case for the campaigns was that depression there was hidden and untreated. The paper is one psychiatrist's argument from sales data and campaign history. It is not a trial, and sales rising after a campaign does not prove the campaign alone caused the rise.
Worth asking
When you see a campaign that teaches you the name of a condition, who paid for it, and what do they sell?
Source
A cold of the soul: a Japanese case of disease mongering in psychiatry — Ihara H (2012)
Read the source: https://doi.org/10.3233/JRS-2012-0560
DOI: 10.3233/JRS-2012-0560
How this was scored
- Study design
- not recorded
- Funding
- not recorded
- Published in
- not recorded
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
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Published September 24, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "not yet assessed". We have not finished checking this source. No judgement either way. One caveat travels with that badge: This is an argument paper by a single author, not a study with a comparison group. Sales can rise because unmet need is finally met, because of marketing, or both, and the paper cannot separate them. The stigma it describes was real, and campaigns that reduce stigma have defenders in public health. The row reports what the paper documents, the phrase and the sales, and does not claim the people treated were not ill. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
A cold of the soul: a Japanese case of disease mongering in psychiatry — Ihara H (2012). DOI: 10.3233/JRS-2012-0560. The full source is linked on this page so you can read it yourself.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.