What is Depression?
Major Depressive Disorder is a condition where an imbalance in brain neurotransmitters (serotonin, norepinephrine, dopamine) causes widespread dysfunction in mood, thinking, and physical functions. It is a common disorder, with 1 in 15 people in Japan said to experience it at some point in their lives.
It is not a matter of "lack of effort" or "being spoiled," but a medical condition that requires treatment. With appropriate treatment, many people recover. The sooner treatment begins, the faster the recovery, and this is also important for preventing relapse.
Our Role (as an Internal Medicine Clinic)
Our clinic is responsible for excluding physical illnesses that cause depressive symptoms and providing initial treatment for mild to moderate depression. In cases of severe depression (strong suicidal ideation, significant functional impairment) or treatment resistance, we will refer patients to a psychiatrist appropriately.
Main Symptoms of Depression
If the following symptoms persist almost daily for two weeks or more, you may have depression (referencing DSM-5 diagnostic criteria).
Mood and Motivation Symptoms
- Persistent low mood or sadness
- Inability to enjoy anything or take interest (anhedonia)
- Strong feelings of self-negation or guilt
- Decreased concentration, thinking ability, and decision-making
- Thoughts of death (suicidal ideation)
Physical Symptoms (Often Overlooked)
- Insomnia (especially early morning awakening) or excessive sleepiness
- Loss of appetite and weight loss (rarely, overeating and weight gain)
- Severe fatigue and easy exhaustion
- Unexplained headaches, stiff shoulders, back pain, gastrointestinal discomfort
- Decreased libido
- Slowed movements and speech (psychomotor retardation)
Many people visit only for physical symptoms
It is said that about 70% of people with depression first visit an internal medicine clinic for physical symptoms (headaches, fatigue, gastrointestinal discomfort). If you have "unexplained physical discomfort that persists," depression may be the underlying cause.
Simple Self-Check (Part of PHQ-9)
How much have you experienced the following symptoms in the past two weeks? If even one applies "almost every day," we recommend seeking medical attention.
- Little interest or pleasure in doing things
- Feeling down, depressed, or hopeless
- Trouble falling or staying asleep, or sleeping too much
- Feeling tired or having little energy
- Poor appetite or overeating
- Feeling bad about yourself, or that you are a failure or have let yourself or your family down
- Trouble concentrating on things, such as reading the newspaper or watching television
- Moving or speaking so slowly that other people could have noticed. Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual
- Thoughts that you would be better off dead, or thoughts of hurting yourself in some way
Physical Illnesses That Can Cause Depressive Symptoms (Differential Diagnosis is Important)
Symptoms similar to depression (fatigue, low mood, poor concentration) can also occur with physical illnesses. Not overlooking treatable physical illnesses is a crucial role of our clinic.
| Condition | Symptoms similar to depression | Tests to confirm |
|---|---|---|
| Hypothyroidism (Hashimoto's disease) | Fatigue, depression, weight gain, cold intolerance | TSH, FT4 |
| Hyperthyroidism (Graves' disease) | Anxiety, insomnia, palpitations, weight loss | TSH, FT3, FT4 |
| Iron deficiency anemia | Fatigue, poor concentration, low mood | CBC, ferritin |
| Vitamin B12/Folate deficiency | Depression, cognitive decline, fatigue | Blood B12, folate |
| Vitamin D deficiency | Mood disturbance, fatigue, bone pain | 25-OH Vitamin D |
| Diabetes/Hypoglycemia | Fatigue, poor concentration, irritability | Blood glucose, HbA1c |
| Sleep apnea syndrome | Daytime fatigue, depression, poor concentration | Interview, testing as needed |
| Chronic diseases (renal, hepatic, cardiac) | Fatigue, lack of motivation | Liver and kidney function, ECG |
| Medication-induced | Depression due to antihypertensives, steroids, etc. | Review of medication history |
Signs That Require Immediate Medical Attention
If you have any of the following symptoms, please consult us as soon as possible
Leaving symptoms untreated can lead to chronicization, worsening, and increased risk of suicide. There is no need to hesitate, wondering "Is it okay to see a doctor for this?"
- Low mood has continued for more than two weeks
- Unable to perform work, housework, or studies as before
- Cannot sleep, or sleeps too much and the day feels short
- Loss of appetite and weight loss (or tendency to overeat)
- Headaches, fatigue, or gastrointestinal symptoms persist without abnormalities found in tests
- No interest in things that were previously enjoyable
- Strong feelings of self-blame
- Thoughts of dying or impulses to self-harm
Strong suicidal ideation or thoughts of death are an emergency
If you have strong feelings of "wanting to die" or "wanting to disappear," or if you have a concrete plan, please consider psychiatric emergency services or "Inochi no Denwa (Lifeline)" (0120-783-556), or seeking consultation with a specialist psychiatrist as soon as possible. Our clinic will also assess the urgency and refer you to an appropriate medical institution.
Examination and Tests at Our Clinic
Key Points of the Medical Interview
- Nature, duration, and severity of symptoms
- Impact on daily life, work, and relationships
- Sleep, appetite, and weight changes
- Presence and severity of suicidal ideation
- Stress factors (work, family, health, bereavement)
- Past medical history and family history (depression, bipolar disorder)
- Current medications and supplements
- Alcohol and caffeine intake
Tests to Exclude Physical Illnesses
| Test Item | Purpose |
|---|---|
| CBC, Inflammatory Markers | Evaluation of anemia, chronic inflammation |
| Thyroid function (TSH, FT4) | Exclusion of thyroid disorders |
| Ferritin | Evaluation of latent iron deficiency |
| Vitamin D, B12, Folate | Exclusion of nutritional deficiency mood symptoms |
| Blood Glucose, HbA1c | Evaluation of diabetes, hypoglycemia |
| Liver and Kidney Function | Evaluation of chronic diseases, safety of pharmacotherapy |
| ECG | QT evaluation before pharmacotherapy |
Treatment Options
Depending on the severity and background of symptoms, we combine pharmacotherapy with lifestyle adjustments and psychological approaches.
Pharmacotherapy
| Category | Representative Drugs | Characteristics |
|---|---|---|
| SSRIs (First-line) | Escitalopram, Sertraline, etc. | Relatively few side effects, takes 2-4 weeks to take effect |
| SNRIs | Duloxetine, Venlafaxine, etc. | Also effective for depression accompanied by physical pain |
| NaSSAs | Mirtazapine | Effective for insomnia and loss of appetite, watch out for drowsiness and weight gain |
| Herbal Medicines (Kampo) | Kamishoyosan, Kososan, Hangekobokuto, Saikokaryukotsuboreito, etc. | For mild cases or those with primarily physical symptoms |
| Sleeping Pills (Short-term) | Lemborexant, Suvorexant, etc. | For insomnia, choose those with low dependence potential |
What to Know About Antidepressants
Antidepressants often take 2-4 weeks to take effect. Side effects (nausea, drowsiness, headache, etc.) may occur immediately after starting, but usually subside within 1-2 weeks. Do not stop suddenly on your own without consulting your doctor, and always adjust in consultation with your primary physician.
Lifestyle Rhythm and Self-Care
- Wake up at a fixed time each day (establishing a sleep rhythm)
- Get morning sunlight (regulates circadian rhythm and serotonin secretion)
- Light exercise within reasonable limits (20-30 minute walk)
- Balanced diet (tryptophan, iron, vitamin D)
- Reduce alcohol and caffeine intake
- Let go of perfectionism ("60% is OK")
- Talk to trusted people and maintain connections
Psychological Approaches
- Cognitive Behavioral Therapy (CBT): Referral to specialized psychological therapy institutions available
- Mindfulness-Based Cognitive Therapy
- Problem-Solving Therapy
About Leave of Absence and Medical Certificates
Taking a break from work is also part of the treatment
If symptoms are severe and it is difficult to continue working, rest is a valid form of treatment. Our clinic issues medical certificates for leave of absence as needed. Please consult us early to avoid worsening your condition due to "guilt about taking a break."
Process for Leave of Absence (at Our Clinic)
- Assessment of symptoms and determination of need for rest during consultation
- Issuance of a medical certificate (typically for a period of 1-3 months)
- Regular follow-ups every 2-4 weeks to evaluate treatment effectiveness and eligibility for return to work
- Consideration of phased return to work (rehabilitation, reduced hours) once symptoms stabilize
Available Systems and Support
- Sickness and Injury Allowance: If a health insurance member takes a leave of absence, approximately 2/3 of their salary is paid for up to 1 year and 6 months.
- Self-Support Medical Care: Outpatient medical expenses are generally covered at 10%.
- Return-to-work support programs (rework)
- Consultation at local mental health and welfare centers
Characteristics of Depression Treatment at Our Clinic
- Thorough exclusion of underlying causes through blood tests for physical illnesses by an internal medicine doctor
- Pharmacotherapy (SSRIs, SNRIs, Kampo medicines) for mild to moderate depression
- Concurrent management of physical symptoms such as insomnia, fatigue, and gastrointestinal issues
- Issuance of medical certificates for leave of absence
- Prompt referral to a psychiatrist for severe or treatment-resistant cases
- Welcome to provide physical health follow-up for those already receiving psychiatric care
- No appointment needed, same-day visits OK / Open daily 9:00-21:00 / 1 minute walk from Jujo Station
For those unsure about seeking medical attention
There is no need to hesitate, thinking "Is it okay to go to an internal medicine clinic for this?" or "I'm scared of being told I have depression." Early consultation is the most important first step in treatment. We also accept consultations from family members only.
