Japan's Online Psychiatry Rules: First Visits, Prescriptions, and the 2026 In-Person Requirement
Online psychiatric care is legal in Japan, and the rules that matter turn on which medicine you need, not on the video call itself. Antidepressants, antipsychotics, and the newer sleep medicines can be started at an online first visit. Benzodiazepine-class medicines, zolpidem, and zopiclone cannot be prescribed online until a doctor has examined you in person for that condition, a rule that took effect in 2026. For the overview of how online care works day to day, start with our online psychiatry guide; this article covers the rules in detail.
What can be prescribed at an online first visit, and what can't?
Most psychiatric medicines can be started at an online first visit; the exceptions are controlled sleep and anxiety medicines and methylphenidate (Concerta). Online care runs on the health ministry's online consultation guideline, revised in 2026. It expects an online first visit (初診, shoshin) to be with your regular doctor in principle. Another doctor can hold one when they can confirm your medical background from your records, a referral letter or your medication notebook, or after a video pre-consultation that checks your history before any diagnosis or prescription. What the guideline restricts is a short list of prescriptions:
| Group | Examples | Online first visit? |
|---|---|---|
| Antidepressants | sertraline, escitalopram, duloxetine, mirtazapine and other antidepressants | Yes |
| Antipsychotics | aripiprazole, risperidone, quetiapine, brexpiprazole and other antipsychotics | Yes |
| Sleep medicines outside the controlled list | eszopiclone (Lunesta), lemborexant (Dayvigo), suvorexant (Belsomra), daridorexant (Quviviq), ramelteon (Rozerem) | Yes |
| Benzodiazepine-class medicines, zolpidem and zopiclone | alprazolam, lorazepam, etizolam and other benzodiazepines, for anxiety or sleep; zolpidem (Myslee); zopiclone (Amoban) | No, and not at online follow-ups either until you have been examined in person |
| Methylphenidate | Concerta | No: the same in-person rule applies, and the registration system applies on top |
When does an in-person visit become mandatory?
When the treatment involves a benzodiazepine-class medicine, zolpidem, zopiclone, or any other controlled psychotropic. Since April 1, 2026, Article 9-6-13 of the Ordinance for Enforcement of the Medical Care Act (医療法施行規則, Iryoho Shiko Kisoku) has prohibited prescribing controlled psychotropics online unless the patient has already received in-person care for that condition. The ministry's April 2026 clarification spells out the consequence: an online first visit followed by online follow-ups, with no in-person examination in between, cannot produce a prescription for any of these medicines at any point.
What this means in practice:
- At least one in-person visit before any of these medicines is prescribed
- No fixed number of visits or timing; the examination is the requirement, not a schedule
- After that visit, online follow-ups can continue the prescription
Two other situations always mean in person: anything that needs a physical examination or a closer assessment, and emergencies. Records alone do not satisfy the requirement; what the rule asks for is that you have been examined in person for the condition.
A separate ministry guideline on psychotherapy by video, published in December 2025 and followed by the insurance rules, allows a psychiatrist's psychotherapy at an online first visit only in narrow public-health outreach cases, so for most patients insurance-billed psychotherapy starts in person. Being seen online is a separate question from psychotherapy, and private-pay counseling in English runs outside this rule (your options).
What changes at follow-up visits?
For most medicines, nothing. Refills of antidepressants, antipsychotics, and non-controlled sleep medicines at an online follow-up (再診, saishin) are routine, and the pharmacy can deliver to your door (how it works).
For benzodiazepine-class medicines, zolpidem, and zopiclone, two things change once you have had the in-person visit:
- They can now be prescribed online, subject to the guideline's warning against prescribing where misuse or resale is suspected.
- Online prescriptions are often shorter than in-person ones, not always.
Concerta (methylphenidate) is also a controlled psychotropic, so the same in-person requirement applies. It also runs through the ADHD registration system, and the pharmacy confirms your registration before dispensing; ask the clinic how it handles follow-ups.
Why do these rules exist?
Safety and abuse prevention. The ministry's guideline states that a video consultation gives the doctor less information about a patient's condition than an in-person one, and it names as improper practice prescribing psychotropics or sleeping pills to a patient who asks for them by name, where resale or misuse is suspected, without an in-person visit to confirm the need. The 2026 rule does not ban online care; it requires an in-person examination before these medicines are prescribed.
How do you tell a service follows the rules?
It tells you which pattern applies to you before promising medication. Three signs:
- It asks for your medical background before an online first visit
- It says plainly that benzodiazepine-class medicines need an in-person visit first
- It treats in-person visits as part of the plan, not as a failure of the online service
A service that offers benzodiazepines, zolpidem, or zopiclone at a first video consultation, or to a patient it has never examined in person, is operating outside the 2026 rule. Offering the sleep medicines outside the controlled list, such as lemborexant or eszopiclone, online is within the rules; the distinction is the medicine, not the channel.
Frequently asked questions
This article is general information, not medical advice for your individual situation. It describes the rules as of 2026 and is not legal advice; the ministry's published guideline is authoritative.
Medically reviewed by our psychiatrist (M.D.). Updated October 16, 2026.