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 and zolpidem cannot be prescribed online until a doctor has examined you in person, 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 is the detailed map of the rules.
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 ADHD stimulants. Online care runs on the health ministry's online consultation guideline, revised in 2026. It lets any doctor hold an online first visit (初診, shoshin) once they have your medical background, through records or a proper intake, and what it restricts is a short list of prescriptions:
| Group | Examples | Online first visit? |
|---|---|---|
| Antidepressants | sertraline, escitalopram, paroxetine, fluvoxamine, duloxetine, venlafaxine, vortioxetine, mirtazapine, trazodone | Yes |
| Antipsychotics | aripiprazole, risperidone, quetiapine, lurasidone, brexpiprazole, blonanserin | Yes |
| Sleep medicines outside the controlled list | eszopiclone (Lunesta), lemborexant (Dayvigo), suvorexant (Belsomra), ramelteon (Rozerem) | Yes |
| Benzodiazepine-class medicines and zolpidem | alprazolam, lorazepam, etizolam, clonazepam and the other benzodiazepine anxiolytics; triazolam, brotizolam and the other benzodiazepine sleeping pills; zolpidem | No, and not at online follow-ups either until you have been examined in person |
| ADHD stimulants | methylphenidate (Concerta) | No online start; the registration system applies |
When does an in-person visit become mandatory?
When the treatment involves a benzodiazepine-class medicine or zolpidem. 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 benzodiazepine or zolpidem prescription 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 from a previous clinic do not replace the examination; the rule is about being seen for the condition, not about paperwork.
One restriction is often mistaken for a ban on online first visits. A separate 2025 guideline on psychotherapy by video effectively rules out insurance-billed psychotherapy at an online first visit. That is a rule about billing, not about whether you can be seen; private-pay counseling in English runs outside it (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 delivery from the pharmacy to your door is standard (how it works).
For benzodiazepine-class medicines and zolpidem, 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, so expect more frequent visits, some of them in person.
Concerta runs through the national ADHD registration system with identity checks at dispensing, and most clinics handle it face to face.
Why do these rules exist?
Safety and abuse prevention. A first psychiatric assessment reads posture, movement, and affect, things a webcam flattens, and prescribing dependence-forming medicines to someone nobody has examined is where the serious mistakes happen. The ministry's guideline names the abuse side as an example of 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 is not a ban on online care; it requires the one risky step to happen in person, at the cost of a single trip.
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 or zolpidem at a first video consultation, or to a patient it has never examined in person, is operating outside the 2026 rule, and that tells you what else it is willing to cut. Offering eszopiclone, lemborexant, suvorexant, or ramelteon 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 September 9, 2026.