It’s time for another mental health post, lovelies! This time I want to tackle depression, and specifically, depression while travelling, or expat depression. Now if you’ve read my expat versus migrant post, you’ll know how much I hate using the word expat at all. Unfortunately, in this context, if I use the word migrant there is a chance that the Google gods will send my post into the depths of blog hell never to be seen again. So please forgive me, and know that when I say expat depression, I really mean depression for anybody who is travelling long-term, or who has left their country of birth to work and live somewhere else.
That being said, expat depression, or feeling depressed while you travel, is a lot more common than you may think. We like to portray the sunny side of travel and life abroad on our social media, and we may even be tempted to hide the hard stuff from our loved ones when we chat. But this just contributes to super unhealthy expectations of what travel is. I think that if we talk more about how travel is difficult, and not always amazing, then we can start to make real change in the industry, and also hopefully encourage healthcare providers to be more open to having specific migrant services.
When we Google ‘travel health’ it often brings up travel clinics that cater to vaccinations or area specific preventative medication, like anti-malaria pills. There’s also quite a lot of info online about what to do if you’re in an accident, or need emergency medical care while you’re travelling. But what worries me, is the lack of info about mental health services, as if you’ll never suffer from anxiety or depression while travelling. The Telegraph even has an A to Z of travel health article that mentions not one single mental health issue.
So here’s my introductory guide to expat depression, or more broadly, what to do if you find yourself struggling with depression while travelling.
Depression or Sadness: What’s the difference?
The first thing we need to do is figure out if we’re actually suffering from expat depression. Popular culture has made many of us believe that depression is just feeling a bit down or sad. We hear people exclaim all the time that, “Ugh, I’m SO depressed!” or “That’s so depressing!” So it’s no wonder that even when we know depression is a serious thing, we still aren’t sure how to tell if what we’re feeling actually qualifies.
If we look at the DSM-5 (the manual that health professionals use to diagnose mental health issues), it has a pretty clear outline for what constitutes a depressive episode.
1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
To be diagnosed with depression you would need to experience five or more of these symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure. More than this, your symptoms need to cause you significant distress, and they’ll need to be impairing your social life, your job, or other important areas of your life. Psycom has a good article dealing with depression in general.
So if we look at the above definition, we can see that depression does involve a feeling of intense sadness, but it is much more than that. When we feel sad, which is a natural and normal part of life, we usually are reacting to a specific event or memory, and we usually bounce back from this feeling relatively easily and quickly. Depression is a deeper feeling of sadness, lasting longer, and may not even be related to an event at all.
Why do I feel like this?
One of the really inconvenient things about depression is that it doesn’t actually need a reason to pop up. When something bad happens you might feel sad, but generally the feeling will pass in time. With depression, you could be having the best time of your life and still feel awful, seemingly for no reason.
This is one of the most dangerous things about expat depression, or depression while travelling. We may ‘have it all’ on vacation, or we may be living out our dreams abroad, and still have crippling depression. When we take on board everything popular culture tells us about travel and ‘living the dream’, we may not admit, even to ourselves, that we are feeling depressed. This means that we can feel worthless, lost, even suicidal, and we feel like we can’t reach out to the people we love for fear of appearing ‘ungrateful’.
But all of these expectations are utter bullsh*t. Depression is often just our brain being an assh*le, and the chemicals that keep us feeling good can start to be in short supply. There are many possible causes of depression, including your brain struggling to regulate your mood, having a genetic predisposition, or even medication you may be taking for something completely unrelated. Depression can also be a response to stressful life events or trauma. If you’re looking for a more in-depth article on the causes of depression, Harvard Medical School has your back.
In short, there are a ton of causes for depression, and not a single one of them is something to feel guilty about. Remove the value judgement on your feelings: there is no good or bad emotion, there are just emotions, and each one tells you a different thing. So depression is simply a way of being that causes you distress, and you can absolutely get help for it. The World Health Organisation believes that more than 300 million people are affected by depression globally. You’re not alone.
Now, full disclosure, I’m a drama therapist by training, so I’m kind of biased when it comes to recommending therapy. I hate that getting psychological help is so stigmatised still in 2019. If you’ve got a broken leg, you don’t think twice about getting yourself to medical help. Yet, when we are struggling to manage our mental health we find so many reasons not to seek out help. Well, depression can be linked to suicide, and 800 000 people die by suicide every year, so it’s a little more serious than a broken leg.
Therapy while travelling
It might help to think of therapy as finding a non-judgmental friend who lets you vent as much as you need without complaint. I have been through therapy for depression, and I can’t recommend it enough. Even if you have had a less than fulfilling experience with therapy before, it’s important to remember that not all therapists are the same. You need to shop around for a good fit like you would when you’re figuring out who to date.
If you’re struggling with depression while travelling, you’re probably not going to have the time, resources, or motivation to look around for an appropriate therapist. In that case, I would recommend looking at using a service like Better Help, an online therapy service that connects you with a therapist immediately. Although you can’t be picky with who you get, you’ll be able to get help quickly, and you can also access therapy through texting, which is a great fit when you’re on the road and can’t necessarily find a private spot to Skype.
Expat depression is a little different, because you can probably take a little more time and energy to find a good therapy fit. It is really up to you whether you prefer in person or online therapy. If you’re in a country that has scarce English and your language skills aren’t fluent, you’ll find some great English options online. If you wold prefer to see someone in person try getting in touch with expat groups on Facebook, as often there’s a network of trusted therapists used by the community.
Remember that there are different types of therapy available too. If you’re not really the talk therapy type, or you suspect your depression might be linked to a traumatic experience, then the arts therapies can be a great option. Art, music, dance, or drama therapy all use different creative techniques to offer symptom relief. They are often called oblique therapies, because you don’t have to talk directly about your trauma, but rather explore your feelings through artistic means.
If you are interested in accessing online drama therapy, I’m just about to launch Drama Therapy Online, so get in touch if you need to talk to someone. Drama therapy isn’t about acting necessarily, and therapy can take place via Watsapp, email, or Zoom, which is a secure program just like Skype.
I know that therapy can be expensive, and it isn’t always covered by insurance. But look into online therapy as a cheaper option, and remember, you wouldn’t have a choice if it was your physical health, so take care of your mind as well.
Although I really hope that you’ll give therapy a chance, I also understand that suffering depression while travelling, or expat depression, often means that you can’t immediately access therapeutic help. There are still things you can do to help lift your mood until you get home or to help.
Exercise is often touted as a feel-good activity, and for good reason. Exercise can kickstart our brains into producing more feel-good chemicals. Depression makes us go into hibernation mode, unable to sleep properly at night, but with little energy to leave the bed during the day. So if you can, get yourself up and active, even to a yoga class so you’re surrounded by people and not trying to motivate yourself to exercise all alone. I’m not saying exercise will cure your depression, but it will go a long way to lifting your mood.
Sunshine is another thing that can really affect our mood, which is why depression spikes in Winter when it’s dark and cold. Getting outdoors can really help lift your mood, and if you mix sunshine with exercise, like getting out for a hike, you’re hopefully going to feel a bit better.
Another thing that can help is taking a look at your diet. If you’ve been subsisting entirely on fast food or a super indulgent diet, it can really effect your mood. Try to get fresh fruit and vegetables into your meals, and just generally be a little more moderate in your indulgences. Again, diet is not going to cure your depression, but it really doesn’t help your mood to feel crappy in your body.
A final option you could try for expat depression is to download a mindfulness app. There is some evidence that using an app that helps you track your mood and be more mindful can help mild to moderate depression. Buddhify is an app I can really recommend, and it is perfect for depression while travelling as it works offline once it has been downloaded. There is a small once-off fee, but it has a range of options for anxiety, stress, and guided meditations.
Talk it out
Expat depression is a difficult and touchy subject. If I can give you one piece of advice, make sure you talk to someone. Whether it is a therapist, a friend, or your partner, don’t force yourself to suffer alone. Expat depression is a huge thing, and there will be people around you that know exactly what you’re going through.
Depression makes us believe that we are alone and unloveable, but I am here to tell you that that couldn’t be further from the truth.
If you found this helpful, save it for later