A Series on Expat Depression #2: What is “expat” depression?

Last week I kicked off this series on expat depression with an introductory post, explaining why this was a subject that needed tackling properly. In this week’s post I look at the term “expat” depression and whether it really needs a category of it’s own. As always, I want to thank mental health specialist and counsellor Anita Colombara for her contribution to this series.

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I have tried writing this post now about three times, and every time I’ve had to screw up the paper I’m writing it in and throw it in the bin (my computer’s bin of course!). I wanted to try and set out exactly what expat depression meant, why it is different from other types of depression, and how knowing about these differences can help you cope with it.

But of course, depression – of any kind – just isn’t that simple, and an easy, straightforward explanation just kept slipping out of my hands.

At first, I based my ideas for this post on feedback I had had whilst carrying out the survey for this series of expat depression posts. I had been told very firmly by more than one person that there was a huge difference between “low feelings” and proper depression. Taking this one step further, I started investigating “clinical” depression – eg that which is caused by a proper chemical imbalance in the brain; and “situational” depression – eg that which is caused by a change in circumstances, the situation you find yourself in. A good example of “situational depression” would be postnatal/postpartum depression, which is well documented and at least partially understood: the mix of a huge change in the life of the new parents, loss of job/career/money, loss of identity, isolation, sleep deprivation…..all things that can be readily compared to moving to a new country and becoming an expat, bar (hopefully) the sleep deprivation.

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Having a new baby can trigger a roller coaster of emotions – much like moving abroad.

So, I wanted to be able to compare the two types of depression – clinical and situational, discuss which was most likely to be experienced by expats and then talk about how one required proper intervention in the form of a counsellor or psychiatrist, or even medication such as antidepressants; whilst the other could be worked through with a mixture of self-help methods and basically the passing of time. I thought making this distinction would make it easier for anyone reading these posts to know what they were dealing with and thus seek the appropriate help.

But then I emailed the mental health specialist, Anita Colombara, and asked for her opinion on this. Did she see the difference between the two and if so did she agree that “expat” depression was much more likely to be “situational” (after all, this makes a lot of sense – it can’t be a coincidence that many of us only ever experience depression or, perhaps, experience it for the first time, on moving to another country). And this was her response:

Situational depression, aka Adjustment Disorder (AD), occurs when one is unable to adjust or cope with a particular stressor or a major life event. This type of depression often alleviates once the stressor resolves or the individual learns to adapt to the situation. Clinical depression, aka Major depressive disorder (MDD), on the other hand, consists of a pervasively low mood that adversely impacts most areas of a person’s life, habits, and general health.

Honestly, I have difficulty separating “situational depression” vs “clinical depression”. Whether ones depression is triggered by a life stressor (situational depression) or a chemical imbalance in the brain (clinical depression), depressive symptoms look and feel pretty much the same. Most people who struggle with depression have at least four of the following symptoms:

• Loss of joy or interest in hobbies you normally enjoy
• Loss of interest in relationships or decreased libido
• Often irritable, impatient with self or others
• Pessimism, feeling stuck, hopeless, empty
• Difficulty concentrating or making decisions
• Insomnia or restlessness
• Low energy, fatigue, or difficulty getting out of bed
• Change of appetite, over eating, not eating enough, or other unhealthy eating habits
• Feelings of guilt, shame, or self-hatred
• Excessive crying or lack of emotion
• Excessive anger, breaking objects
• Lack of self-care, grooming, or hygiene
• Thoughts or attempts at self-harm or harming others

In other words, when someone feels crappy, does it matter what it is triggered from? Yes, treatment may be different depending on whether there is a chemical imbalance component involved. However, seeking professional help would not hurt either way. A good therapist will help determine where the depression is coming from and assess what kind of intervention would be appropriate.

So I felt like I was back to square one. But not really because thinking this issue through, and discussing it first with Anita and then with a “real-life” friend here in Pretoria who has first-hand experience of depression, has been a useful exercise in itself. Because what it taught me was never to make assumptions, don’t try and pigeon-hole something, don’t assume that everything is as straightforward as it might at first seem. Which is a really useful way of looking at depression – it isn’t something that comes with a label and a list of instructions. It is something that might…or might not be. That this may work for….or may not. That this is what it is like for you….but not for her.

On the other hand, though, there are also commonalities (as described by Anita above). And one of the things I hope to be able to do is pinpoint some of these commonalities and help you understand a bit more about why you might be feeling why you do, recognise the symptoms as early as possible, and then try and do something about it. Whether that be self-help methods, seeking professional assistance or a mixture of the two will be very much a personal decision but I hope I can at least show you what had worked for others.

Next week, I will start to look at some personal experiences of when and why expats have been affected by depression – which, I hope, will help you prepare if you know you are likely to find yourself in similar situations.

Photo credit: omgponies2

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17 thoughts on “A Series on Expat Depression #2: What is “expat” depression?

  1. “In other words, when someone feels crappy, does it matter what it is triggered from?” Not really. Poignant topic that is smart to address. Feelings of depression can happen to anyone, intelligent, self-aware people and should not bring any shame. Will be interested to see what your queries develop. Cheers from Copenhagen!

    Liked by 1 person

  2. Thank you for your blog. I read through the symptoms and identified at least 5 that I am struggling with due to a year of being unsettled, death if a parent and moving to Accra. I am looking forward to your next blog.

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  3. I think there’s some evidence from the neuroscience field that if you suffer from low mood caused by situational depression for a while, that can in itself lead to a change in the chemical balance in the brain – turning situational depression into clinical depression. So, little difference in how they feel, and probably eventually little difference in how they would present to a scientist/doctor.

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  4. Thank you so much for posting this. I posted months ago about how easy it is to suffer depression when you are living thousands of miles away from home and it feels great to know that it wasn’t just me and that it is being talked about. I look forward to reading your next post and the discussion. 🙂

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  5. Thanks for the post. Living in a cross-cultural situation, I’ve felt many of the things described, and have found that seeking local help can be limited by: contacts, language, income and culture. So I’ve been thankful for friends ‘back home’ who are on the other side of my computer.

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  6. I’m really glad you’re doing this series. For what it’s worth, I think Expat Depression IS different. Although there are more and more expats with globalization, there is still the issue of community support which can be daunting, especially if one is dealing with an issue with some degree of social stigma (not sure this is the correct term) such as infertility or PPD. In other words, whereas you may be able to find help outside your own social circles with people who are “like you, but not with you” in your neighborhood, such as an AA meeting across town or a support group elsewhere for something else, the expat community is generally so small news about what you’re coping with spreads like wildfire and that can be so hard. One is faced on one hand with a community that knows your daily life and really, really gets it, but yet wanting a certain degree of anonymity or privacy while working through something that might be difficult to have out there. Make sense? So “normal triggers”, such as loss, marital strife, employment concerns, substance issues, get magnified. It’s the difference between a wound and an infection.

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    • This is a very good point. So expat depression really has two factors to be aware of – one that things that happen to you as an expat can cause depression; the other is that normal things that happen to you are magnified because of being away from your usual support networks. And then the two together – wham. Thank you for your comment, I really encourage people to weigh in with their own thoughts and experiences. I am by no means an expert, I am simply sharing what others have told me. But the more we can openly discuss this then hopefully the more we can reach those that need it.

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  7. I have been researching the web trying to find answers and somehow hoping to feel less alone. I’ve been battling expat depression for 3 years. In my case, it was triggered by post partum depression. Motherhood was such a roller coaster of emotions and the isolation of expat life did not help at all. As one of the commenters said in a different post, there’s a stigma attached to having a difficult time being a mom and/or an expat. And one of the commenters pointed out a very interesting issue: anonymity and privacy are rarely available within the expat community. I live in a small country with small expat communities it is extremely difficult to deal with depression or any kind of emotional issues (health troubles, money troubles, family troubles, infertility, death in the family, etc) in these circumstances. If you cherish your privacy (like I do) and tend to be an introvert (again, like me) it makes it nearly impossible to function in a ‘normal’ way. Everyone knows everyone’s business (people love to gossip everywhere!) and in a way you feel a lot of social pressure. And this made my depression even worse because I kept to myself as I didn’t feel safe and confident enough to show the world my struggles. I am in therapy but back home, I don’t feel comfortable enough to seek help here.
    I’m just starting to read and share online my pain so thank you for this!

    Liked by 1 person

    • Thanks for your comment Jana and I’m glad you found us. I have often talked about the similarity between moving abroad and having a baby so to do both at the same time can be devastating, I would love to do more on PPD and expat life so let me know if you would be happy to share your story (anonymously is fine) clara@expatpartnersurvival.com. And in the meantime please keep reading and do share any other resources you find that might be helpful.

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  8. Pingback: A series on expat depression: round-up |

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