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.

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