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

A series on Expat depression: introduction

Last year I wrote a post that has been read again and again and again…..barely a day goes by when it, or another on the same subject, doesn’t get looked at. When I wrote the post I don’t think I had any idea what a big topic this was. I almost didn’t write it at all, it was actually a bit of a last-minute thing prompted by a link someone had put on my Facebook page.

What was this post about? Expat depression. And since writing that post, I have realised just what a neglected subject this is.

Time to Talk

The original post was called Depression and the Expat Life: Something we Don’t Talk About Enough. I wrote it to mark the 2015 Time to Talk campaign – a UK campaign that encourages us all to talk to someone about mental health. Today is the 2016 Time to Talk day and this seems like the perfect time to launch my new series on expat depression. The campaign is about de-stigmatising mental health issues, and in my original post I set out to highlight how this was something that we needed to do within the expat world where these issues can really be a big problem.

That post has been read many times since I wrote it, not because I have a huge following but because a lot of people find it by searching under the term “expat depression” or something similar. The more I realised this was happening, the more I realised I needed to write more about this important subject.

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Interview with a professional

Due to the pressures of finishing and publishing my book the Expat Partner’s Survival Guide (which includes a chapter on culture shock and depression), and then moving to South Africa, it took me a while to get back to this. Eventually though I was contacted by an expert on the subject – Anita Colombara, who is mental health specialist with a particular interest in the international community. Anita agreed to be interviewed for my blog and to fill in some of the gaps I had about depression in the expat community. The information she was able to give me was excellent, really good practical stuff that I  hope will help a lot of people.

But although the reaction to Anita’s interview was great, with lots of views and lots of feedback, I still knew there were plenty of people out there that I wasn’t reaching. So I decided to tackle this subject properly. Following the same format as I used to write the Expat Partner’s Survival Guide, I felt that the best way to do this would be to share real-life stories, experiences, tips and advice. Often, just knowing you are not alone can help. So I set up a survey and watched as the answers came in.

Shared experiences

In the end, I had pages and pages of material. Some of the answers were one-liners, some were out-pourings. I was awed that people were willing to share so much, convinced the more I read how important it was that I did this.

It is important though to point out that I am not a medical professional, a therapist or a counsellor. My role here is as a writer and blogger, as well as an expat. I am not the one who can tell you what to do or how to cope. I can only do what I have been doing ever since I wrote my book which is to share the experiences of myself and of others. By doing this I genuinely hope I will help others – by making them realise they are not alone, things will get easier, that they should seek help, that they should talk to someone, how they can help themselves, where they can get help from…..

As I am not the expert I decided to call on the assistance of a professional to ensure that what is published stays within the remit of being responsible. So for this reason I have asked Anita to be part of this series. I have asked her to read each post before it is published and to contribute if she thinks it would be helpful. Many people pointed out as I asked for help with the survey that there was a difference between clinical and situational depression, and that the responses to each could be quite different. I want to explore these differences and I want to ensure that anyone who thinks they need help knows where to at least start trying to find it.

New series

So today, Time to Talk day, I launch this new series on expat depression as a way to hopefully help everyone out there who is suffering from one of the unspoken sides of expat life. I hope to post weekly and will include when and why depression is most likely to hit, how it manifests itself, the link between culture shock and depression and the ways people have found to help themselves. Later I will also talk about how to help others – including partners.

I hope many people will find these posts useful; even if you yourself don’t think this is something you need to know about please share as you see appropriate as only by reaching as many people as possible will I feel I have started to do what I set out to do. I look forward to your comments and feedback.

Photo credit: ashley rose