Dealing with the emotional struggles
of expat life
Transitioning out of any familiar
environment can be stressful, especially if this new environment is a different
country all together. Families, men and women,
come here from very different places and have often left from different
cultural backgrounds, away from family or other support network, hobbies,
interests, away from their old jobs and their children’s school.
Often I see people in my clinic who having
already lived here for a year, it suddenly hits them and they feel low and
disillusioned. It is not surprising that the sudden change of moving into a new
country affects us, but what is reassuring is that anyone who moves here can
seek help to settle in, and those are the ones that end up not wanting to
leave!
I still have vivid memories of my
first year in Bangkok; it was towards the end of that year that I became
depressed. Previously, I had been practicing GP and medicine which included a
lot of practical work, but when I moved here I found a job in an organization
that told me they have never had a foreigner before. They offered me an office
job, requiring administrative skills to write proposals and reports on health
projects. I remember crying while my husband would help me write proposals; it
was like starting to learn all over again. I would ask him things such as “What
is an objective?”, “What is a goal?” At the same time I was also taking Thai
classes, I was busy with little time to relax or time meet friends (that I had
not yet made). I also joined a women’s group, which back then I felt too young
and unsure for; however in the 22 years that have passed I have grown to enjoy
and appreciate the group more and more.
At least one in every six people becomes depressed in the
course of their lives. And I believe that the added stress that expatriates
face push this statistic even higher.
What are the symptoms of depression?
Depression shows itself in many
different ways. People don't always realize what's going on because their
problems often seem to be physical, not mental. They tell themselves they're
simply under the weather or feeling tired. But if you tick off five or more of
the following symptoms, it's likely that you are experiencing some form of
depression:
- Being restless and agitated
- Waking up early, having
difficulty sleeping, or sleeping more
- Feeling tired and lacking
energy; doing less and less
- Using more tobacco, alcohol or
other drugs than usual
- Not eating properly and losing
or putting on weight
- Crying a lot
- Difficulty remembering things
- Physical aches and pains with
no physical cause
- Feeling low-spirited for much
of the time
- Being unusually irritable or
impatient
- Getting no pleasure out of life
or what you usually enjoy
- Losing interest in your sex
life
- Finding it hard to concentrate
or to make decisions
- Blaming yourself and feeling
unnecessarily guilty about things
- Lacking self-confidence and
self-esteem
- Being preoccupied with negative
thoughts
- Feeling numb, empty and
despairing
- Feeling helpless
- Distancing yourself from
others; not asking for support
- Taking a bleak, pessimistic
view of the future
- Experiencing a sense of
unreality
- Self-harming (by cutting
yourself, for example)
Dealing with depression
While feelings of depression will
pass in 6 months or so for most of us, there are ways that you can actively
address the issue; you should consider the following ways to help yourself:
Medication in the form of SSRIs (Anti
depressants)
These are selective serotonin reuptake
inhibitors, which work by boosting your serotonin levels in the brain.
Serotonin is a neurotransmitter in the brain that is responsible for feelings
of well-being, and SSRIs maintain a higher level of serotonin thus lifting your
mood. It is easy to say, but medicine such as an SSRI isn’t a quick fix to make
you feel better and depersonalize the situation so you don’t think about “Me” (yourself
all day), instead you can start to look at things in positive ways, make
changes, and start to do new things and make friends.
I’ve often found that medication
works best combined with lifestyle changes, for example increased exercise as
well as a more balanced diet. This helps decrease the chance of becoming
over-reliant on the medication, and augments the chances of feeling better.
It is important to treat depression, since excessive
amounts can affect brain function and can have a wider impact on your life. It
often takes between two to four weeks before the drugs take effect. The usual
recommendation is that you stay on them for six months in order to prevent a
recurrence. If you feel that you may be depressed make sure you seek medical
help, it is a highly treatable condition.
I often tell my patients that depression is like an injured
knee, by using the treatment it will get better but at the same time even after
taking some ibuprofen, it will take time to heal.
Another type of medication is St Johns Wort, this is a
traditional herbal medicine which helps relieve anxiety and remedy low spirits.
It too works by interacting with Serotonin and also noradrenalin and so is
similar to SSRIs. It can be bought at many health shops that sell products made
by GMC or Blackmore’s. Because its effects are fairly mild you don’t need a doctor’s
prescription however it is important to research any medication before you take
it, especially if you take other medication regularly. If you take St Johns
worth then don’t take SSRI (anti-depressants) at the same time.
Whenever I encounter patients who are dealing with stress,
anxiety or depression I find that an appropriate and effective form of
treatment is counselling. Whether you’re adjusting to expat life, grieving or
even going through relationship troubles being able to speak to someone is
always helpful. Counselling services used to be fairly sparse in Bangkok, but
as the number of expats grew so did the availability of help. There are now
several counselling organization in Bangkok and some individual counsellors,
some specializing in different areas of counselling.
At my clinic we have enlisted the help of Samantha Pryor
who is an experienced and highly qualified psychotherapist and hypnotherapist.
I’ve found that when dealing with personal problems you can’t emphasize enough
the importance of counselling.
I always say don’t look at a counsellor as an agony aunt
where you will just vent until you feel better, you’ll learn some useful
practical exercises on how to deal with your thinking habits and behaviour. You
can look at counselling as some life coaching; ideally it will not only help
your immediate problems but also help you tackle other issues that crop up in
life.
Apart from immediate life events depression can be caused
by other factors that are completely out of your control. As such it is
important that if your depression lasts for extended periods of time or arises
for no reason, you see a doctor to determine the cause. Health issues such as
underactive thyroid hormone condition can lead to feelings of fatigue and
exhaustion. This issue is common in both women and men and is easily treatable.
Also low levels of vitamin B12, or Vitamin D3 can induce symptoms of depression:
often this can be normal but a blood test will check your levels and a doctor
will be able to advise if you need supplement or not. An untreated medical
problem such as anaemia can also have an impact; symptoms can augment over time
to the point where you can no longer ignore it. However this too is easily
treatable, an amendment in diet or even iron supplements can easily alleviate
such symptoms.
Of course adapting a regular exercise routine can help by
boosting your endorphins. Endorphins are responsible for pleasurable feelings
and these are released whenever we exercise. As a result your mood is
immediately uplifted. Also I am a strong believer of people feeling good when
they look good, and exercise is definitely the most effective method to feel
good!
And finally adopt some new hobbies and interests so you that
don’t dwell on yourself all day. I remember feeling isolated when I first moved
to Bangkok, only to discover several women’s groups and other activities on
offer. Nowadays Bangkok is such an international place with organizations for
nearly everyone. I personally love to exercise as well as get personally
involved with my children’s school, I was glad to meet people with similar
interests through the British Women’s group and school commitments. These
proved to be a welcome distraction and before I knew it I was well adapted and
settled into my new life here.
