Settling blues

                       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.