Photo: Zara
For travelers with clinical depression, traveling can make it especially difficult to manage treatment. Here are some considerations.
“She won’t get out of bed,” Fatima said to me worriedly, in French. I was a month into a trip through Morocco, and Fatima had picked me up in a train station and brought me home along with a few other backpackers. Carmen, the girl in bed, had been there for a month.
Carmen was fine when she arrived from the bus stop like the rest of us, but after a week at Fatima’s, she stopped going out as much. Then she stopped going out at all. She stayed inside the house, then inside her room, and finally, in her bed.
Nobody had spoken to her, although several people tried. First she was there, and then she wasn’t, like she’d been kidnapped out from behind her own eyes without anyone noticing.
What is Clinical Depression?
Photo: Bandita
Nobody knows quite where clinical depression comes from; like the proverbial thief in the night, it sneaks in and takes your sense of humor, your motivation, and sometimes, your ability to get up in the morning. The prevailing theory is that it’s genetic in nature, meaning that if an immediate family member has it, you might too.
Having depressive symptoms doesn’t mean that you’re about to leap from the Golden Gate Bridge; it might mean that you’re suffering from a milder form of depression. Also, most depressive disorders can come and go; while someone may never be completely healthy, they will usually have good periods and bad periods. These variations are more similar to a cancer and remission than everyday “ups and downs.”
It’s important to stress that depression is not just “being sad.” You can’t “pull yourself up by your bootstraps” and just get over it; it’s a serious illness. It requires treatment, which should be supervised by a doctor. Being depressed can be debilitating, but most people with milder depression can work, parent, and also travel.
Depression and Travel
Photo: MeAndTheSysop
If you’re already aware that you have a mood disorder, and still want to travel, there are several things to consider. First, if you’re taking a medication, make sure you have enough of your prescription to last the length of your trip.
Tell your doctor how long you’ll be away, and she may give you a larger-than-usual refill. She may prefer to give you several refill scrips that you can have filled at pharmacies wherever you are. Remember to have her list both the name-brand and generic versions of the drug. In some countries, medications that are only available by prescription in the United States can be purchased over the counter.
It’s very important to note that not all countries have pharmacies outside large cities; if you’re visiting Thailand, the quality of medical care decreases dramatically outside of Bangkok. If you’re going somewhere out-of-the-way or your doctor won’t give you refill scrips, consider making your trip shorter.
It’s better to come back a little early than run out of medication abroad. However, if you lose or run out of your medication while traveling, you may be able to get refills from a drop-in clinic. Provide a copy of your original prescription (you did photocopy your prescription to carry with you, right?).
If they won’t dispense it or don’t understand, go to an emergency room. This may seem over-the-top, but unless you’re heading home in the next day or two, it’s pretty darn important to keep your medication dosage correct: abruptly stopping any kind of drug can lead to serious withdrawal symptoms, and you don’t want to be stuck getting sick again when you can avoid it.
If you’ll be somewhere unusually warm, ask about storing your medication in a refrigerator, or at least, keep it out of direct sunlight. Check the drug insert or ask your pharmacist about how temperature affects your medications.
If you’re not on medication for your disorder, then make sure you feel comfortable with whatever treatment plan you’ve drawn up. If you plan to write in a journal every day, or have Skype conferences with your psychologist, do it. You might consider setting up regular check-ins with someone who knows you well, so you have an external perspective on how you’re doing. You might not be aware of symptoms creeping back in until the evil spirits are in full force.
Recognizing Depression on the Road
Photo: r.f.m.II
So what if you’re already traveling and you start to show symptoms of depression? The onset of depression can occur at any time, although women have a significantly higher risk than men.
Some symptoms to watch for are:
- feeling sluggish or unmotivated
- losing interest in things you previously enjoyed
- feeling hopeless
- crying
- trouble sleeping
- irritability and restlessness
Having any of these things isn’t a sign you should go rushing to a doctor, but having lots of them, or if they last for longer than a week or two, might need some more investigation.
Dealing with Depression on the Road
The first thing to check is whether you are physically sick. Some illnesses have the same symptoms as depression. Second, consider what you’re putting into your body, including recreational drugs. Larium, a commonly prescribed anti-malarial treatment, lists “hopelessness and permanent depression” in its side effects.
Remember that you may be in danger if you go OFF a drug as well; being unprotected for malaria in a mosquito-infested region is hardly optimal. The best-case scenario is not taking drugs that can cause these symptoms in the first place. Do some research and make an informed decision.
If you think your depression is unrelated to other medications or illness, try to see a counselor or other health professional. Ask in the ex-pat community if anyone has doctor recommendations. If you’re in a place where English isn’t commonly spoken, seek out organizations like Amnesty International or the Planned Parenthood Federation; they often have English-speakers as volunteers, and may offer counseling services.
It’s hard to make decisions about whether or not to go on medication when you are away from home; doctors usually want to monitor your progress and check the dosage level. Some doctors may refuse to issue psychiatric medications, or be unable to do so.
You may run into doctors who won’t acknowledge your illness as valid, or may label depression as “weakness.” If this is the case, go to another doctor.
Some people find alternative treatments like meditation or physical exercise can help. Herbal supplements like St. John’s Wort are unregulated and untrustworthy; they can also interfere with other medications, including birth control pills and psychotropics.
If you continue to have symptoms, please see a doctor, either abroad or when you return home. Remember that mental illness is an illness, which means it needs treatment like any physical illness.
Overall, mild depression, or a more serious depression receiving proper treatment, shouldn’t stop you from traveling, but it’s important to be aware of yourself and your situation. Take care of yourself first and foremost.
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6 Comments... join the discussion!
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Claire, there are real issues around refilling prescriptions outside of the issuing doctor’s country. For example, a US pharmacy isn’t legally allowed to fill a scrip from a foreign-based doctor. Likewise, a UK or Swedish pharmacy can’t fill a US prescription. There are emergency exceptions, but those are limited to maybe a week’s supply.
Also, many drugs may not even be available in the country you’re traveling to, or not available in the right dosage.
All in all, the best choice is *always* to bring enough meds to last the trip and some margin. Also have a family member or friend at home with a stash for you which can be FedEx-ed to you in an emergency.
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Hey Claire, thanks for this fantastic post that I’m sure will help a lot of people.
Just wanted to add a couple of things. In more than a few cases, hypothyroidism (low thyroid function) can be an underlying cause of depression, especially for women. I have seen quite a few clients for which this is the case, and nothing helped them, even anti-depressants, until they went on thyroid medication. Stress, not eating one’s normal diet, and lack of sleep, all part of travel, also effect the thyroid. AND, thyroid tests don’t always show the whole story, because they test the production of thyroid hormone, but not necessarily if the body is properly converting it. An easy at-home-or-on-the-road test is taking one’s basal temperature–in the armpit–for three days (for women, first three days of their period) and averaging out the temps–if this number comes out to 96.3 or below, pretty much can bet on hypothyroidism.
Also, there HAVE been studies done on the positive affect of St. John’s Wort, but it IS important to not take an herbal antidepressant while on a pharmaceutical antidepressant. I think there are better natural remedies for depression than SJW, though, including using amino acids, SAM-e, and my fav, Me-cofactors (a precursor to SAM-e and a more stable version). Julia Ross does excellent work with amino acid therapy at her clinic–http://www.dietcure.com/consulta.html.
Thanks again…
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I’ve run into two people out here who’ve had trouble getting meds…and then went off of them. Not pretty. I really feel for anyone who has to pop a pill every day, especially our traveling types. It can be very convoluted to get meds that are issued in other countries, especially in countries that haven’t even heard of what you need.
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I have very bad depression, pretty much the whole list (i don’t drink and if i did i would be dead and being negative is something i know better about so i fight and be positive as much as possible if not once again i would be dead) and the depression as ruined my life, i have lost relationships over it, i can’t work because of it and i did see help for it right away, in fact i was seeing a few doctors about it, they tried to medicate me, didn’t work or hardly worked, i was around 18-19 at this point.
Now when i say i had depression, it was bad, killing myself would come up time and time again, i felt horrid but im a very strong person, only reason im alive right now.
But i looked into it, i know all about how the medical community works and how they sell there “pills” and out of all the doctors and professions, you know what? i cure myself! yup! i did it!
i used vitamins, noni juice and i worked out/trained, i ate what i was suppose too eat and didn’t eat what i wasn’t suppose to eat, and before my diet wasn’t really bad either, and 1000’s of other other people have done this too!
If anyone tell you that you HAVE to take drugs for the rest of your life because of depression then you better have some kinda special case because its caused from what you don’t have in your body and thats vitamins and daily activity like training(or if you work a hard job that can help too) but the noni juice worked like a charm! incredible stuff, for the first week i felt not so great but thats because my body was detoxing then after that i felt good! one oz a day for every bottle your drinking, i got like 2, but even one is good, and the combination made life worth living, these aren’t mind altering drugs, even doctors and scientists yes with real degrees not bought off say this stuff is incredible, its even good if you burn yourself, 5 mins later the pains gone!
i don’t sell the stuff, i just tell people about how good it works and as for the vitamins? shaklee, the best quality you can get which is what i call the same as food vitamins, go ahead and goggle it, find out for yourself what the company is about, oh and its been around since the 40’s, and there the only vitamins i know of that actually work!
Your depressed because of the poisons in your body and your body doesn’t have the nutrition to deal with it, best too stay away from whats bad and bring in whats good!
Tried, tested and true!
The only way you can truly be happy is if you don’t abuse your body and take care of it, and it takes care of you and your mind and emotions, worked for me and its worth a try!
here is where you can buy some noni juice or google it for a location closer too you, this kind is the best (there are always other brands that are shoddy) http://www.nonijuicecentral.com/prodjuice.htm
im not selling any of this, this is not spam this is education, heck people talk about going too the doctor and having drugs sold too them in that case anyone who talks about drugs are pushing that, so what im doing is no different except im not making profit, im giving you all the chance i got and took and there isn’t a better way to live!
http://www.shaklee.com
Ps: if your low on money, at least get the noni juice, if i had the money i would buy it all for you.
remember your not sad because of a lack of drugs, its a lack of life for your body, mind and there for emotions!↵ -
Dear Sir
My name is Rewat Chhetri; From Bhutan i am Aslyum Seeker in Belgium
my mother expired when i was 17 years and my brother lost and my father also expired i moved many place india or nepal for looking job; i escaped from bhutan with my father i got more trouble that periodSir I have following Problems
1. Lack of Energy tired; thinking too much2. Dry mouth and my heart beat moving fast and i feel i am going to heart attack; lonelies feel alone feel
3. I am harrasment and when I wake up morning i have vomiting I cant eat any things some times in morning gidding and sweat; that time i am going to fall down and i sit even very cold here but i have too much sweat
4. I am not wake up in the morning and late night too much matter playing with me in night and when sleep my body suddenly wake up some times hand some times one leg and i wake up hi god please help me i say and many time i am counting 100 to 1 but i am not sleep deeply half sleep but interest always let down in the bed
i am not interest to talk people and i weap in the room (falling my tears);
Sir doctor given me following tablets i use it daily
1 . Efexor – Exel 75 mg venlafaxin 75 mg
2 . Mirtazapine 30 mg
3. Propraholol HCI 80 mgplease give me some suggestion
sincerely
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