Anxiety & Depression


Many of us will have some experience of these feelings and usually we will have learnt how to deal with them. However when we travel additional stress can sometimes make symptoms worse or
bring out underlying feelings or problems we have been struggling with affecting our wellness and mental health. Feelings of anxiety and depression often go together so this information sheet is about both.

What are the symptoms of anxiety and depression ?

As well as having a low mood or feeling stressed  we may lose sleep, loose  appetite and find it harder to relax, concentrate or work. Life may be less enjoyable and we may
lose our sense of humour. Our sex drive may become less, or occasionally more. Sometimes too we may have physical symptoms such as palpitations, sweating, muscle tension and pains, breathing problems, dizziness, faintness, indigestion and diarrhoea. In order to avoid such unpleasant symptoms people tend to avoid situations which may trigger them, meaning their activities can become a bit restricted. This may be a bit harder to do when overseas or working in a team.

How are symptoms graded?

Symptoms of anxiety and depression are classified as mild, moderate or severe depending on the
extent to which they interfere with the normal way we function. Mild symptoms are commonly linked to a stressful life event and resolve with little, if any, treatment; moderate symptoms may
respond to psychological help alone: severe symptoms usually require medication and sometimes
hospital admission as well.

What can trigger these symptoms?

Anyone, whatever their age, gender or background, can be affected by anxiety or depression.
There are some factors which make us more vulnerable to developing these disorders, including
our genes, family background and childhood experiences. So can chronic physical ill health and
the misuse of alcohol or drugs, including marihuana.

A specific event may trigger an episode of anxiety or depression. If we have experienced these
symptoms before, especially recently or severely, they may come back without any obvious cause
or be brought on by something we would usually be able to deal with. In general the longer we
have gone since we had any significant problems the more likely it is we will be able to cope.

How can we deal with depression & anxiety?

Before going there are some things we can do:

+ An approach known as Cognitive Behaviour Therapy [CBT] works well for many people with
mild to moderate conditions and can give skills in dealing with problems which might
otherwise be a bit beyond us. Unfortunately it is not always easy to get access to CBT but
there are several self-help resources that use this approach.

+Counselling can also be helpful in understanding how the condition came about and
addressing some of the factors that may have contributed. Sometimes psychotherapy can
help if there are more major issues that from the past that need to be dealt with, but it is
better not to start this if you are feeling depressed.

+Sometimes medication can be very helpful. For anxiety, tablets called benzodiazepines
e.g. diazepam are good at relieving symptoms but should only be used for a short time.
Antidepressants are the drugs most commonly used for both anxiety and depression and of
these the SSRIs e.g.fluoxetine or paroxetine are the most commonly used. There are many
people working overseas (and home) who have found that these enable them to carry on
with their normal activities. Current guidelines recommend that these drugs should be
continued for a period of 4-6 months after recovery, to reduce the risk of illness
returning, and because additional symptoms can occur when we start reducing the dose.
Staying on antidepressants may be helpful in some cases to keep anxiety under control or
to prevent recurrent depression.

When depression is part of a recurring condition such as Bipolar Disorder[swinging from being very elated to quite depressed) drugs known as mood stabilisers are often helpful e.g. lithium,
carbamazepine and valproate. With some of these drugs regular monitoring by blood tests are
needed- which can often be arranged in main cities abroad. Again they can enable many people to continue working in overseas situations.