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?

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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

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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

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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.