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. Feelings of anxiety and
depression often go together so this information sheet is about both.
What are the symptoms?
As well as having a low mood or feeling tensed up we may lose sleep, have a change in our
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. Information can be found
from the Oxford Cognitive Therapy Centre www.octc.co.uk

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.
Travelling internationally
A history of anxiety or depression doesn’t stop you from being able to undertake travel or work
abroad but you will need to think carefully whether or not it is wise to go on certain projects or
for long periods of time. Jobs can be demanding and require long working hours, and many team
projects, though exciting can be stressful and may trigger a recurrence of symptoms or make
existing symptoms worse. Often it is harder to get help if a problem does recur.
If you have been recently severely depressed or anxious and suffered from a psychosis, or felt
suicidal, it is worth having a period of at least two years before going on an overseas assignment.
Discuss this with your doctor or specialist.
If you are on medication don’t stop this just before going abroad. This is for two reasons: firstly
because of symptoms which often occur when reducing the dose, and secondly because of the risk
of relapse. You and your medical advisor will need to make a decision about this well before the
proposed trip, so as to decide whether you should gradually come off the drugs before you go, or
to decide how to obtain supplies if you continue to take them. In some countries antidepressants
can be bought over the counter. If they can’t, it is usually possible to get them sent out from
home.
It’s important that you “know yourself” ie come to recognize the warning signs and take
appropriate action, - whatever works best for you and eases tension. If you are going on an
assignment or a GAP year programme it is a good idea for your team leader or programme director
to know about the problem: that takes the pressure off everyone including you and means you can
get quicker support if problems do arise.
Finally, make sure you do not use the antimalarial mefloquine (Lariam) which can make symptoms
worse.
Further Guidance and Information
Resources for dealing with Anxiety and Depression
Anxiety and depression are often experienced together so this resource sheet gives information
about help for both. Some conditions, e.g. phobias may exist on their own and resources for these
are also listed. This list is not exhaustive and not a substitute for seeking medical advice but can
give useful pointers for self help and for additional support.
Useful Websites

Depression Alliance is a UK charity for people affected by depression.

The Royal College of Psychiatrists has information for sufferers and carers on a wide range
of mental health problems.

National Institute for Clinical Excellence provides guidance on the management of many
conditions including anxiety and depression in primary and secondary care.

The Newcastle, North Tyneside and Northumberland Mental Health Trust has a range of
information and self help leaflets that are available to download and use.

The Mental Health Foundation is a charity which promotes research and education on
mental health matters and has information leaflets and briefings available.

MIND is a mental health charity and they have booklets to read and purchase on many
mental health and related issues.

MDF - The Bipolar organisation is a user led charity for those with bipolar disorder
[formerly called Manic Depression]

The British Association for Counselling and Psychotherapy can help with finding a
counsellor or therapist and the website also has links to other sources of help.

The British Association for Behavioural and Cognitive Psychotherapies promotes the
development of these therapies. It can provide details of accredited therapists.

Oxford Cognitive Therapy Centre publishes educational and self help booklets which can
be purchased via the website.

The Wellness Shop This is run by Ultrasis and is a commercial site offering CBT. Its
programme Beating the Blues has been recommended by NICE.

Living Life to the full - This gives CBT-based life skills training, including dealing with
anxiety and depression, and is sponsored by the health department of the Scottish
Executive.

The National Phobics Society is a UK charity for those with anxiety disorders offering
advice, support and help

No Panic provides advice and befriending and runs a helpline 0808 808 0545

Mood Gym offers a free self help programme to teach CBT to people vulnerable to anxiety
and depression
For young people: Young Minds
Books
Note: Concentration is affected in severe depression so reading is not always easy. Some of the
material is best used as a way of preventing illness or relapse.

Overcoming Anxiety: A Five Areas Approach. This is a workbook focusing on practical
approaches. By Chris Williams [Hodder Arnold Publications]

Overcoming Depression also by Chris Williams

Overcoming anxiety: A self help guide using Cognitive behavioural techniques by H.
Kennerley [Robinson London]

Mind Over Mood by Christine Padesky and Dennis Greenberger – a CBT self help workbook
by well respected therapists. [Guilford Press]

Living with fear: Understanding and Coping with anxiety by Isaac M Marks [Mc Graw- Hill].
Isaac Marks is a world expert in behavioural treatment of anxiety.

I’m not supposed to feel like this – a Christian self-help approach to depression and
anxiety by Chris Williams, Paul Richards & Ingrid Whitton [Hodder&Stoughton]

A Practical Workbook for the Depressed Christian by Dr John Lockley [Authentic
Publishing]. The author is a GP who has personal experience of depression.

Overcoming mood swings: A self help guide using cognitive behavioural techniques by J.
Scott [ Robinson London]
Sheldon Press publish several books on anxiety and depression:

Coping with Depression and Elation by Patrick McKeon.

Depressive Illness: the curse of the strong by Dr Tim Cantopher

Letting go of anxiety and depression by Dr Windy Dryen
More information can be found in: The Traveller’s Good Health Guide’, Ted Lankester; 3rd Edition
2006
Copyright © InterHealth
While InterHealth endeavours to ensure that the information published in this guidance note is correct, InterHealth does
not warrant the accuracy and completeness of the material in this guidance note. The information in this guidance note is
for information only and should not be used for self diagnosis or self treatment. Readers are always encouraged to seek
medical help from a doctor or other competent professional health adviser.