Low Mood Abroad

Low mood after moving abroad is common and often eases as life settles. Depression is different: it's a clinical condition that lasts weeks or months, and a GP or doctor should assess it. People often call this "expat depression". This page explains the difference, when to get medical help, and where person-centred counselling can fit alongside it.

What does low mood abroad feel like?

It often doesn't arrive straight away. The first months are busy with paperwork and flat hunting. Then the busyness stops.

Imagine it's December in Amsterdam. It's dark before five, your friends at home are asleep when you finish work, and the colleagues who were friendly at lunch go home to their own lives. You can't quite say what's wrong. You just feel heavy.

You might notice:

• Losing interest in things you used to enjoy, including the city you moved for.
• Sleeping much more, or much less.
• Finding it hard to get going in the morning.
• Snapping at your partner, then feeling bad about it.
• Avoiding calls home because you don't want to worry anyone.
• A sense that everyone else is coping better than you.

Some of this overlaps with homesickness and culture shock, which are ordinary reactions to a move. The difference is often in how long it lasts and how much of your life it touches.

Is it low mood or depression?

The NHS says that "a low mood often gets better after a few days or weeks", and that a low mood lasting two weeks or more "could be a sign of depression" (NHS, low mood). It describes depression as "more than simply feeling unhappy or fed up for a few days" (NHS, depression in adults).

Other signs of depression include losing enjoyment in life, feeling hopeless, struggling to concentrate, and having thoughts of suicide or self-harm.

Depression needs a doctor's assessment. I'm a counsellor, not a doctor, and I can't diagnose it. If you've felt low for more than two weeks, or you're struggling to cope, please see a GP or a doctor where you live. If you haven't registered with a doctor since moving, that's a worthwhile first step.

If it would help you put your symptoms into words before an appointment, the PHQ-9 self-check is a widely used nine-question depression questionnaire (Kroenke, Spitzer and Williams, 2001). It isn't a diagnosis, and it's most useful as something to show your doctor.

Why does living abroad affect your mood?

The psychiatrist Dinesh Bhugra, reviewing research on migration and mental health, concluded that migration "is and can be a very stress-inducing phenomenon", while also noting that not all migrants go through the same process and that coping and resilience matter (Bhugra, 2004).

Some of the stresses are easy to see: a new language, a new job, the loss of friends and family nearby. Others are quieter. The constant small effort of living in a culture that isn't yours, sometimes called acculturative stress, can wear you down without you noticing. Expat loneliness often plays a part too.

For women from close-knit families, there can be an extra layer. You may feel you can't admit you're struggling, because the move was meant to be an opportunity, or because mental health isn't easily talked about at home. Keeping it hidden is understandable. It also makes it heavier.

Exhaustion can look like low mood as well. If work is the main drain, the page on burnout may be relevant.

Does NICE recommend counselling for depression?

In the UK, NICE (the National Institute for Health and Care Excellence) sets out treatment options for depression in adults. Its guidance lists counselling among the options for both less severe and more severe depression. It describes this as an intervention "delivered by a practitioner with therapy-specific training and competence", using a protocol developed specifically for depression, and notes it "may be useful for people with psychosocial, relationship or employment problems contributing to their depression" (NICE, 2022).

That's NHS treatment, offered after assessment. It isn't the same as private counselling with a trainee. I mention it because it shows that talking-based, emotion-focused support has a recognised place. It doesn't replace your doctor.

Can depression counselling online help with expat depression?

Person-centred counselling, including person-centred counselling online, can be one part of looking after yourself, alongside medical care where it's needed. It offers a regular hour where you don't have to seem fine.

In practice, that might include:

• Talking about the move honestly. What you hoped for, what it's actually been like.
• Noticing what you've lost. People, language, status, a sense of being known.
• Making room for feelings you've been hiding. From family, from your partner, from yourself.
• Finding your own sense of what might help. At your pace.

Online sessions mean you can talk in English from wherever you live, without needing to explain yourself in a second language. If you're still deciding what kind of help to look for, the guide on how to find a therapist abroad may help.

What can help with low mood abroad?

Small, ordinary things don't cure depression, but they can make low mood a little lighter while you get support:

• Register with a doctor if you haven't yet, so help is easier to reach.
• Protect your sleep. Dark winters and shifted time zones can unsettle it. The free sleep resources include checked NHS and public health guides, some in German, Dutch and French.
• Plan one contact a week that isn't on a screen: a class, a volunteer shift, a regular coffee with a colleague.
• Tell one person at home the truth about how it's going.

There's also a list of free self-help for low mood and depression, and resources for expats and migrants, including a WHO stress guide available in 49 languages.

When to look for other or urgent help

If you're having thoughts of ending your life, or you're worried you might act on thoughts of harming yourself, please get help now:

• UK: call 999 or go to A&E. For urgent help that isn't an emergency, call NHS 111 and choose the mental health option. Samaritans are free on 116 123, 24 hours a day.
• EU: call 112.
• Elsewhere: the helplines directory lists verified crisis numbers by country.

Related reading

• Online therapy for expats, on time zones, moves and how sessions work.

I'm a trainee person-centred counsellor and BACP student member, working under supervision. If you'd like to talk, you can book a session.