Travel and Depression

Everyone has mood changes. However, a very low emotional state (depression) and extremely elevated mood swings (as occurs in bipolar disorder) affect how you think, behave, and function. Depression and sudden mood changes can disrupt travel or cause a relapse in persons with mood disorders. Managing travel stress, recognizing the warning signs of depression and mood changes, and knowing where to get help are key to a safe trip.

Even if you have no prior history of depression, the stress of travel, change in routine, or a triggering event may cause a change in your mental state.

What is depression?

Depression is a type of mood disorder characterized by a sad, despairing mood that typically lasts full days for more than two weeks. It affects your relationships, emotions, daily functioning, and physical health. Depression is a serious medical condition that requires treatment and support. Depression with psychosis (hallucinations/delusions) or thoughts of suicide need to be addressed immediately.

Signs of depression include:

Feelings of hopelessness and worthlessness
Guilt, sadness, crying
Irritability, lack of concentration
Insomnia, fatigue, lethargy, oversleeping
Changes in appetite
Withdrawal from friends and family
Loss of interest in previously enjoyed activities

What is a mood disorder?

Mood disorders are a group of conditions that affect a person’s mood, typically causing highs (mania) and lows (depression). During a manic episode, a person may feel uncharacteristically active, happy or excitable. In extreme circumstances a person may suddenly experience rage, psychosis (incoherence, delusions, hallucinations), or catatonia (physical agitation, odd movements).

Signs of mania include:

Euphoric moods, feeling invincible
Exaggerated self-esteem
High energy, high libido
Racing thoughts
Irritability
Decreased need for sleep or eating

How can I manage my depression or mood disorder while travelling?

Travellers who are actively managing and controlling depression or another mood disorder can travel safely. Consult your mental health professional to determine if travel is an appropriate activity for you. Talk to family and friends about your plans and if needed, stay in touch with your mental healthcare practitioner or find a qualified doctor at your destination in case of an emergency.

Travelling with depression

If you are prone to depression, try to anticipate your reaction to being away from home, isolated from familiar support systems, and immersed in a different culture. Life-changing events that occur just prior to a trip such as a death in the family, a birth, illness, or difficult personal/professional circumstances may also influence your psychological well-being and social interactions during travel. Although a trip may bring temporary relief to some depressive symptoms, it is not a cure.

Travelling with a mood disorder

If you have a mood disorder, such as bipolar disorder, heightened sensory stimulation like noise, crowds, smells, sights, and some social interactions can be overwhelming. Unfamiliar environments, language barriers, not understanding cultural and social mores can increase stress which may trigger an episode or relapse.

Plan ahead: Travel with a trusted person, choose a low-stress destination, consider time zone changes, take direct flights or routes, and allow for plenty of time to arrive and leave during transit. Recognize stress factors and warning signs that can lead to an episode and seek medical attention as soon as possible.

Know before you go

Travellers who experience a depressive or manic episode before or during travel may be at risk of making poor judgements and engaging in behaviour that puts themselves or others at risk. A triggering event may lead to isolation, substance use, or negative social interactions, and may force you to abandon original plans and activities. Treatment during travel usually involves hospitalization to stabilize symptoms and possible evacuation. When travelling with a mental health condition, it's important to know and prepare for factors that can influence your ability to access healthcare abroad.

Cultural perceptions of mental health

Social and cultural acceptance of mental health in your destination country determines the type of psychiatric care you will receive. Forced admission (where voluntary consent is not the norm), substandard psychiatric facilities (unhygienic living conditions), questionable treatment (isolated confinement, lack of appropriate medicines), and difficulty finding mental healthcare professionals that speak your language should be taken into account when planning your trip.

In some countries, disturbing the peace, uttering threats, or exhibiting strange behaviour can lead to arrest, criminal charges, imprisonment, or forced admission to a hospital or mental health facility.

Travel health insurance coverage

Standard travel health insurance plans do not cover mental health conditions. As a result, you may be responsible for the full cost of medical expenses if you require psychiatric care abroad. Look for travel health insurance plans that cover psychiatric care – an independent broker can help.

Get coverage from a company that specializes in emergency evacuation and repatriation. This service generally covers patients who have managed their illness and are being hospitalized abroad. Check the fine print for restrictions and exclusions. Last-minute evacuation insurance is extremely expensive (starting in the tens of thousands of dollars) and may be refused on the basis of the patient’s mental health condition.

Travelling with medication

If you are travelling with any medication, be aware that your destination may place restrictions on the amount or type of medication you can import. Substances that are legal or available over-the-counter in one country may be illegal or require a prescription for importation in others. The importation of medication that contains controlled substances – drugs that are classified as having a high potential for abuse or addition such as narcotic and psychotropic medication – is highly regulated around the world.

Country-specific regulations regarding the import of controlled substances can vary widely. In most cases, travellers are permitted to bring a 30-day maximum supply of medication containing controlled substances, but some countries place stricter regulations or require specific documentation.

You can learn more about travelling with medication here:

Helping a family member or friend

If you are accompanying a traveller with a mental illness, it's important that you don't forget about your own health. Know how to recognize signs of psychological stress and avoid being isolated. You may want to hire a professional companion traveller to help during all or parts of the trip.

If you suspect someone is at risk of self-harm or suicide, remove self-harming objects such as knives, toxic chemicals, alcohol, and other psychoactive substances from reach and seek help from a mental health professional that speaks your language. Contact the person's embassy or consulate for emergency assistance. Note that suicide attempt survivors may require legal assistance in countries where suicide is illegal.

Travel and mental health checklist

Before you leave

Consult your healthcare practitioner to discuss if the type of travel you are planning is right for you. Get advice on how to stay healthy and cope with the effects of travel stress and jet lag. Ask if you can stay in touch with your health professional during your trip.
Find a reputable mental health professional at your destination who speaks your language. You may want to contact them prior to your trip to ensure continuity of care.
Familiarize yourself with the psychiatric healthcare system of your destination country. Know what steps you need to take in case of an emergency.
Book the most direct route possible to your destination; avoid layovers and long hours in transit.
Travel with a trusted friend, family member, or professional travel companion. If you are travelling alone, set up regular check-in times to reach a family member or friend.
Register with your embassy or consulate in case you need their assistance during an emergency abroad.
Make sure to pack enough medication for the duration of your trip. Check whether your medication is regulated or restricted at your destination.

During your trip

Give yourself plenty of time to arrive and go through security checks. Note that airports, train stations, bus depots generally have medical facilities that can support you as needed.
Establish a routine that sets the tone for your trip. Familiarize yourself with your surroundings and if you can, integrate some activities that you are used to doing back home or bring you a sense of comfort.
Bring a calming item (a book, listening to music on your iPod), memento, or journal that provides comfort during stressful situations.
Know your mental and physical limits. Regularly re-assess your original plans and change them to minimize stress levels.
Know when to stop a challenging situation from escalating. Find non-confrontational solutions.
Practice relaxing breathing exercises and integrate physical activity like walking and stretching to relieve stress. Get the appropriate amount of sleep, eat a healthy diet, and stay hydrated.

When you return

Book an extra day or two off after you return to mentally and physically recover from your trip. This will help you adjust from jet lag and help you get back into your daily routine.
Follow up with your healthcare practitioner if you needed emergency care abroad or to address any concerns you may have related to post-travel readjustment.