Expat Depression
Photo © Simona Dalla Valle

If you’re reading this article, it’s likely that you are a foreigner living in Nuremberg (or its whereabouts) and haven’t mastered the German language yet. You could be living temporarily in this city, or you could have longer-term plans, maybe because of a German partner. Whatever your situation, you’re likely to be an expat.

Every year, Nuremberg attracts people from all over the world relocating to work in one of the big, international companies such as Adidas, Puma (whose headquarters are in the city of Herzogenaurach, some 18 km north-west of Nuremberg) and Siemens, or to study at FAU – Friedrich-Alexander-Universität in Erlangen.

While being on the move, academically and professionally, can be beneficial – among its advantages there’s a broadening of mindset and skills, meeting new people, getting to know a new culture and seeing new places, improving career prospects and more, it is also something that can take a heavy toll.

Dealing with bureaucracy, experiencing the so-called culture shock, having to adjust and sometimes re-learn new things, struggling with the local language, feeling lonely or homesick are only a few of the feelings that can be filed under the definition of “expat depression”. The coronavirus pandemic has only worsened all these aspects, adding a layer of uncertainty for the future and worry for far-away relatives and friends.

A little history of depression

In ancient times, “melancholia” was the term used to refer to what is now generally known as depression. In his humoural theory, the Greek physician Hippocrates (460-370 BC) described it as a physical disease caused by an imbalance of body fluids, with a predominance of black bile over the others (blood, phlegm, yellow bile). In the Middle Ages, mental disorders were viewed as a human weakness. Those affected were considered as being possessed by demons or evil spirits, and exorcisms may have been performed. Between the 19th and 20th century, those who were mentally ill were kept in lunatic asylums, and it was only in the 20th century, thanks to the advancement of science, that mental health started being looked into. German psychologist Emil Kraepelin (1856-1926) was among the first to give mental disorders a name. He identified what he called manic depression (known today as bipolar disorder) as opposed to dementia praecox (schizophrenia). Sigmund Freud (1856-1939) formulated his theory on depression in his work “Mourning and Melancholy” (1917). Still, it wasn’t until the 1920s, with the advent of behaviourism, that studies such as those conducted by  Dr. Pavlov and Dr. Watson started showing the influence of learned behaviours on people’s minds. This led the way to American psychologist Martin Seligman’s (1942) belief that depression is a “learned helplessness”. This hugely influenced the development of the discipline in the Sixties and Seventies through the formulation of cognitive behaviourism theory by psychiatrist Aaron Beck (1921) and rational emotive behaviour therapy by Albert Ellis (1913-2007). In modern days, epigenetics has shown that not only is depression  partially inherited through genes, but it is also affected by social and psychological components.

Expat Depression

Photo © Simona Dalla Valle

An interview with Clinical Psychologist and Psychotherapist Elizabeth Provan-Klotz

Elizabeth Provan-Klotz is American and works as a behavioural-cognitive therapist at Studentenwerk in Erlangen. Having lived in Germany for about thirty years, she has gone through many of the difficulties Expat life can bring. 

“Depression is a syndrome, meaning it’s multifaceted and elaborate, – says Provan-Klotz – many people could have it and show completely different outcomes because it is linked to several factors that can be genetic or ‘learnt’”. A depression diagnosis depends upon three key symptoms: persistent sadness or low mood, loss of interests or pleasure, and fatigue or low energy, as well as other associated symptoms that have to be present for at least two weeks.

Expat depression is a particular form of depression that, as the name goes, affects expats.

Living abroad, struggling with a new culture or language, being far away from friends and family can trigger a depressive episode. “But it’s not just the small things, it’s sometimes dealing with a completely different system. For example, coming to Germany to find that your degree is not recognised, so basically the things you base your self-worth on, are taken away from you. It’s easy to lose confidence and enter a spiral of low confidence and self-blaming”.

“Not everybody is homesick or close to their family in the same way, so not everyone will experience the same triggers” explains Provan-Klotz “but what can happen is also the experience of a reverse culture shock: going to your home country for the holidays to find out that things have changed, or that you have changed, is far from uncommon”.

Expat Depression

Photo © Simona Dalla Valle

What to do if you feel you need help?

“First of all, it’s important that you don’t wait until it becomes chronic but act at the first signs. Get out and talk to people; you’re likely to find someone who understands what you’re going through. Depression affects 30% of the population at some time during their lives, so it’s more common than you think. Physical activity was recommended even in the age of Hippocrates, and for a reason: going for a walk or moving your body is proven to have a positive effect on the mood. Also, make an effort to learn the language: increasing your ability to speak with the locals will make you feel more integrated with your surroundings and will increase your self-esteem”. 

Some advice to expat-wannabes: “Being prepared is something I would recommend to anyone who’s considering moving abroad: make sure you know what your motives and expectations are, and accept that it’s going to be difficult. Challenge your negative thinking: as humans, we’re inclined to remember only the things that go wrong, but it doesn’t have to be this way. Last but not least – don’t hesitate to look for help from a mental health professional. For urgent matters Krisendienst Mittelfranken offers phone and in-person help, but if you cannot find anyone who speaks English, getting in touch with the Samaritans in the UK or MHA in the US can be the easiest and fastest option”.

Contact numbers (costs may be involved) for helplines in various languages can be found here:

International Helplines


Expat Depression

Photo © Simona Dalla Valle

Simona Dalla Valle
Simona is Italian and has been living abroad for over ten years. She has a Master’s degree in foreign languages and a diploma in photography and filmmaking. She loves going to concerts and she’s obsessed with Greece, dogs and true crime. Her favourite directors are Werner Herzog and Michael Haneke. She enjoys talking about anthropology and will quote at least a Morrissey song a day. Multi-talented and incredibly productive, Simona writes in-depth articles, contributes stunning photographs documenting Nuremberg, as well as executing translations from German into English.


  1. If you are searching for a therapist, you can ask your doctor or Krankenkasse for a list of local practitioners, or go directly via https://www.ptk-bayern.de/ptk/web.nsf/formular?openForm&formular=depsychotherapeutensuche

    Unfortunately if you are used to the workings of the NHS this can seem like a lot of phoning around as it can be hard to find someone who has an available appointment, but don’t lose hope. Ask a friend to call around for you, or leave messages or emails with the therapists to call you back.

    You only need to bring your insurance card to a first appointment, and the therapist will arrange the funding for further sessions (and subsequent renewals) with your insurance.
    There is no limit on psychotherapeutic sessions, and you will initially get around 12.

    Do not be afraid to switch therapists if you don’t click with someone. Plenty of practitioners speak English so please do not suffer alone.

    Here is the helpline for the Deutsche Depressionshilfe:

    Young people and children who need help with worries including bullying, low mood or family problems can call this number for free:

    1. This is so helpful! Thanks a lot for sharing all these great resources!

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