Depression and Anxiety in Expats: Why It Happens and What to Do in Japan
Depression and anxiety are treatable problems among foreign residents in Japan, and English-speaking care exists here. Moving abroad raises the strain on you and removes most of your usual supports at the same time. If your mood or anxiety has been getting worse since you moved, that is a recognized pattern with standard treatment, not a personal failing.
Why does living abroad cause depression and anxiety?
Because relocation raises the strain on you while removing most of what was supporting your mental health, all at once:
- Your support network stayed behind. Friends who notice when something is wrong, family within reach, a doctor who knows your history, familiar routines. Rebuilding these takes time.
- Everyday tasks became difficult. At home you were competent; here, renting an apartment or reading a letter from city hall can take far longer than at home. That constant low-level frustration wears people down.
- Operating in a second language is tiring. It costs mental energy and leaves less room for the easy, precise conversation that close relationships depend on.
- A new workplace has its own rules. Hours, hierarchy, and ways of communicating can differ from what you are used to, even in international companies.
- Struggling abroad can feel harder to justify. Problems that you would take seriously at home can be easier to dismiss abroad, both for you and for the people around you.
None of this means Japan is bad for you. It means your risk went up while your support went down.
What is the typical timeline?
There is no fixed timeline, but one pattern people describe is an early period that goes well, followed by a dip once the novelty stops offsetting the costs. The dip can come with a specific event: a first winter, a contract renewal, a breakup, a visit home that felt unexpectedly strange. Many people recover as their life here fills in. Some get worse instead, and that group needs an assessment, not more time.
When is it more than an adjustment?
Four working rules, rough ones rather than a diagnosis:
- Duration: low mood or anxiety that has lasted for weeks, most of the day on most days
- Body signals: sleep breaking down, appetite or weight shifting, energy gone, concentration failing at tasks you used to do without effort
- Function: work, relationships, or basic self-care visibly slipping
- Feeling trapped or hopeless: thinking about leaving is common; feeling trapped, hopeless, or having thoughts of not wanting to live is a different category and a reason to be seen soon
If several of these describe your last month, read our depression guide or see what a first visit involves. A single assessment gives you a clearer answer than months of self-monitoring.
What forms does this take?
The same pressures show up differently in different people, which is why this guide has branches:
- Depression
- Seasonal and transition slumps, including May disease
- Panic disorder: repeated panic attacks and the fear of the next one
- Generalized anxiety: worry that is hard to stop
- Social anxiety, and how living in a second language affects it
- Adjustment disorder: symptoms that follow an identifiable stress, such as a move, without meeting the criteria for depression
- Burnout, the work-centered version
They overlap, and an assessment sorts them out.
Why don't expats get help?
Often for practical reasons:
- Not knowing how the Japanese system works
- Assuming care will not exist in English
- Assuming it is unaffordable
- Believing you should be able to handle it yourself
The answers are also practical. You don't need a referral (how to book directly). Health insurance covers psychiatric care, and most residents are already enrolled. English-speaking psychiatry exists, mainly in the big cities, and online care reaches the rest of Japan. The system guide walks through all of it.
What does treatment look like?
The approach to treatment is the same as at home; the visit style is different. It usually involves:
- An assessment conversation
- Sometimes medication; the same classes of antidepressant are used in Japan, although which products and doses are approved can differ from your home country (the medication you took at home)
- Sometimes counseling alongside, in English, in person or online
- Practical work on sleep, daylight, movement, and social contact, which supports the other treatments
- Scheduled follow-up, so a professional tracks your progress instead of you judging it alone
One expectation to adjust: routine psychiatric follow-ups in Japan are short, often five to ten minutes, and longer conversations happen in separate counseling sessions rather than inside the doctor's visit (why).
Improvement is gradual, at a pace that varies from person to person. The expat-specific part is only the getting started; the treatment itself is standard.
Frequently asked questions
This article is general information, not medical advice for your individual situation. If you're unwell, please see a doctor.
Medically reviewed by our psychiatrist (M.D.). Updated October 16, 2026.