Mental health and sleep
Mental health
For low mood, anxiety and stress
with a medical interpreter
24 hours a day, 365 days a year
OK to consult together
payment information
About
About Mental health
We help with mental health concerns such as low mood, anxiety and severe stress. You can also talk to us comfortably in Japanese about the stress and isolation of working overseas.
Why it happens
Low mood and anxiety aren't just a matter of personality or attitude. They are thought to be states in which ongoing severe stress or changes in environment alter brain function, the autonomic nervous system and hormone balance. When working overseas, stresses such as differences in language, culture and ways of working, rebuilding your daily life and having few people to talk to tend to pile up in a short time, and problems can appear during the process of adjusting. Rest and proper care often lead to recovery, but pushing through can make it last longer.
What's happening in the body
Mental health problems aren't simply a matter of attitude. When severe stress continues, the nerves in the brain that regulate emotions, motivation, sleep and appetite are thought to change how they work. So besides low mood, it often shows up as physical symptoms, such as not being able to sleep, loss of appetite, tiredness that won't go away, or ongoing headaches and stomach trouble. If you've been told nothing is physically wrong but you still feel unwell, this may be why. When working overseas, strains such as changes in environment, the language barrier and having few people to rely on tend to pile up, and thoughts like "I've come all this way" or "I don't want to worry my family" make it easy to keep things to yourself. Consulting early widens the range of options.
Main symptoms
- Low mood, unable to enjoy anything
- Loss of motivation or concentration, lower productivity at work
- Strong anxiety, restlessness
- Palpitations, breathlessness or dizziness (can appear as physical symptoms)
- Trouble sleeping, waking early, or sleeping too much
- Loss of appetite or overeating
- Physical symptoms that tests rarely explain, such as headaches, stomach pain or diarrhea
- Getting irritated easily or becoming tearful
- Strong feelings of blaming yourself
When you can wait and see
What you can do yourself
- Keep bedtimes and wake-up times as regular as possible
- Get morning light and move your body, even briefly
- Make rest the priority instead of trying hard to get better
- Talk to someone you trust, and have somewhere you can talk in Japanese
- Don't rely on alcohol (it lowers sleep quality)
Please consult us
If any of the following apply
- Low mood or lack of motivation that doesn't go away
- Strong anxiety or a racing heart
- Work or daily life feels hard
Seek care right away
If any of the following apply
- Thoughts of wanting to die, or urges to harm yourself
- Unable to eat or drink, or to take care of yourself
- Losing touch with reality, or saying and doing things others find hard to understand
- Unable to stop using alcohol or drugs on your own
- Severe anxiety attacks that make daily life impossible
Don't wait for a Cotovia consultation; call the emergency number in your country.
See the emergency guide for each countryIf you're not sure, ask us on LINE
Differential
Telling it apart from similar conditions
Symptoms that look the same may need different care depending on the cause. Use this as a guide to find what's closest to your situation.
A temporary reaction to a change in environment
There's a clear trigger such as a posting or move, and it eases over time
Start by getting your daily rhythm back. If it continues to be hard, please consult us
Adjustment problems
There's a trigger, and it continues to the point of affecting daily life or work
The focus is on adjusting your environment and supportive care
Persistent low mood
Being unable to feel interest or pleasure for most of the day for 2 weeks or more
Consulting early is recommended. We assess the treatment options
Severe anxiety or panic
A sudden racing heart, shortness of breath and intense fear, and worry that it will happen again
We assess it, including ruling out physical illness
Physical illnesses such as thyroid disease
With weight changes, a racing heart, sweating and tiring easily
This can be assessed with a blood test. Even symptoms that seem mental can have a physical cause
Mainly a sleep problem
Poor sleep comes first, and daytime problems follow as a result
We look at your sleep in detail before deciding on care
* This is not a complete list. If you're not sure, please consult us.
When it might be something else
Course
Typical course
This is the general course. Actual progress varies from person to person.
- Arrival to 3 months
Adapting to a new environment keeps you tense, so you tire easily at this stage
Prioritize your daily rhythm and sleep. It's also important not to push yourself too hard to adjust
- 3–6 months
The initial excitement fades, and confusion about the differences tends to set in
Avoiding isolation and having someone to talk to helps
- After 6 months
Most people gradually adjust
If things feel harder even after this point, please consider consulting us
- If it lasts 2 weeks or more
When low mood or loss of interest lasts 2 weeks or more
Whatever the stage, a professional assessment is recommended
Local Insight
For people living in Southeast Asia
The climate, healthcare and access to medication differ from Japan. Here are points specific to this region.
A survey of Tokyo companies that send staff overseas reported that about half had experienced cases of mental health problems among expatriate employees. The strain of working overseas can affect anyone; it's nothing unusual.
Family members who come along (especially spouses) can easily become isolated because they can't work, can't drive or have a limited community, and they may show problems before the employee does. Family members are welcome to consult us too.
Many Southeast Asian countries strictly regulate bringing in and prescribing psychiatric medications such as anti-anxiety drugs and sleeping pills. In Singapore, some medications require an application to and approval from the authorities in advance, and when bringing them from Japan it's recommended to prepare prescription information in English. The same medications as in Japan may not be available locally.
At local medical facilities it's hard to communicate subtle nuances in Japanese, so many people hesitate to seek care in this area. Simply having a way to consult in Japanese can lead to earlier care.
Care
What Cotovia can do
- A careful consultation in which we listen to you
- Prescribing or continuing medication as needed (prescribing is at the doctor's discretion)
- Help with medical certificates and other documents
- Referral to counseling with a psychologist
Tests you may have
Not knowing what will happen can make people hesitate to seek care, so here's what actually takes place.
Time to talk
Understanding how things have developed, your circumstances and how hard it is for you
Questionnaire assessment
Gauging mood and anxiety levels as an objective guide
Blood test
Checking for physical causes such as thyroid function or anemia
Treatment options
Adjusting your environment
Reduces the source of the strain itself
We work through your work situation, daily rhythm and support network together
Counseling
Helps you sort out ways of thinking and coping
We'll tell you about options available in Japanese
Medication
Eases symptoms and lays the foundation for recovery
Some take time to work. Prescribing is at the doctor's discretion
Restoring sleep
Improving sleep eases daytime symptoms
Sleep is the foundation of mental recovery
* Tests, procedures and prescriptions are decided by the doctor after a consultation. Services may vary by country and location.
Preparation
Before your visit
When seeing a doctor abroad, simply organizing what you need to say makes a big difference.
What to bring
- Passport or residence card
- Insurance card and your insurer's contact details
- Your medication record and the medication you take
- Information on any treatment you received in Japan
What to tell us
- Roughly when it started and what feels hard
- Changes in sleep, appetite and weight
- How much it affects your daily life and work
- When you arrived and how your living environment has changed
- Whether you're drinking more
Self Care
What you can do yourself
Along with seeing a doctor, here are things to keep in mind in daily life.
Prevention
- In the first 1–3 months after arriving, don't overdo it, and focus on settling into daily life
- Build connections outside work, such as the local Japanese community or hobbies
- Keep in regular contact with family and friends in Japan
- Watch out for isolation among family members who came with you (a spouse or child may show problems first)
How to Consult
How to be seen
Choose from 3 ways to be seen, depending on your symptoms and schedule. If you're not sure, we'll guide you on LINE.
Online consultations
See a doctor by video call from home or the office. Medication delivered or from a pharmacy.
Available for this symptom
In-person care
In-person consultations at our clinics and partner hospitals, including tests and procedures.
Available for this symptom
Cotovia Counter
Support with an interpreter for visits to general hospitals.
Available for this symptom
If an online consultation finds that tests or procedures are needed, we'll guide you to in-person care or Cotovia Counter.
From consultation to receiving medication
Add us on LINE and consult
Tell us your symptoms, and we'll recommend the right way to be seen.
Book and be seen
See a doctor online or at the nearest location, with an interpreter present.
Receive your medication
Have it delivered or pick it up at a pharmacy or the clinic (varies by country).
Follow-up
You can also consult us on LINE about how you're doing afterward.
Special Care
People who need extra care
Family members who came with you
They can be affected by the change of environment even more than the employee, and without a workplace or school to belong to, they can easily become isolated
Children
Children may not be able to put it into words, and it may show up as stomachaches, headaches or reluctance to go to school
If you have thoughts of wanting to die
Please don't hesitate to contact us right away. If it's urgent, also consider local emergency services
People who were receiving treatment in Japan
The same medication may not be available locally. Please bring your medication record book
FAQ
FAQ
Common questions before a visit, and common assumptions that lead people to judge for themselves.
QI don't want my family or company to know.
Your privacy is strictly protected, so please feel free to talk to us. We can also discuss whether anything needs to be reported to your company, taking your wishes into account.
QI'm not sure whether I should see a doctor.
You're welcome to consult us even while you're unsure. Whether or not there's a diagnosis, we can start by helping you sort out what's troubling you.
QCan I keep taking medication prescribed in Japan while I'm here?
Regulations on psychiatric medications differ by country, and the same medication may be hard to obtain. If you show us information about your medication, we can discuss whether you can continue it or what alternatives there are.
QShould I go back to Japan?
The options depend on your condition and circumstances. We can work through them together based on your situation, such as continuing treatment locally, taking time off or returning to Japan.
Common misconceptions
Myth It's just attitude; it's because you're weak
Fact Ongoing severe stress is thought to change how the brain works; it isn't a question of willpower
Myth Working overseas is a privilege, so you shouldn't say it's hard
Fact Research has reported the psychological strain of overseas postings, which has nothing to do with privilege
Myth Your company will find out you consulted us
Fact What happens in a consultation is confidential. If you're worried, please check with us beforehand
Myth Once you start medication, you can't stop
Fact Medication is adjusted as things progress, in consultation with the doctor
Myth You have to put up with it until you go back to Japan
Fact Consultations in Japanese are available locally. Starting early gives you more options
Feel free to ask us on LINE first
It's fine to contact us even if you're not sure you need to see a doctor. We're available in Japanese 24 hours a day, 365 days a year.
- Symptoms
- When it started
- Your country of residence
- How you'd like to be seen
Sending these 4 things helps us respond faster. It's fine if you don't have them all.
Ask us on LINE