Psychometric analyses of different rating scales have shown that the construct validity of depression in relation to patients from other cultural backgrounds than Western is unclear. This calls for more knowledge on the qualitative properties of depression in a transcultural context. The aim of the study was to examine how Arabic speaking patients understand and speak about mental distress, while also exploring to what degree they find depressive symptoms as defined in the ICD-10 and selected rating scales meaningful. Six semi-structured interviews with Arabic speaking patients from Syria, Lebanon and Iraq receiving treatment at a Danish treatment centre were conducted. Data was analysed by the use of thematic analysis. Various Arabic terms in relation to a state comparable to depression were obtained, especially in relation to the core depressive symptoms of “low mood”, “low energy” and “loss of interest”. Symptoms regarding guilt and loss of self-confidence were not recognized as a part of a depressive state to the same degree as the other depressive symptoms. Some symptoms, such as somatic complaints, were more accepted to speak openly about than others. It was concluded that the participants in the study generally recognized the depressive symptoms as defined in the ICD-10 and would use comparable Arabic terms to describe mental distress. However, cultural background may influence to what extend depression is accepted to speak about, which should thus be taken into consideration and addressed by mental health professionals. In a clinical setting, this knowledge can be used to include culture specific terms and phrases in the conversations with Arabic speaking patients.