How to write about medical illness

How to Write About: Depression

This is the fourth post in my “How to Write About Medicine Series”. This series is, hopefully, going to make it easier for writers to include medically accurate information in their books.

Disclaimer: This post is not to be used to diagnose or treat anyone. I am not allowed to diagnose people over the internet, nor am I fully board certified to practice on my own. The sole purpose of this post is to help writers write medically accurate books. I am also not a writer so this information is coming from a doctors’ standpoint rather than a writers; regardless I hope you find this information helpful!

What is Depression?

Depression is a mood state characterized by feelings of sadness, despair, hopelessness, or emptiness.

Unipolar Major Depression (also called Major Depression Disorder) is what you probably think of when you hear the word “Depression”. It is the mental disorder that people are diagnosed with when they have depression.

Confused yet? Yeah me too.

Basically it’s all semantics. Depression is the mood state, Unipolar Major Depression is the diagnosis. So if a doctor is telling a character they have depression the doctor will call it Unipolar Major Depression or Major Depressive Disorder, if doctors or health professionals aren’t involved just call it depression.

What symptoms will a Character with Depression have?

I have included the DSM V (official guidelines for how to diagnose mental health disorders) criteria for Depression and have edited them for clarity. If you want to look at the actual DSM V criteria you should be able to find it with a simple Google search.

  • A. To be considered Unipolar Depression the person must have at least five of the following symptoms for at least two weeks. At least one of the symptoms has to be depressed mood or loss of interest in activities.
    • 1) Feeling depressed (sad, empty, hopeless) most of the day everyday
    • 2) Person no longer wants to do normal activities and does not enjoy the things they used to enjoy
    • 3) Loss of appetite or increase in appetite, or weight loss/ weight gain
    • 4) Changes in sleep habits- person is sleeping all the time, or person has insomnia and cannot sleep
    • 5) Feeling restless (psychomotor agitation) or feeling slowed down or sluggish (psychomotor retardation)
    • 6) Fatigue or loss of energy nearly every day
    • 7) Person feels worthless or has feelings of guilt
    • 8) Person feels like they are not able to concentrate, feels as though they cannot make even simple decisions.
    • 9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
  • B. The Symptoms bother the person. They no longer want to get up, go to work, hang out with friends. It has a serious impact on all aspects of their life.
  • C. The depression is not because of another medical condition, or another drug.

How to Treat Depression

The best initial treatment for Depression is the combination of medication and therapy.

Typically an SSRI or an SNRI are chosen as first line agents.

For therapy, typically Cognitive Behavioral Therapy (CBT) is chosen. I don’t think you need to worry too much about this aspect of it, but if you wanted to write a scene where a character is in a therapy session, you can look up what’s involved in CBT counseling.

How to Write a Character with Depression

Here is a short example of a person with depression:

John Doe is a 30 year old male who has been feeling sad and depressed for the last two weeks. John says that work has been really tough recently and he no longer wants to get out of bed in the morning; he has been having trouble doing his normal around the house chores and has been fighting with his wife about his inability to help around the house. He used to go golfing with his brother on the weekends, but has canceled the last three trips because he doesn’t want to go. He has not been feeling very hungry and says that his clothes are fitting more loosely than they used to . He has been feeling guilty that he hasn’t been pulling his weight around the house, and wonders if his wife would be better off if he were dead.

So I am not a writer, and that reads more like a patient note than it does like a fiction story. However I think it gets the point across.

Depression can look differently for different people. One person might sleep all the time and have an increased appetite and weight gain; another person might not be able to sleep at all and might have decreased appetite and weight loss. Also there can be different levels of severity, the person doesn’t have to be bed ridden to have depression- a person might seem normal to those who don’t know them well but be internally struggling.

I think one of the biggest criteria is criteria B- the symptoms have to be causing a disruption in the person’s usual life. Maybe the person has lost their job because they can’t get out of bed, or they’ve alienated their friends by always canceling plans.

When writing a character with depression: use the criteria I’ve listed and work you’re way backward. Also talk to people who have been depressed and use their experiences to create a well rounded character.

Summary

As always: please be courteous and respectful when mentioning mental health disorders in your writing. Please also be accurate.

Some things NOT to do when talking about a depressed character:

  • Say that antidepressants are addictive- THEY ARE NOT. I really don’t know where this misconception came from but please don’t repeat it in your writing. I’m assuming this is talking about Xanax or other benzos, but they are not used to treat depression and are not really used to treat anxiety due to their potential for misuse.
  • Say that antidepressants made the character feel emotionless: depression makes people feel flat and emotionless, the antidepressants SHOULD NOT. If a person feels emotionless on their antidepressant they probably need to try another type or another dose.
  • Say that your character took themselves off an antidepressant: medications can definitely be stopped. The recommended trial for a person with one episode of depression is 6 months. Once the trial is over, the doctor will help the patient ween off the medications. Stopping antidepressants too quickly can result in rebound depression and a whole host of other unpleasant side effects. PLEASE DO NOT ENDORSE THIS IN YOUR WRITING.
  • Say anything that puts down the mental health field, or might make a depressed reader feel like they shouldn’t seek help. I understand that not all people have good experiences with their doctors and therapists and its okay to mention those experiences. But the overall message about depression should be positive and centered around seeking help and treatment.

Please let me know if you have any questions and if you get nothing out of this post please read my list of “what not to do” above.

I honestly, stop reading books when any of the above statements are made, because they are so harmful to the mental health community!

If anyone with depression wants to share their experiences below for writers to get a better idea of what depression looks like, feel free! Also if you blog about depression and want to leave a link below, please feel free to do so!

Check out my post on How To Write About PTSD

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