Since I don’t have a guest post today, I thought I would put in one of the A Writer’s Guide articles I received, since this series is going to be put on hold for a while, I wanted to share the last few I had.
This is part of the series of blog articles called “A Writer’s Guide…”. The purpose of this series is to give detailed information on skills and occupations that writers can use when creating characters.
Check out today’s article by writer Tobias Salem is on writing about a character with depression.
by Tobias Salem
It makes sense that, as writers, we may be expected or feel compelled to include accounts of psychological illnesses in our fiction. Maybe, like me, you are dealing with your own mental illness.
Or, perhaps, it’s your partner, parent, sibling, or child. After all, an estimated 25% of the global population will contend with a mental illness at some point.
There is a lot of misinformation out there in regard to mental disorders. Fiction in its many facets has too-often sensationalized these illnesses.
So-called “multiple-personality disorder” is one of the most frequently demonized or turned into a horror trope. (The condition is actually called Dissociative Identity Disorder, by the way).
The most prevalent mental disorder is depression. So, what is it? Can’t you just “snap out of it”? I will give some insights into how we can bring these real conditions into our writing and do so respectfully and tactfully.
So, you think your character is depressed?
It has long been believed that depression was triggered by some sort of chemical imbalance in our brains. While chemicals may very well have a part to play, there is more than one cause.
Many other factors can make someone predisposed, or susceptible, to depression. Genetics, stressors in life, medical conditions (particularly of the serious or chronic kind), as well as medications can all induce depression.
If you are writing a character that is experiencing depression, what sorts of things should you highlight to convey their mindset?
- Generally speaking, a depressed individual will be solemn, prone to crying, or even emotional outbursts of anger, even over seemingly insignificant things.
- They may be restless or sleep more than usual.
- It is common for depression to manifest as apathy toward things that once gave them joy: sports, friends, hobbies, or sex.
- The most prevalent personality difference while depressed is the undercurrent of despair, hopelessness, and self-blame. They fixate on negative emotions and it can be difficult to see any way out of their despair. That is why suicide is so high among clinically depressed individuals.
- STRESS can exacerbate many conditions, both physical and psychological. Stress hormones very likely can play a role in the development of depression. Numerous studies have suggested causation between early trauma and people later suffering from depression. When an already depressed person experiences significant stress in their life, as everyone does, it can make the depression feel even more like a burden, weighing them down.
Depression can be insidious. It can be sneaky. There are “good” days and “bad” days. I myself dealt with it in my teenage years. In fact, my drive to understand it led to me getting a degree in psychology.
As writers, we can delve into the psyche of a depressed character if we understand that depression is not likely to result in constant thoughts of self-harm all day, every day.
There will likely be somewhat of a disconnect, even on a “good” day. A depressed person is also very aware of the absence of their negativity.
How would your character seek treatment?
You’ve determined that your character is depressed; now you might consider how they might be treated. Often, undiagnosed or un/under-insured people will self-medicate by using alcohol or other drugs.
But let’s assume they have the means and motivation to seek professional physician help. Certainly, the pharmaceutical option would come up. Let’s examine the different classes of antidepressants, what they do, and how they differ.
After all, with so many of our readers (and selves!) experiencing these disorders, knowing this can set you apart.
Antidepressant drugs typically fit into four categories: SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors), Tricyclic (affect serotonin, norepinephrine, and dopamine), and MAOIs (monoamine oxidase inhibitors). These hard-to-pronounce names are the chemicals in our brains which these drugs affect.
- SSRIs increase the levels of the neurotransmitter serotonin in the brain by blocking (inhibiting) the reabsorption (reuptake) of it. Prozac, Paxil, Zoloft, Celexa, and Lexapro are brands of SSRIs you have probably heard of. Side effects of these drugs can be rather bothersome and include: dry mouth, nausea, headache, nervousness, insomnia, and sexual dysfunction.
- SNRIs block the reabsorption of both serotonin and norepinephrine, increasing the levels of both neurotransmitters. Cymbalta and Effexor XR are the more common brands of these drugs. SNRIs have all of the same side effects as SSRIs with the added list of: constipation, weight loss, increased cholesterol, and increased heart rate.
- Tricyclic drugs affect 3 chemicals: serotonin, norepinephrine, and dopamine. They impact the serotonin and norepinephrine by blocking the reuptake, as both prior drug classes do. Where they differ is that it also blocks acetylcholine, which opposes dopamine. Norpramin, Tofranil, and Vivactil are among the tricyclic antidepressant brands. Because these drugs block acetylcholine, these carry some more serious side effects, such as: blurred vision, urinary difficulties, difficult in thinking or memory, worsening of glaucoma, and drowsiness.
- MAOIs work by preventing an enzyme, monoamine oxidase, which removes serotonin, norepinephrine, and dopamine from the brain, making more of all three of those neurotransmitters available, which combats the effects of depression. Nardil, Parnate, Marplan, and Emsam are among the MAOI brands. MAOIs are typically seen as a last resort treatment, once other options have been exhausted, due to some severe side effects, or at least potential ones: Sudden drop in blood pressure upon standing, weakness, dizziness, agitation, involuntary movements, weight gain, and abdominal pain, plus the other laundry list from the drugs above. It also carries some serious interactions with other medications and even foods.
- There is also another class of drugs, atypical antidepressants. Since many of these share some of the same mechanisms as the other four types, but with variations on them and variations on the typical side effects, I did not delve into them in detail. Brands of atypical antidepressants are Wellbutrin, Remeron, Viibryd, and Brintellix. Some of these are likely to cause constipation while others tend to cause diarrhea. Some may be unlikely to carry the sexual side effects while others do. So the ‘atypical’ tag certainly fits because these drugs don’t fit neatly into the other categories, though all have some sort of interaction or blocking of brain chemicals.
Of course, some people either do not want to use drugs or are recommended to use drugs in conjunction with various forms of psychotherapy.
- CBT – Cognitive Behavioral Therapy seeks to modify a patient’s thought patterns. In turn, this should alter their behaviors and/or moods. CBT is about improving one’s state of mind in the present time and setting them up for a more hopeful future, rather than reflecting on the past.
- IPT – Interpersonal Therapy posits that, while things surrounding interpersonal relationships don’t cause depression, the depression certainly exists within those contexts and undoubtedly affects those relationships. The short term goals of this therapy are to improve social adjustment and reduce the symptoms of depression. The goal, long-term, is to enable and empower patients to make the adjustments they need for themselves.
I decided to focus on depression and the ways in which we, as writers, can do better at giving it, and all mental disorders, the respect and tact that it deserves, simply because of the prevalence of depression.
How can you work depression into fiction?
So, with an understanding of what it is, and what the treatment options are, I wanted to provide some specific examples of ways to write a character experiencing depression.
Characters taking anti-depressants: Knowing the negative side effects that many anti-depressants carry, your character may have a certain level of fear or anxiety about taking them, even though they are fully aware that it will help the depression.
That inconsistency alone can make for a compelling character. After all, the best and most well-rounded, three-dimensional characters will have flaws or behavior discrepancies.
A particularly intelligent character battling depression will perhaps fear that their medication will negatively impact their thinking. In their heads, the drug interferes with chemicals in the brain, after all, so it could hinder their intelligence.
They may also falsely come to think that they are broken, unable to love or to be loved, or are a burden to those around them.
This can manifest explicitly, with them saying those words, or implicitly, with them withdrawing and being averse to letting other people into their lives. Characters acting in that way could be said, by others, to be “guarded”, “shy”, or “aloof”.
Example: I decided to stay in my room all day, only emerging for basic needs of bathroom or occasional food. Part of me wanted to be outside, enjoying the sunshine and warm weather. Or, at least, part of me wanted to want that.
My friends pretty much abandoned me as I started to talk less and less and neither joked nor laughed at their jokes. So who would even be missing me if I stayed inside all the time? I glanced over at my pill bottle.
I couldn’t remember whether or not I’d taken the Zoloft. In honesty, I didn’t care if I had or not—I wasn’t taking that shit anymore. It didn’t help and it only made me dumb. I’m not winning any friends over with my cheery disposition; I may as well not be stupid on top of that.
Characters Suffering Withdrawal:A character may decide to skip their medication or completely stop taking it. This is not a good idea in reality, nor should it be a simple task in fiction. Abruptly stopping some of the antidepressants can produce severe withdrawal symptoms, not unlike DT’s from alcohol withdrawal.
Symptoms of antidepressant withdrawal include anxiety, insomnia, dizziness, headaches, irritability, flu-like symptoms including aches and chills, nausea, electrical shock sensations, and of course, the return or intensifying of depression symptoms.
Conclusion: Hopefully, this post shed some light on the details of depression. Understanding what it is and how it is treated can help inform our characters.
I do want to add in here, if you or someone you love is feeling the symptoms of depression, especially the hopelessness and suicidal thoughts, please seek help.
In the USA, you can call the National Suicide Prevention Hotline, free, confidential, and 24-hours a day at 1-800-273-8255. Here is a link to international sources: https://togetherweare-strong.tumblr.com/helpline
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About Tobias Salem
Tobias lives in Asheville, NC with his wife and daughter. He has been writing most of his life, whether screenplays, short stories, or song lyrics.
The Arcane Lore, his paranormal dark urban fantasy series, is his first novel and he’s crossing his fingers that it gets published soon.
Tobias has a degree in Psychology from the University of North Carolina at Asheville.
He also has Generalized Anxiety Disorder and experienced depression as a teen, which is why he felt compelled to share some knowledge with his fellow writers about accurately depicting the common ailment.
He loves heavy metal, horror films, Jeopardy, nature, and being with his family.
I hope you liked this article and if you have any questions for Tobias, please drop them in the comments below. Check out all the current “A Writer’s Guide” articles on their new page for easy access.
Do you have knowledge of a condition, skill or occupation you could write about?
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