This is part of a series of The Psych Writer. I tend to write about pretty heavy topics because they’re mainly about mental illness, and though there are many things we can laugh and joke about to alleviate pain, these topics can be painful for some. So I ask you to stay with me and be tough. Put on your writer’s cap and use one of my favorite defense mechanisms–intellectualize with me.

And now, for a disclaimer: None of this is a substitute for professional medical advice. This is for the sole purpose of writing a character with realistic tones. Of course, there’s always poetic license. If you have Major Depressive Disorder (MDD), note your individual experience may vary. If you see yourself in anything I’m describing, consult with a licensed clinician in your area for help.

This is only an introduction. MDD is a complex mood disorder with several possible complications and offshoots, so in order to keep your eyes from falling out of your head (disclaimer: not responsible for deleterious effects), I am going to have to break it up into parts other than this introduction.

• Part I will be about the basics of writing MDD.
• Part II will be about writing Treatment-Resistant Depression (TRD), which I prefer to pronounce ‘turd.’
• Part III will be about writing MDD with psychotic features.

So for now, let’s just get to know what MDD is all about. MDD has a lengthy symptom list. The DSM-5 lists MDD as a mood disorder. I’m going to attempt to put it all into plain English here for you, using the copy I have at home.

Here are the criteria for diagnosing Major Depressive disorder:

• The symptoms must be present daily or nearly every day for a minimum of two weeks before a diagnosis can be made. That means it’s persistent and pervasive.
• The symptoms must be a change from how the person functioned previously.
• Five or more of the symptoms must be present during that two-week minimum period. On top of that, the person must have either a depressed mood (feelings of emptiness, sadness, irritability) or loss of interest and pleasure (aka anhedonia). They can have both, but at least one of these must be consistently present.
• You’re not allowed to include symptoms that can belong to other medical conditions. In other words, they want you to make sure it’s not something else before treatment. Other physical conditions to rule out include:
  • Central nervous system diseases (e.g., Parkinson disease, dementia, multiple sclerosis, neoplastic lesions)
  • Endocrine disorders (e.g., hyperthyroidism, hypothyroidism)
  • Drug-related conditions (e.g., cocaine abuse, side effects of some CNS depressants)
  • Infectious disease (e.g., mononucleosis)
  • Sleep-related disorders
  • Adjustment Disorders
  • Anemia
  • Chronic Fatigue Syndrome
  • Dissociative Disorders
  • Hypochondriasis
  • Hypoglycemia
  • Hypopituitarism (Panhypopituitarism)

  Other psychological conditions to rule out include:

  • Dysthymia
  • Bipolar Disorder
  • Anxiety Disorders (e.g, PTSD, OCD, GAD)
  • Eating Disorders
  • Personality Disorders
  • Schizoaffective Disorder
  • Schizophrenia
  • Somatic Symptom Disorders

    ET CETERA

Okay, so now, the clinician gets into the symptoms. Symptoms of MDD (remember, there is a minimum of five with depressed mood and/or anhedonia being one of them) include:

• Depressed mood most of the day, nearly every day for at least two weeks. The person can report this themselves (“I feel sad,” “I feel empty,” or “I feel hopeless), or it can be observed by others (“Patient appears tearful.”). For kids and teenagers, there is often a sharp increase in irritability, although irritability is sometimes seen in adults with depression, too. It’s just more often seen in the young ones.
• Noticeably losing interest and/or pleasure in all or almost all activities that the person enjoyed before. This can be self-reported or by observation from someone else.
• Significant weight loss when not dieting or weight gain–within one month, losing or gaining more than 5% of the person’s starting weight–or, an increase or decrease in appetite nearly every day (e.g., the person who used to eat their three square can barely choke down a bowl of pudding every day, or a person who used to eat lightly now eats constantly. In kids, this will be seen as failure to make their expected weight gain.
• Not sleeping (insomnia) or sleeping too much (hypersomnia) almost every day.
• Moving around too much (fidgeting) or not moving around enough (lethargy) nearly every day. This criterion is known as psychomotor agitation or psychomotor retardation. It also cannot be self-report alone–this must be observable by others.
• Lack of energy nearly every day (fatigue). Can be self-reported or observed.
• Feeling worthless or guilty inappropriately, sometimes to the point of being delusional. This isn’t just basic self-reproach or feeling guilt about an illness. It’s a magnified feeling.
• Difficulty concentrating or making decisions nearly every day. This can be self-reported or observed.
• Thoughts of death repeatedly–not just fear of death, suicidal thoughts without a plan, with a plan, or an attempt to commit suicide. This also includes repeated suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

And finally, the criteria for these symptoms has to fit as below:

• The symptoms cause significant distress or inability to function in social situations, on the job, or anywhere a person needs to function.
• The episode isn’t because of any of the conditions listed previously or because of drugs.
• The depression isn’t better explained by another psychological condition as listed above.
• The depression didn’t come with any mania or hypomania. Clinicians can’t count this exclusion if the mania/hypomania is due to a drug/substance or because of a medical condition.

Did you think that MDD was easy to diagnose? As you can see from above, it’s not always clear-cut. That’s why it’s important to pay attention to symptoms.

Keep all this in mind as we venture into the depths of writing MDD, and again, if you need help, contact a licensed clinician in your area for help.

I am a former supervised therapist with experience in the mental health field since I began graduate schooling in 2003. Now, I write about the things in my head.