Low mood and hard feelings

Sometimes what is most missing is not mood but drive: the flat, cannot get started feeling. That can be named as the target in its own right.

Antidepressants lean in different directions, and one or two are weighted more towards the system carrying energy and alertness than towards…

Most antidepressants share a family resemblance. Bupropion does not, so much of what you have read about the others simply does not apply to it.

It works on the systems carrying drive and alertness rather than on serotonin, which is why its effects, wanted and unwanted, sit at an angle to the…

A medicine that lifts drive is not the same as one that settles anxiety, and for some people the energising kind makes the worry louder.

Bupropion is the clearest example: often good for flatness and lack of motivation, often unhelpful on its own when anxiety and a racing, sleepless…

When the same medicine keeps turning up for unrelated problems, that usually means one action touches all of them. It does not mean somebody has found a cure for everything.

Bupropion appears in depression, in stopping smoking, in a weight loss combination and sometimes in attention problems, because the system it works…

If the usual antidepressants have not reached you, there are treatments that work on an entirely different system in the brain. They are worth asking about.

Esketamine, given as a nasal spray in a clinic, acts on glutamate rather than on serotonin or noradrenaline, and the change it brings can arrive in…

The newer thinking about depression is less about topping up a missing chemical and more about connections that have thinned out being rebuilt. Recovery looks more like regrowth than refilling.

Long stretches of depression seem to leave parts of the brain less richly connected, and some treatments appear to work by helping those links form…

When a treatment is offered, it is fair to ask whether it is the licensed version or a use that sits outside the licence, and what monitoring comes with it.

Ketamine for depression is the live example. The doses used are far below anaesthetic ones, the nasal form has approval for treatment resistant…

Before anyone concludes that nothing works, go back over the ordinary explanations: a dose that never went high enough, a trial that stopped after three weeks, doses missed on the hard days.

Treatment resistant has a technical meaning, which is that at least two proper trials at a proper dose and length have failed. A great deal of what…

When someone says they feel nothing, find out where the nothing reaches. All the time, or only towards good things, or only here, in this conversation, when criticism is in the air?

The three answers point in quite different directions. Numb everywhere, day and night, is worth taking to a doctor. Numb to good things while the bad…

If a medicine has taken the edge off everything, including the good things, that is worth raising with whoever prescribed it. Taking the sharpness out of pain is one thing. Feeling nothing at all is not a way to live.

It matters practically as well as personally. Anything you are trying to change, in a relationship or in yourself, needs some feeling to work with,…

Going still and needing nothing is usually something a person worked out young, somewhere it was the sensible answer.

If reaching out met dismissal, or worse, then not reaching out is not a flaw of character. A child who stops asking, stops showing what they feel and…

Name one hard thing today and ask what it might be growing in you: patience, humility, nearness to God.

Not denying the difficulty. Finding the meaning inside it that makes it bearable.

When a thought lands hard, ask whether you know it for certain, and what you would actually put forward if you had to make the case. Then go looking for the bits that point the other way.

Do this once you have settled a little, not in the worst of it, or the questions become another way of arguing with yourself. Write the answers down…

Notice the standard you are holding yourself to, then ask whether you would hold anybody else to it. If what you blame yourself for happened when you were a child, ask honestly whether a child could have carried that.

Shame usually rests on a rule that was never said out loud, something along the lines of I should have known, or I should have stopped it. Written…

Picture somebody you love saying this exact thought about themselves. What would you say back, and why is none of that available to you?

Most of us are far kinder outward than inward, and the kind version is usually the more accurate one as well as the warmer one. Say your answer to…

Imagine yourself some years from now, well past this, and let that version of you say something to you about today. Write down whatever arrives.

It sounds like a party trick and it usually is not. The future you tends to speak in a tone you cannot yet manage towards yourself, less panicked and…

Shame does something cruel. It makes you want to disappear from the very person whose warmth would settle it, so if you notice yourself going quiet and pulling back, that pull is the shame talking rather than the truth about you.

Watch for the small retreats. Not answering a message, keeping an answer short, changing the subject when someone asks how you are. You do not have…

When you go blank or shut down under pressure, try meeting it with 'of course I did'. That response was learned somewhere it was needed, and it is still running long after the danger passed.

Put a place on it if you can. Whose house were you in when going quiet was the safest thing available? Naming where it came from does two things at…

Shame speaks in one flat sentence: I am bad. Notice that it never offers evidence, it just announces a verdict.

Because the claim covers all of you, no good day can disprove it. That is what makes it different from ordinary regret, which points at one thing you…

You were the child. They were the adults. Say it as often as you need to, because shame will keep quietly filing it the other way round.

It is not an argument to win, more a fact to keep returning to. When a memory arrives with you cast as the guilty one, try describing the same scene…

Stop fighting what already is. Accepting a hard reality, without approving of it, ends the extra layer of pain.

Saying it is so is not the same as saying it is fine. Dropping the war with what already happened frees you to respond.

Soothe yourself through the senses: a warm drink, a soft cloth, a good scent, a slow walk. Be kind to the body.

When you cannot fix the feeling, comfort the one who is feeling it. Small kindnesses to the body settle the mind.

Accepting reality as it is means dropping the fight with what has already happened. It does not mean staying somewhere that is still harming you.

The two get confused often, usually by people who were told to be patient by whoever benefited from their patience. A rough test: acceptance is for…

Watch for the small thing that happens right as a feeling starts: the reach for a tissue, the laugh, the change of subject. Notice it once and say nothing, notice it again, and only then mention it.

One instance is an incident and three is a pattern, and the difference matters when you name it, because a pattern can be looked at together without…

Sometimes the thing that stops your tears is an order somebody gave you decades ago, and you are the one carrying it out now. One woman found her father's words sitting behind a habit of wiping her face dry the moment she cried.

That is worth knowing because it changes who the rule belongs to. It was his voice, in her hands, running long after he had gone. Naming the source…

Before going towards a hard feeling, decide what will hold you while you are inside it: a way of breathing, a way of standing, a sentence, a person you can picture or ring.

Going in with nothing is not brave, it is flooding, and it teaches your system that feelings really are dangerous. Pick two or three supports in…

Whether a feeling is nowhere to be found or far too much, the questions are the same: what breath, what movement, what sentence, what person helps me stay with this?

Numbness and overwhelm look like opposites and they are both a problem of not being able to stay with the material. The same supports work in either…

Anger wants the body to do something, so let it. Breathe deeper and higher into the chest, stand up, press both palms hard into a wall, walk on the spot, push down through your feet.

Pressing against something solid gives the mobilisation an outlet with nothing broken and nobody hurt. Keep going until the charge drops a little,…

When anger floods you, step away before you speak, and come back when your body is calm.

Past a certain heat the body cannot hear reason. Leave, settle, and return.