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Areas › Low mood and hard feelings › When everything feels flat
This is why two people with the same diagnosis get offered different tablets. A flat, pleasureless presentation points one way, a fatigued and achey one another way, relentless worry another way again. For a person taking the medicine it is more useful still. Pick the symptom that is costing you most this month and make that the thing you and the prescriber are both watching.
The Qur'an describes its teaching as 'a healing for what is in [your] hearts' (Quran 10:57). What is actually in there is what gets addressed, and naming it is the first half of that.
يونس
يَٰٓأَيُّهَا ٱلنَّاسُ قَدۡ جَآءَتۡكُم مَّوۡعِظَةࣱ مِّن رَّبِّكُمۡ وَشِفَآءࣱ لِّمَا فِي ٱلصُّدُورِ وَهُدࣰ ى وَرَحۡمَةࣱ لِّلۡمُؤۡمِنِينَ
People, a teaching from your Lord has come to you, a healing for what is in [your] hearts, and guidance and mercy for the believers
Qur’an 10:57read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
In a secondary analysis of 440 depressed patients from a randomised trial, both cognitive behavioural therapy and behavioural activation improved the loss of pleasure and interest, but that symptom responded less completely than the others and often lingered. Separately, in nearly 2,000 adults followed for three years, repetitive negative thinking predicted worse depression and anxiety later on. Different symptoms behave differently over time, which is exactly why they are worth tracking one at a time rather than as a single score.
Alsayednasser B, Widnall E, O'Mahen H, Wright K, Warren F, Ladwa A, Khazanov GK, Byford S, Kuyken W, Watkins E, Ekers D, Reed N, Fletcher E, McMillan D, Farrand P, Richards D, Dunn BD. (2022). How well do Cognitive Behavioural Therapy and Behavioural Activation for depression repair anhedonia? A secondary analysis of the COBRA randomized controlled trial.. Behaviour research and therapy doi
Spinhoven P, van Hemert AM, Penninx BW. (2018). Repetitive negative thinking as a predictor of depression and anxiety: A longitudinal cohort study.. Journal of affective disorders doi
Strength of evidence: one line of research. A single study, or a theoretical account.
You can only tell whether a treatment is working if you decided beforehand what it was meant to touch.
For some young people self-harm carries something besides relief: belonging, recognition, a name for who they are among friends who do the same.
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.
A genetic test can tell you how quickly your body clears a medicine. It cannot tell you whether that medicine will lift your mood, and it helps to keep those two questions apart.