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Areas › Low mood and hard feelings › When everything feels flat
Four competing versions sit under the same umbrella: too little released, reuptake running too hard, too much broken down, or receptors that need an unusually strong signal before they answer. Each has a drug class built on it. The last has held up best, because a simple shortage cannot explain why a transporter blocked within hours takes a month or more to change how somebody feels.
'Look, then, at the imprints of God's mercy, how He restores the earth to life after death' (Quran 30:50). Restoration is described here as a process with a season to it rather than a switch.
الروم
فَٱنظُرۡ إِلَىٰٓ ءَاثَٰرِ رَحۡمَتِ ٱللَّهِ كَيۡفَ يُحۡيِ ٱلۡأَرۡضَ بَعۡدَ مَوۡتِهَآۚ إِنَّ ذَٰلِكَ لَمُحۡيِ ٱلۡمَوۡتَىٰۖ وَهُوَ عَلَىٰ كُلِّ شَيۡءࣲ قَدِيرࣱ
Look, then, at the imprints of God’s mercy, how He restores the earth to life after death: this same God is the one who will return people to life after death- He has power over all things
Qur’an 30:50read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
Pooling individual patient data from nine trials, mindfulness based cognitive therapy lowered the risk of depressive relapse over sixty weeks compared with usual care, and performed comparably to staying on maintenance antidepressants. That is evidence about preventing relapse, not about receptors. What it suggests is that the same endpoint can be reached by more than one road, which fits a system that adapts rather than a tank being refilled.
Willem Kuyken; Fiona C Warren; Rod S Taylor; Ben Whalley; Catherine Crane; Guido Bondolfi (2016). Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse. JAMA Psychiatry doi
Strength of evidence: one line of research. A single study, or a theoretical account.
If the level changed on day one and the mood did not, the level was never the whole story.
If pain is part of what you are carrying, bring it into the same conversation as the low mood. They are not two separate appointments.
A newer version of a familiar medicine is usually a tidier version rather than a leap, and tidier is still worth something.
SSRIs became the default for four reasons, and being more effective is not among them. They are easier to tolerate, taken once a day, far safer in overdose, and cheap as generics.