Loading practices
Loading practices
Areas › Low mood and hard feelings › When everything feels flat
The transporter is blocked within hours, so the delay belongs to slower changes further down the line. In practice that means picking a date four to eight weeks out at a proper dose and agreeing to review it then, instead of reading the tea leaves every few days. It also means those weeks are not dead time. They are precisely when everything else that helps is worth building.
'When the messengers lost all hope', the verse says, 'Our help came to them' (Quran 12:110). Relief arriving after the point where you had stopped expecting it is a pattern the Qur'an describes rather than an accident.
يوسف
حَتَّىٰٓ إِذَا ٱسۡتَيۡـَٔسَ ٱلرُّسُلُ وَظَنُّوٓاْ أَنَّهُمۡ قَدۡ كُذِبُواْ جَآءَهُمۡ نَصۡرُنَا فَنُجِّيَ مَن نَّشَآءُۖ وَلَا يُرَدُّ بَأۡسُنَا عَنِ ٱلۡقَوۡمِ ٱلۡمُجۡرِمِينَ
When the messengers lost all hope and realized that they had been dismissed as liars, Our help came to them: We saved whoever We pleased, but Our punishment will not be turned away from guilty people
Qur’an 12:110read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
A meta-analysis of 16 randomised studies found that scheduling and increasing pleasant and purposeful activity produced large reductions in depression, comparable to cognitive therapy. Those trials tested the activity programme in its own right rather than as something done alongside a new prescription. Even so it is the best argument that the waiting period has something in it to do rather than only to endure.
Cuijpers P, van Straten A, Warmerdam L. (2007). Behavioral activation treatments of depression: a meta-analysis.. Clinical psychology review doi
Strength of evidence: one line of research. A single study, or a theoretical account.
The chemistry changes quickly and the brain's adjustment to it does not, and the wait lives in that gap.
If things get worse rather than better in the early weeks, and particularly if you begin thinking about harming yourself, that is not something to wait out; contact the prescriber straight away.
You can say what an SSRI does in one sentence. It blocks the doorway that carries serotonin back out of the gap between two nerve cells, so more of it stays there for longer and is likelier to be picked up.
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.
Nearly all of them do the one thing: keep a monoamine hanging about in the synapse for longer. So when you hear that some other tablet is stronger, be a little sceptical.