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Areas › Low mood and hard feelings › When everything feels flat
Which is why your own record is worth more than any comparison chart. Keep a plain list: what you took, at what dose, for how long, what it helped, what it cost you, why it stopped. Each further switch tends to give a little less than the one before, so that list is what stops the same ground being covered twice. It is also what tells you when it is time to add something that is not a tablet.
Even the messenger and the believers with him cried, 'When will God's help arrive?' (Quran 2:214). Asking that after a long stretch of trying things is not a failure of faith.
البقرة
أَمۡ حَسِبۡتُمۡ أَن تَدۡخُلُواْ ٱلۡجَنَّةَ وَلَمَّا يَأۡتِكُم مَّثَلُ ٱلَّذِينَ خَلَوۡاْ مِن قَبۡلِكُمۖ مَّسَّتۡهُمُ ٱلۡبَأۡسَآءُ وَٱلضَّرَّآءُ وَزُلۡزِلُواْ حَتَّىٰ يَقُولَ ٱلرَّسُولُ وَٱلَّذِينَ ءَامَنُواْ مَعَهُۥ مَتَىٰ نَصۡرُ ٱللَّهِۗ أَلَآ إِنَّ نَصۡرَ ٱللَّهِ قَرِيبࣱ
Do you suppose that you will enter the Garden without first having suffered like those before you? They were afflicted by misfortune and hardship, and they were so shaken that even [their] messenger and the believers with him cried, ‘When will God’s help arrive?’ Truly, God’s help is near
Qur’an 2:214read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
Across 419 randomised trials, psychological interventions produced small but real improvements in wellbeing, with effects varying by the type of intervention and the population. That summary is about psychological treatment rather than medication. Small and real is still a useful corrective to the hope that the next thing tried will be the one that changes everything, and it argues for choosing on fit and on what you can sustain.
van Agteren J, Iasiello M, Lo L, Bartholomaeus J, Kopsaftis Z, Carey M, Kyrios M. (2021). A systematic review and meta-analysis of psychological interventions to improve mental wellbeing.. Nature human behaviour doi
Strength of evidence: one line of research. A single study, or a theoretical account.
When the options are more alike than they look, your own history becomes the most informative thing in the room.
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.
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.
For some young people self-harm carries something besides relief: belonging, recognition, a name for who they are among friends who do the same.