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Areas › Low mood and hard feelings › When everything feels flat
Triptans, tramadol, dextromethorphan, linezolid and St John's wort all count, as do other antidepressants. Someone who mentions in passing that they have started something for their migraines has just told you something worth passing to the prescriber or the pharmacist that same week. Keep asking about the whole list rather than the psychiatric part of it, because most people do not think of a supplement as a drug at all.
Ya'qub tells his sons to 'go and seek news of Joseph and his brother' (Quran 12:87). Going and asking, rather than waiting to be told, is the posture.
يوسف
يَٰبَنِيَّ ٱذۡهَبُواْ فَتَحَسَّسُواْ مِن يُوسُفَ وَأَخِيهِ وَلَا تَاْيۡـَٔسُواْ مِن رَّوۡحِ ٱللَّهِۖ إِنَّهُۥ لَا يَاْيۡـَٔسُ مِن رَّوۡحِ ٱللَّهِ إِلَّا ٱلۡقَوۡمُ ٱلۡكَٰفِرُونَ
My sons, go and seek news of Joseph and his brother and do not despair of God’s mercy- only disbelievers despair of God’s mercy.’
Qur’an 12:87read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
In a cluster randomised trial in UK primary care, structured collaborative care, where a case manager works alongside the GP, produced modestly better depression outcomes than usual care over four months. The trial tested the whole model rather than any single habit inside it. What matters here is that keeping one shared picture of a person's care is a job somebody has to do, and doing it measurably helps.
Richards DA, Hill JJ, Gask L, Lovell K, Chew-Graham C, Bower P, Cape J, Pilling S, Araya R, Kessler D, Bland JM, Green C, Gilbody S, Lewis G, Manning C, Hughes-Morley A, Barkham M. (2013). Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial.. BMJ (Clinical research ed.) doi
Strength of evidence: one line of research. A single study, or a theoretical account.
The risk lives in the combination, so it is only visible to whoever knows the full list.
A fast heartbeat with shivering, sweating, tremor or twitching after a new medicine has been added needs urgent medical assessment rather than a wait and see.
Depression is not one thing with one address. Fatigue, blank concentration, lost libido and the loss of pleasure do not all come from the same place, so it helps to name which one you most want moved.
Never come off an antidepressant on your own. The taper belongs to the prescriber, and for some drugs it needs to be slower and longer than people expect.
The reason depression is mostly treated by GPs now is pharmacological. A drug you can start without an ECG, blood monitoring or a diet sheet is a drug that fits inside a ten minute appointment.