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Areas › Low mood and hard feelings › When everything feels flat
It is the most sedating in the class, the least activating, and carries a high risk of exactly the effect they ruled out, with weight gain and the roughest withdrawal on top. Something more activating, fluoxetine or sertraline, fits that person far better. The reasoning is not clever. Take the presentation, take the non-negotiable, and let the two of them rule out what they rule out.
'You see the earth lying desolate, but when We send water down on to it, it stirs and grows' (Quran 41:39). What a flat stretch needs is whatever makes it stir.
فصلت
وَمِنۡ ءَايَٰتِهِۦٓ أَنَّكَ تَرَى ٱلۡأَرۡضَ خَٰشِعَةࣰ فَإِذَآ أَنزَلۡنَا عَلَيۡهَا ٱلۡمَآءَ ٱهۡتَزَّتۡ وَرَبَتۡۚ إِنَّ ٱلَّذِيٓ أَحۡيَاهَا لَمُحۡيِ ٱلۡمَوۡتَىٰٓۚ إِنَّهُۥ عَلَىٰ كُلِّ شَيۡءࣲ قَدِيرٌ
Another of His signs is this: you see the earth lying desolate, but when We send water down on to it, it stirs and grows. He who gives it life will certainly give life to the dead. He has power over everything
Qur’an 41:39read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
A meta-analysis of randomised trials found that resistance exercise training reduced depressive symptoms, with the benefit largely independent of how much strength participants actually gained. That is evidence about an activating intervention, not about choosing between tablets. It sits here because the flattened presentation is the one where activation of some kind, pharmacological or otherwise, is worth building in deliberately.
Gordon BR, McDowell CP, Hallgren M, Meyer JD, Lyons M, Herring MP. (2018). Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials.. JAMA psychiatry doi
Strength of evidence: one line of research. A single study, or a theoretical account.
A drug that pushes further in the direction the person is already stuck in makes the stuckness worse.
Serotonin syndrome comes from stacking, and the second agent is usually something nobody thought to mention: a migraine tablet, a cough medicine, a herbal remedy for low mood.
For some young people self-harm carries something besides relief: belonging, recognition, a name for who they are among friends who do the same.
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.