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Areas › Low mood and hard feelings › When everything feels flat
Bupropion was pulled from the market over seizures and came back once a slow release form existed, because what drove the risk was the sharp peak after each dose rather than the total taken across a day. Spreading the same amount out flattened the peak. This is also why a modified release tablet should be swallowed whole, and never crushed or split to make it easier.
When the messengers lost all hope, Our help came to them (Quran 12:110). Help arriving after something looked finished is worth remembering when a treatment has been written off.
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.
Delivery changes results in psychological treatment too. Across twelve randomised trials, internet delivered cognitive behavioural therapy produced moderate to large improvements in depression and anxiety symptoms, and programmes with some human support outperformed those without. Same content, different delivery, different outcome.
Spek V, Cuijpers P, Nyklícek I, Riper H, Keyzer J, Pop V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis.. Psychological medicine doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Spreading a dose out lowers the peak, and the peak is often what does the harm.
Never change the form or the timing of a modified release tablet yourself; ask the pharmacist first.
Two rough shapes of low mood are worth telling apart: the irritable, restless, crabby kind, and the flattened, heavy, nothing matters kind.
Sometimes what is most missing is not mood but drive: the flat, cannot get started feeling. That can be named as the target in its own right.
Some antidepressants take weeks to build up and weeks to clear, so both the improvement and the aftermath run on a slower clock than you would expect.