Practices

Where ADHD and disordered eating meet, the pattern is more often bingeing, or bingeing and purging, than strict restriction. Restriction tends to travel with over-control, while bingeing travels with impulse and reward seeking.

This matters because the questions asked at assessment are usually the restriction ones, so a binge pattern can sit unnoticed for years. If you…

Pick one small change and leave the rest alone. A full overhaul asks the most of you at the point when you have the least to give, and it usually collapses in the second week.

One change, small enough to be almost boring, kept for a month. Then another. It feels slow while you are in it, and it is the version that tends to…

Health advice usually assumes a kitchen, a fridge and money for the week. If you are working with less than that, the answer is not to try harder at the advice. It is to shrink the plan until it fits what you actually have.

A plan you cannot keep does more than fail. It quietly adds to the pile of evidence that nothing you do makes any difference, and that pile is heavy…

Months of fog, where thinking feels like wading, is a real complaint and deserves looking into rather than waving away. It usually has more than one cause, which is part of why it gets dismissed.

Fog sits where several things overlap: dissociation, anxiety, poor sleep, thyroid and iron problems, infections, medication. Because it belongs…

Very low vitamin D produces fatigue, low mood and a flatness that looks exactly like depression, and it is not part of routine bloods in most places. If you have never had it measured, it is a fair thing to ask for.

One clinician telling this story about himself had a level that was almost undetectable, and no antidepressant would have raised it, because what was…

Before settling on depression as the whole story, ask for thyroid function and vitamin D to be checked. Both are common, both are cheap to test, and an underactive thyroid produces a picture that looks like depression from the outside.

An untreated thyroid problem also blunts how well antidepressants work, so missing it can mean months on a treatment that was never going to do the…

Before settling on a purely psychological account of months of anxiety or broken sleep, it is worth having the ordinary bloods done. Low iron, low vitamin D or low magnesium can produce symptoms that look exactly like a mental health problem.

This is not about swapping therapy for supplements. It is about not spending a year working on something a blood test could have partly explained. If…

If your body has something going on as well, try to get both looked after at the same time rather than in a queue. Therapy for what happened to you does not have to wait for your gut to settle, and it often goes better when the two run side by side.

Plenty of people park the physical thing while they do the psychological work, or the other way round, then wonder why progress keeps sliding back. A…

Low mood that arrives with bloating, fatigue and a foggy head is worth looking at from the food side too. An immune reaction to something you eat regularly can produce all three, and it gets labelled depression far more often than it gets tested.

The point is not to start cutting foods out on a hunch. It is to say the possibility out loud to a doctor, particularly if the gut symptoms and the…

There is a particular relief in hearing a room of strangers admit the same frightened thing you have never said aloud. It is why groups reach people that advice does not.

You go in expecting contempt. What comes back is usually recognition, along with a few nods from people who have been ruder to their families than…

If the worst part of low mood is that your thinking has gone foggy, say so specifically. Concentration can be treated as a target of its own rather than as something that will tidy itself up later.

Depression and attention problems overlap enough that the fog often gets filed under whichever label arrived first. Naming it separately gives you…

Heaviness in the body, aching, and a tiredness that sleep does not touch are part of low mood. They are not a separate complaint to raise another time.

There is a group of antidepressants that add a second action aimed partly at these bodily symptoms, which is one reason a prescriber may lean that…

Before deciding a medicine did not work, check that it was taken at a dose and for a length of time that could have worked.

Venlafaxine is the standard example. At low doses it behaves much like a plain SSRI, and the second mechanism people choose it for only comes in…

If pain is part of what you are carrying, bring it into the same conversation as the low mood. They are not two separate appointments.

The pathways that dampen pain and the ones involved in mood overlap, and one of the antidepressants is licensed for nerve pain and long term…

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.

Antidepressants lean in different directions, and one or two are weighted more towards the system carrying energy and alertness than towards…

If the usual antidepressants have not reached you, there are treatments that work on an entirely different system in the brain. They are worth asking about.

Esketamine, given as a nasal spray in a clinic, acts on glutamate rather than on serotonin or noradrenaline, and the change it brings can arrive in…