Practices

A bridge year can be a deferred place, a course at the local college, a job, or a stretch of genuinely doing very little. That last one is a real option and not a refusal to choose.

For someone who has just come apart, a fresh demand can restart the same collapse, so a few months with nothing scheduled is sometimes the…

The next step has to be theirs. A job that looks like nothing to you might be the first thing in two years they chose without being pushed, and that is exactly why it holds.

Parents tend to want the step that recovers the lost ground. The young person needs the step they can actually take on Monday. Shifts in a shop, one…

This is not a milestone you pass. The two year old's version goes, then a version comes back at twenty two, and again at fifty two, wearing whatever clothes that stage of life provides.

So think maintenance rather than course completion. When conditions change, a new baby, a new manager, an illness in the family, expect the old…

If reminders, other people's deadlines and a bit of chivvying are what keep you moving, you are allowed to keep them. Inner drive arrives later for some of us, and taking the scaffolding away early does not hurry it along.

Families often pull the supports back on a birthday, as though a certain age should switch on self-direction. What tends to happen is that the only…

Coming off an antidepressant is a piece of work in itself. Plan it slowly with the prescriber rather than stopping on the day you feel well.

Some, venlafaxine especially, leave the body fast enough that a missed dose is felt within a day: dizziness, strange electrical sensations, a mood…

With the fast acting treatments, the plan for what happens afterwards matters as much as the treatment itself.

Electroconvulsive therapy can shift severe depression quickly, and without something in place afterwards the relapse rate is high, which is why…

Sometimes the honest answer is that there is nothing in your surroundings to feel good about. Changing them counts as treatment, not as running away.

A life with no friends nearby, no work that means anything and a steady drip of criticism will produce low mood in most people, and skills practised…

Finding the dose is a search rather than a calculation. It goes up in small steps until either the effect you want turns up, or the side effects get annoying enough that you come back down a step and settle there.

There is no way to work the right dose out from body weight or from how bad things look, which surprises people who expect medicine to be more exact…

One of the founding figures of biological psychiatry summed the whole business up as some medicine helping some people at some doses some of the time. Knowing that before you start makes the first disappointment much easier to survive.

Most people need more than one adjustment: the dose, then the timing, sometimes the drug itself. Go in expecting the first prescription to be the…

If every step you try keeps not working, however small you make it, that is information rather than failure. A more intensive programme is the next thing to look at, and it should be put to you as an option.

The whole point of shrinking the steps is to find one that moves. When nothing moves at any size, staying in the same weekly arrangement out of…

The strengthened warning on this class covers misuse, addiction, physical dependence and withdrawal. The part most people miss is that dependence builds with ordinary correct use over weeks, with nobody doing anything wrong.

That distinction needs handling gently, because patients hear dependence and hear addict. Physical dependence is the body settling around something…

Walking away from a course or a job that was never going to fit can be the sensible move rather than a failure of nerve. It is also frightening, particularly when other people are paying for it.

Fit does more work here than effort does. The person who cannot survive a rigid nine to five in an open plan office may be excellent somewhere with…

Some people book their first assessment on the day they turn eighteen, because it is the first day they can consent without a parent. If you have been waiting like that, the waiting was not laziness.

Where a family or a community treats mental health care as shameful, a young person can spend a decade struggling with nobody's permission to ask for…

You cannot work out in advance what will light you up. The only reliable method is a wide and slightly undignified search: many activities, many people, plenty of reading and watching, until something catches.

This means giving yourself permission to try things badly and drop them, which is hard if you have been told all your life that you never finish…

Far more people have ADHD than are ever assessed for it. If you have wondered about yourself for years, the odds that an assessment would be worth your time are better than you think.

The usual fear is being told you are making it up, or wasting a professional's morning. In practice adults are missed far more often than they are…

There is no age at which finding out stops being worth it. People have been diagnosed in their eighties and described it as the first explanation that ever fitted.

A late diagnosis will not give back the jobs or the years, and it is fair to grieve those. What it does is rewrite the story: not a person who kept…