Practices

Every practice in the library, in one list. Narrow it by how long you have, who it is written for, and where you are right now.

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161 practices

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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…

Five minutesWhen everything feels flatMedical and treatmentQur’an 30:50One line of research

Most antidepressants share a family resemblance. Bupropion does not, so much of what you have read about the others simply does not apply to it.

It works on the systems carrying drive and alertness rather than on serotonin, which is why its effects, wanted and unwanted, sit at an angle to the…

Five minutesWhen everything feels flatMedical and treatmentQur’an 16:69One line of research

A medicine that lifts drive is not the same as one that settles anxiety, and for some people the energising kind makes the worry louder.

Bupropion is the clearest example: often good for flatness and lack of motivation, often unhelpful on its own when anxiety and a racing, sleepless…

Five minutesWhen everything feels flatMedical and treatmentQur’an 8:24One line of research

When the same medicine keeps turning up for unrelated problems, that usually means one action touches all of them. It does not mean somebody has found a cure for everything.

Bupropion appears in depression, in stopping smoking, in a weight loss combination and sometimes in attention problems, because the system it works…

Five minutesWhen everything feels flatMedical and treatmentQur’an 41:49One line of research

There is more about low mood and hard feelings than the practices: the low mood and hard feelings area has the themes and the courses too.

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…

Five minutesWhen everything feels flatMedical and treatmentQur’an 39:53One line of research

The newer thinking about depression is less about topping up a missing chemical and more about connections that have thinned out being rebuilt. Recovery looks more like regrowth than refilling.

Long stretches of depression seem to leave parts of the brain less richly connected, and some treatments appear to work by helping those links form…

Five minutesWhen everything feels flatMedical and treatmentQur’an 41:39One line of research

If a treatment reliably produces strange sensations, describe them beforehand. Expected strangeness is far easier to sit through than strangeness that arrives unannounced.

With esketamine, feeling oddly detached from your body or the room is the drug doing what it does, not a sign of harm, and it usually clears within a…

Five minutesWhen everything feels flatMedical and treatmentQur’an 6:125One line of research

When a treatment is offered, it is fair to ask whether it is the licensed version or a use that sits outside the licence, and what monitoring comes with it.

Ketamine for depression is the live example. The doses used are far below anaesthetic ones, the nasal form has approval for treatment resistant…

Five minutesWhen everything feels flatMedical and treatmentQur’an 26:80One line of research

Before anyone concludes that nothing works, go back over the ordinary explanations: a dose that never went high enough, a trial that stopped after three weeks, doses missed on the hard days.

Treatment resistant has a technical meaning, which is that at least two proper trials at a proper dose and length have failed. A great deal of what…

Five minutesWhen everything feels flatMedical and treatmentQur’an 15:56One line of research

Put something in before you take something out. Removing the only way a person has of coping leaves them with nothing, which is not safer.

In practice this looks like smaller steps than a promise to stop: cutting the frequency, changing what is used, agreeing to wait ten minutes and do…

Five minutesWhen everything feels flatParts workQur’an 65:7One line of research

There are around twenty five antidepressants and nowhere near twenty five mechanisms. What comes next is decided mostly by side effects, other conditions, and what has already worked for you.

Which is why your own record is worth more than any comparison chart. Keep a plain list: what you took, at what dose, for how long, what it helped,…

Twenty minutesWhen everything feels flatMedical and treatmentQur’an 2:214One line of research

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.

That has been good for access, and it puts a lot of weight on a very short conversation. Go in with the specifics written down: which symptoms, since…

Twenty minutesWhen everything feels flatMedical and treatmentQur’an 16:69One line of research

When something has helped a little and then stalled, adding a different kind of help often does more than pushing harder on the first one.

That is the thinking behind adding a second medicine with a different action rather than only raising the dose of the first, and it is the same…

Twenty minutesWhen everything feels flatMedical and treatmentQur’an 42:28One line of research

Six to eight weeks is what an antidepressant needs before it can be judged. The first fortnight will mostly tell you about side effects.

The transporter is blocked within hours, so the delay belongs to slower changes further down the line. In practice that means picking a date four to…

LongerWhen everything feels flatMedical and treatmentQur’an 12:110One line of research

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…

LongerWhen everything feels flatMedical and treatmentQur’an 16:127One line of research

A few treatments are only given in a clinic, with someone sitting with you afterwards. The chair and the hours are part of the treatment rather than paperwork.

Esketamine is the current example. It is a nasal spray, given on site, with a monitoring period of about two hours afterwards because blood pressure,…

LongerWhen everything feels flatMedical and treatmentQur’an 94:1One line of research

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…

LongerWhen everything feels flatMedical and treatmentQur’an 12:110One line of research

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…

LongerWhen everything feels flatParts workQur’an 8:24One line of research

When a feeling grips you, name it in one plain word: this is anger, this is fear, this is hurt.

Not a story about why. Just the name. Putting the feeling into a word loosens its hold.

A minuteName what you feelMindfulnessQur’an 3:119One line of research

Give the feeling a number from zero to ten, and watch the number instead of obeying it.

A rating turns a wave you are inside into something you are measuring from the shore.

A minuteName what you feelMindfulnessQur’an 40:19One line of research