Practices

When your partner talks, shift the focus off yourself. It is not about being interesting, it is about being interested.

Postpone your own agenda for a while. Tune into their world before you bring yours.

Try to see the situation from your partner's side, not your own. Assume there is a good reason they feel as they do.

Their reality has its own validity. Start by looking for why it makes sense, not why it is wrong.

Ask open questions that cannot be answered yes or no, then really listen to the answer.

Tell me the story of that opens the heart. Follow up on what you hear instead of waiting to talk.

Hold your advice until you fully understand, or until it is asked for. Understanding always comes before solutions.

Words of understanding must precede any words of advice. Always. Fix later, if at all.

Say back what you heard, then validate: I hear you saying this, and it makes sense you would feel that way.

Validation is not agreement. It is showing you understand even part of their experience.

Take your love needs to your partner, not outside the relationship. Going outside almost always makes it worse.

When something is missing, ask for it at home. Seeking it elsewhere deepens the wound.

Under every complaint or hard feeling there is a longing. Listen for the wish underneath.

Behind the anger or sadness is a desire. Find the longing and you find what they actually need.

Do not stay hidden. Tell your partner about your day, your worries, your inner world.

Hiding your reality to protect them keeps you strangers. Let them know you.

You can say what an SSRI does in one sentence. It blocks the doorway that carries serotonin back out of the gap between two nerve cells, so more of it stays there for longer and is likelier to be picked up.

Worth being able to say plainly, because most people are carrying something vaguer and more frightening than that. It also sets a fair expectation.…

The blockade is partial. Serotonin is not trapped in there forever: enzymes still break it down and the transporters that are not blocked carry on working.

That matters for accuracy and it matters for reassurance, because people do picture something flooding and stuck. It also explains why serotonin…

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.

Triptans, tramadol, dextromethorphan, linezolid and St John's wort all count, as do other antidepressants. Someone who mentions in passing that they…

When someone says they react badly to normal doses of almost everything, take it as information about their body rather than as a personality trait.

Bodies differ in how fast they break a medicine down. Give two people the same dose and one of them may be holding far more of it for far longer,…

Whether a medicine works can turn on something as ordinary as taking it with food or moving it to bedtime.

Vilazodone is the clear case. On an empty stomach a good deal less of it is absorbed, and the nausea it can cause is easier to sit with overnight…

The same medicine can be dangerous given one way and safe given another. Slow release is not a marketing word.

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…

The chemistry story runs backwards from how it is usually told. Nobody found a low chemical and then built a drug. They noticed what certain drugs did to mood and reasoned back to what must have been missing.

Reserpine emptied out the monoamines and people became depressed. Iproniazid and imipramine raised them and mood lifted. Out of that came the account…