Practices

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The stimulant shortage is not your pharmacy being disorganised. Regulators set a fixed annual quota of the raw material, and the ceiling has been too low to cover the prescriptions being written.

Knowing that changes what you do with your energy. Ringing round twenty chemists is exhausting and it creates no supply, so spend the effort on…

Five minutesMedication and how it worksMedical and treatmentQur’an 9:91One line of research

When a prescription cannot be filled, you can report it to the medicines regulator's shortage inbox, naming the medication and the pharmacy. Nobody writes back, and people often find their prescription turns up soon afterwards.

The value of this is partly practical and partly in not being stuck. Being told no at a counter, month after month, is what makes people quietly…

Five minutesMedication and how it worksMedical and treatmentQur’an 65:3One line of research

Waking your child at six to give the tablet so it has taken hold by breakfast, then letting them fall back to sleep, is not a strange thing you invented because you are failing. It is a reasonable answer to a real gap in how the medicine works.

Families quietly carry a lot of these. The early alarm, the switch to a faster product, the parent who does the whole morning alone because it goes…

Five minutesMedication and how it worksMedical and treatmentQur’an 9:91One line of research

Doing badly on one long acting product does not mean the medicine inside it was wrong for you. The same molecule in a different capsule can behave differently enough to be worth trying before anyone gives up on it.

What gets described as the medicine not working is often the shape of the day being wrong: too slow to start, too abrupt at the end, strongest at the…

Looking for a whole subject rather than a single practice? Start from the nine areas.

The cost of avoiding

Obsessions and compulsions

What worry does

Reading, numbers and learning differences

Breathing

Emotions as signals

Feeling from the inside

Being seen and judged

When you use something to cope

Breaking the worry loop

Treatment and medication

Remembering to do it

Practising under provocation

Bringing the future closer

Growing empathy

Structure and routine

Exercise, food and other supports

Question the thought

Posture and how you carry yourself

When you go numb

Making it stick

When anger turns to harm

Letting it out safely

Self-compassion

Facing it a step at a time

Living with uncertainty

What you are actually defending

Rest and pacing

Panic and the body

Anger, alcohol and the body

Use your strengths

Righteous anger and perfectionism

Five minutesMedication and how it worksMedical and treatmentQur’an 33:5One line of research

People usually stop for one of three reasons: the side effects are not worth it, the price is too high, or the dose was never raised far enough to do anything. The last one is the saddest, because it makes a workable medicine look useless.

If a trial ended with the words nothing happened, it is worth going back over what dose was actually reached and for how long it was held there. A…

Five minutesMedication and how it worksMedical and treatmentQur’an 17:35One line of research

Before anyone concludes that medication does not work for you, check what dose was actually reached. Doses in general practice often stay lower than a specialist would use, and a fair share of so called non responders respond once the dose goes up.

You are allowed to ask this, gently and without any accusation in it: what was the highest dose tried, and how long did it stay there? A trial that…

Five minutesMedication and how it worksMedical and treatmentQur’an 49:6One line of research

If one family of stimulant did nothing, or felt awful, that tells you very little about the other. Methylphenidate and amphetamine work in overlapping but different ways, and plenty of people who do badly on one do well on the other.

Stopping after a single class is one of the commonest routes to believing that nothing helps. Trying the second one is a normal next step rather than…

Five minutesMedication and how it worksMedical and treatmentQur’an 53:28One line of research

A medicine can give you back some energy. It cannot turn a bad situation into a good one, and it helps to be clear which of the two you are hoping for.

If home has been miserable for two years, feeling steadier may just mean you notice the misery more sharply. People often read that as the medicine…

Five minutesMedication and how it worksMedical and treatmentQur’an 21:83One line of research

For someone who cannot swallow tablets, or whose mornings fall apart long before the tablet gets taken, patches exist that release medicine slowly through the skin over hours.

Going through the skin skips the first pass through the liver and smooths out the peak, which changes the timing and sometimes how well it is…

Five minutesMedication and how it worksMedical and treatmentQur’an 5:6One line of research

Much of the progress in these medicines over the past twenty years has been in how the drug is delivered rather than in new molecules. So if one version did not suit you, another form of the same drug can still be worth a try.

People often conclude that a whole class has failed them when what failed was one release pattern: too sharp, too short, too much at once. That is a…

Five minutesMedication and how it worksMedical and treatmentQur’an 33:5One line of research

A pharmacy refusing a valid prescription is often working from a made-up rule or a plain mistake. It can usually be escalated, and it usually resolves fast.

People have been turned away for having a prescriber in the next county, or told the shop does not stock narcotics for a medicine that is not one.…

Twenty minutesMedication and how it worksMedical and treatmentQur’an 5:87One line of research

Medication treats the attention difficulty. It does not teach reading, lift a depression, or repair a household that has been fighting for years.

Those things need treatment of their own, and they are often what the family actually came about. Treating the attention difficulty well can stop…

Twenty minutesMedication and how it worksMedical and treatmentQur’an 21:83One line of research

Smoking runs high in ADHD, and nicotine genuinely does something for attention. It helps to treat that as self-medication rather than as one more impulsive habit.

It changes what a conversation about stopping looks like. If a cigarette is doing a job, taking it away and leaving the job undone is a plan that…

Twenty minutesMedication and how it worksMedical and treatmentQur’an 39:53One line of research

With many of these medicines the unpleasant part turns up on day one and the good part takes weeks. Knowing that in advance is most of what carries people across the gap.

The first fortnight can feel like a bad bargain, because it is one: you pay now for something that arrives later. Put a date in the diary two to four…

Twenty minutesMedication and how it worksMedical and treatmentQur’an 94:5One line of research

Treat the first fortnight as a stretch that needs contact rather than silence. Say plainly that things may feel worse before they feel better, and arrange to hear from the person during that window instead of after it.

This is when most people quietly stop. Somebody who has been warned experiences a rough two weeks as expected; somebody who has not experiences it as…

Twenty minutesMedication and how it worksMedical and treatmentQur’an 3:159One line of research

When a medicine seems to be underperforming, look at what else is in the room before reaching for a higher dose. Anxiety, low mood and a wrecked sleep pattern can each blunt a good response or imitate a poor one.

Otherwise the dose climbs while the real driver goes untreated, and the side effects arrive without the benefit. Ask what a bad night actually looks…

Twenty minutesMedication and how it worksADHD skillsQur’an 16:43One line of research

Being in recovery is not a reason to leave an attention difficulty untreated. The restlessness that made a substance useful is still there once the substance goes.

Clinicians often hold back here, uneasy about a stimulant for someone with a history, and that caution is understandable. The other choice carries a…

LongerMedication and how it worksMedical and treatmentQur’an 21:83One line of research

For a small number of children the question was never about school reports. A toddler who runs into a road and keeps running, a child who climbs the pool fence: what is being weighed there is whether they stay alive.

Most decisions about treating a very young child are finely balanced and deserve to be taken slowly. Where the behaviour itself is life threatening,…

LongerMedication and how it worksMedical and treatmentQur’an 21:84One line of research

If the first medicine disappoints, that is information about the first medicine. Plenty of people who get nothing from one class do well on another.

Methylphenidate and amphetamine are not the same drug at different strengths. They work by partly different routes, so a poor result on one says…

LongerMedication and how it worksMedical and treatmentQur’an 94:5One line of research

Most people who try do find something that helps, but often not the first thing they try. Not responding to one class of stimulant says surprisingly little about the other.

The high response figures you may have read come from people who worked through more than one option, not from one prescription going well. Response…

LongerMedication and how it worksMedical and treatmentQur’an 33:5One line of research