Practices

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,…

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…

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…

For some young people self-harm carries something besides relief: belonging, recognition, a name for who they are among friends who do the same.

That is uncomfortable to sit with and it changes what helps. If a behaviour is the reason someone feels understood, taking it away without touching…

Ask what the behaviour does for them, and then ask how they would like to feel instead. Both questions open more than telling them to stop ever does.

The first question maps what is being managed: numbness, rage, panic, a need to make something visible. The second gives you a goal in their words…

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…

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…

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,…

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…