Areas › Low mood and hard feelings › When everything feels flat
SSRIs became the default for four reasons, and being more effective is not among them. They are easier to tolerate, taken once a day, far safer in overdose, and cheap as generics.
Tricyclics match them for lifting mood and are dangerous in overdose because of what they do to the heart. MAOIs carry food and drug interactions that need real vigilance. So the class that won, won on safety and on being liveable. If somebody asks whether they have been given the best one, the honest answer is that they have been given the safest one to start with.
Qur’an and Sunnah
'It is in the remembrance of God that hearts find peace' (Quran 13:28). What settles a heart is something a person can return to again and again, which is also the test of a treatment.
ٱلَّذِينَ ءَامَنُواْ وَتَطۡمَئِنُّ قُلُوبُهُم بِذِكۡرِ ٱللَّهِۗ أَلَا بِذِكۡرِ ٱللَّهِ تَطۡمَئِنُّ ٱلۡقُلُوبُ
those who have faith and whose hearts find peace in the remembrance of God- truly it is in the remembrance of God that hearts find peace
Qur’an 13:28read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
A small randomised trial of gentle yoga for women with major depression measured acceptability alongside symptoms, and found the programme acceptable as well as associated with less rumination and fewer symptoms. It was feasibility scale, so the symptom findings are preliminary. The reason it sits here is that acceptability was treated as an outcome in its own right, which is the same logic behind choosing a first line drug on tolerability.
Kinser PA, Bourguignon C, Whaley D, Hauenstein E, Taylor AG. (2013). Feasibility, acceptability, and effects of gentle Hatha yoga for women with major depression: findings from a randomized controlled mixed-methods study.. Archives of psychiatric nursing doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
A treatment only helps if the person can actually keep taking it.
This one is still a draft. It is waiting on a scholar and a clinician to read it before it is published.
Near this one
With the fast acting treatments, the plan for what happens afterwards matters as much as the treatment itself.
If you know something about a person's history that the prescriber may not, say it. A past eating disorder or a single seizure can change what is safe to prescribe.
One person's side effect is another person's treatment. Sedation is a burden for someone who cannot get out of bed and a gift for someone who cannot get to sleep.