Areas › Low mood and hard feelings › When everything feels flat
Some antidepressants take weeks to build up and weeks to clear, so both the improvement and the aftermath run on a slower clock than you would expect.
Fluoxetine is the usual example. It and the substance it turns into stay around a long time, which means a fair trial is counted in weeks and stopping does not empty it out of you by the weekend. Two practical things follow. Do not judge it after a few days, and tell any new prescriber what you have taken recently even if you stopped a month ago, because some combinations are unsafe while the old drug is still in you.
Qur’an and Sunnah
When will God's help arrive? Truly, God's help is near (Quran 2:214). Even the believers asked the question out loud, and near did not turn out to mean immediate.
أَمۡ حَسِبۡتُمۡ أَن تَدۡخُلُواْ ٱلۡجَنَّةَ وَلَمَّا يَأۡتِكُم مَّثَلُ ٱلَّذِينَ خَلَوۡاْ مِن قَبۡلِكُمۖ مَّسَّتۡهُمُ ٱلۡبَأۡسَآءُ وَٱلضَّرَّآءُ وَزُلۡزِلُواْ حَتَّىٰ يَقُولَ ٱلرَّسُولُ وَٱلَّذِينَ ءَامَنُواْ مَعَهُۥ مَتَىٰ نَصۡرُ ٱللَّهِۗ أَلَآ إِنَّ نَصۡرَ ٱللَّهِ قَرِيبࣱ
Do you suppose that you will enter the Garden without first having suffered like those before you? They were afflicted by misfortune and hardship, and they were so shaken that even [their] messenger and the believers with him cried, ‘When will God’s help arrive?’ Truly, God’s help is near
Qur’an 2:214read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
Research here is measured over long stretches rather than days. Pooling individual patient data from nine trials, mindfulness based cognitive therapy lowered the risk of depressive relapse over 60 weeks and performed comparably to staying on maintenance antidepressants. Whether something is working, in this field, is a question answered over months.
Willem Kuyken; Fiona C Warren; Rod S Taylor; Ben Whalley; Catherine Crane; Guido Bondolfi (2016). Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse. JAMA Psychiatry doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
A drug that leaves the body slowly is still acting long after the last dose.
When not to
If stopping or switching is on the table, work the timing out with the prescriber rather than alone.
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
Some newer antidepressants do two jobs in a single tablet: the familiar one of keeping serotonin available, plus a direct nudge at the receiving end.
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.
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.