Practices

Sometimes what is most missing is not mood but drive: the flat, cannot get started feeling. That can be named as the target in its own right.

Antidepressants lean in different directions, and one or two are weighted more towards the system carrying energy and alertness than towards…

Most antidepressants share a family resemblance. Bupropion does not, so much of what you have read about the others simply does not apply to it.

It works on the systems carrying drive and alertness rather than on serotonin, which is why its effects, wanted and unwanted, sit at an angle to the…

A medicine that lifts drive is not the same as one that settles anxiety, and for some people the energising kind makes the worry louder.

Bupropion is the clearest example: often good for flatness and lack of motivation, often unhelpful on its own when anxiety and a racing, sleepless…

When the same medicine keeps turning up for unrelated problems, that usually means one action touches all of them. It does not mean somebody has found a cure for everything.

Bupropion appears in depression, in stopping smoking, in a weight loss combination and sometimes in attention problems, because the system it works…

If the usual antidepressants have not reached you, there are treatments that work on an entirely different system in the brain. They are worth asking about.

Esketamine, given as a nasal spray in a clinic, acts on glutamate rather than on serotonin or noradrenaline, and the change it brings can arrive in…

The newer thinking about depression is less about topping up a missing chemical and more about connections that have thinned out being rebuilt. Recovery looks more like regrowth than refilling.

Long stretches of depression seem to leave parts of the brain less richly connected, and some treatments appear to work by helping those links form…

When a treatment is offered, it is fair to ask whether it is the licensed version or a use that sits outside the licence, and what monitoring comes with it.

Ketamine for depression is the live example. The doses used are far below anaesthetic ones, the nasal form has approval for treatment resistant…

Before anyone concludes that nothing works, go back over the ordinary explanations: a dose that never went high enough, a trial that stopped after three weeks, doses missed on the hard days.

Treatment resistant has a technical meaning, which is that at least two proper trials at a proper dose and length have failed. A great deal of what…

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…

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…

More of the medicine is not automatically better. What you are looking for is a level that sits inside the working range, and going past it usually brings side effects rather than sharper thinking.

It is a natural thought that if some helps a little, double would help twice as much. In practice people describe the higher dose as flat, or wired,…

If sleep has gone since starting, look at what time the dose is being taken before deciding the medicine is the problem. A long acting dose swallowed at one in the afternoon is still working at bedtime.

Extended release preparations are built to cover eight to twelve hours from whenever they are taken, so a late start pushes the whole thing into the…

Do not compare your dose with anybody else's. Two milligrams of one medicine and a hundred milligrams of another can both be perfectly ordinary, because strength per milligram differs from molecule to molecule.

This comes up in waiting rooms and family group chats and it causes real alarm about being on a lot. The number on the box only means something…

If you are living on campus, ask the pharmacist to split the month's supply across two labelled bottles. Then whichever one you are carrying has a valid prescription label on it.

Carrying a controlled medicine loose in a bag, or in an unlabelled tin, is a disciplinary and sometimes legal problem quite separate from any medical…

If you open atomoxetine capsules to mix the contents into food, keep it away from your eyes and wash your hands afterwards. The powder stings badly.

The molecule is acidic and cannot be softened without falling apart, so the fix is in the handling rather than the chemistry. Take it with something…