Practices

The blockade is partial. Serotonin is not trapped in there forever: enzymes still break it down and the transporters that are not blocked carry on working.

That matters for accuracy and it matters for reassurance, because people do picture something flooding and stuck. It also explains why serotonin…

When someone says they react badly to normal doses of almost everything, take it as information about their body rather than as a personality trait.

Bodies differ in how fast they break a medicine down. Give two people the same dose and one of them may be holding far more of it for far longer,…

Whether a medicine works can turn on something as ordinary as taking it with food or moving it to bedtime.

Vilazodone is the clear case. On an empty stomach a good deal less of it is absorbed, and the nausea it can cause is easier to sit with overnight…

If a medicine leaves you wired, restless or with a pulse that will not settle, report it rather than tolerating it quietly.

The antidepressants that act on noradrenaline as well as serotonin can raise blood pressure and put nerves on edge, and with some of them that grows…

The same medicine can be dangerous given one way and safe given another. Slow release is not a marketing word.

Bupropion was pulled from the market over seizures and came back once a slow release form existed, because what drove the risk was the sharp peak…

Try putting a sentence between you and the mood: this is what my brain is doing right now. It does not make me a bad person, and it does not mean I cannot cope. It just feels that way today.

Low mood does not arrive labelled as a mood. It arrives as facts about you, that you are useless, that nobody wants you around, and it is very hard…

The chemistry story runs backwards from how it is usually told. Nobody found a low chemical and then built a drug. They noticed what certain drugs did to mood and reasoned back to what must have been missing.

Reserpine emptied out the monoamines and people became depressed. Iproniazid and imipramine raised them and mood lifted. Out of that came the account…

Depression is not one thing with one address. Fatigue, blank concentration, lost libido and the loss of pleasure do not all come from the same place, so it helps to name which one you most want moved.

This is why two people with the same diagnosis get offered different tablets. A flat, pleasureless presentation points one way, a fatigued and achey…

Nearly all of them do the one thing: keep a monoamine hanging about in the synapse for longer. So when you hear that some other tablet is stronger, be a little sceptical.

Head to head, the differences in how much they lift mood are modest. Where they really differ is in everything else they do to you, and in how well…

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…

Stopping suddenly can bring lethargy, nausea, irritability and headache within a few days. That is discontinuation, not the illness coming back.

Timing is the giveaway. Withdrawal starts within days of the last dose and often has a particular feel to it: dizziness, odd electrical zaps, a…

Discontinuation gets mistaken for relapse constantly, by clients and by clinicians. The mistake runs in both directions and both directions cost something.

Read withdrawal as relapse and a person concludes they will need the tablet for life, when what they needed was a slower taper. Read a real relapse…

Never come off an antidepressant on your own. The taper belongs to the prescriber, and for some drugs it needs to be slower and longer than people expect.

The moment to raise this is before anybody acts, not afterwards. If a client is feeling better and starting to think about stopping, that thought is…

Four things carry most of the difference within the class: how much it sedates, how much it activates, what it does to weight, and what it does to sex.

Before anything is chosen, write down which of the four you cannot live with. Almost nobody is neutral about all four, and the one you will not…

A genetic test can tell you how quickly your body clears a medicine. It cannot tell you whether that medicine will lift your mood, and it helps to keep those two questions apart.

Where these panels earn their place is in dosing and tolerability. Someone who breaks a drug down slowly may need less of it, and someone who clears…

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…

No option comes without a cost. The useful question is not which medicine has side effects, it is which side effects you could live with.

One drug may unsettle your stomach for a fortnight and leave your sex life alone. Another may be kind to the stomach and flatten desire for as long…

If the worst part of low mood is that your thinking has gone foggy, say so specifically. Concentration can be treated as a target of its own rather than as something that will tidy itself up later.

Depression and attention problems overlap enough that the fog often gets filed under whichever label arrived first. Naming it separately gives you…

Heaviness in the body, aching, and a tiredness that sleep does not touch are part of low mood. They are not a separate complaint to raise another time.

There is a group of antidepressants that add a second action aimed partly at these bodily symptoms, which is one reason a prescriber may lean that…

Before deciding a medicine did not work, check that it was taken at a dose and for a length of time that could have worked.

Venlafaxine is the standard example. At low doses it behaves much like a plain SSRI, and the second mechanism people choose it for only comes in…