Practices

If stopping has been harder for you than it seems to be for other people, that is worth taking seriously rather than reading as a flaw in your character.

Some people are working against more than a habit. The thing they are giving up was quietly doing a job for them, holding attention steady or keeping…

Skin prick and IgE blood tests find real allergies. The IgG food sensitivity panels sold direct to families have not been shown to measure sensitivity at all, and they tend to come back with a long list of foods to avoid.

IgG antibodies mostly show that you have eaten something, not that it harms you, which is why the results look alarming and change so little when…

Put an actual number on it: how many coffees, teas, energy drinks and colas in a normal day. Without that number, your sleep problems, your anxiety and how well a medication is working are all being read against an unknown.

People underestimate this, partly because it feels embarrassing and partly because a large takeaway cup is often two or three servings. Count across…

Stimulants sharpen focus in almost anyone, so responding well to one does not confirm you have ADHD. The diagnosis comes from your history and how you function, not from a trial of tablets.

This cuts both ways. Someone can be handed a diagnosis on the strength of a good response, and someone else can be doubted because their response was…

Food and movement are powerful, and hardly anyone keeps them up as prescribed. So the question is not what works best on paper. It is what you will still be doing in six weeks.

Roughly a third of people follow a prescription exactly as it is written, and keeping to a diet or an activity plan goes worse than that. Which means…

Working out what you have comes before choosing what to take. The right remedy for the wrong condition is still the wrong remedy, however good the remedy happens to be.

The health food shop route usually starts with a self diagnosis, and that first step is the one worth slowing down. St John's wort will do nothing…

Supplements are regulated as food rather than as medicine. Nobody checks strength or purity before a product goes on sale, and the main rule is that the packet cannot claim to treat a disease.

Most people assume the opposite, that anything on a pharmacy shelf has been through some kind of approval. Regulators here generally act only once a…

When researchers ran DNA testing on 13 herbal products, only 2 contained the plant on the label. Three had none of it at all, and several were padded out with rice, soy or wheat that nobody had declared.

The obvious problem is paying for something you did not get. The quieter problem is the undeclared filler, which matters a great deal if you avoid…

If you are going to buy supplements, look for an independent verification mark: USP Verified, NSF, or a product tested by ConsumerLab. It is the nearest thing available to the check that regulators do not carry out.

Those schemes test identity, strength, purity and how a product was made, and manufacturers pay to take part voluntarily. There are different tiers,…

St John's wort can cut the effectiveness of the contraceptive pill by around a third. If you take both, that is worth knowing today rather than finding out later.

It speeds up the way the liver clears certain drugs, so the pill is not the only thing affected. Warfarin, some HIV medicines, ciclosporin and a…

Some of these do have real evidence behind them. St John's wort has repeated support in mild to moderate depression, SAMe and methylfolate have reasonable backing as additions to treatment, and omega-3 has looked weaker in the larger and better run trials.

That last part is worth sitting with, because it is what usually happens. An early promising effect shrinks as trials get bigger and better…

If you want to use herbal remedies, two things carry most of the risk. Make sure whoever prescribes for you knows what you are taking, and buy from a source that has been independently tested.

That is a short list on purpose. Nearly all the harm in this area comes from an interaction nobody knew about or a product that was not what it…

Water, sleep, food and digestion are not the boring preamble to the real work. When those are running badly, everything else you try has less to work with.

It can feel almost insulting to be asked about breakfast when what you carry is so much bigger than breakfast. But a body short of sleep and short of…

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…

Match the tablet to the person rather than to the diagnosis. For someone flattened and slowed who has said clearly that they will not accept sexual side effects, paroxetine is close to the worst choice available.

It is the most sedating in the class, the least activating, and carries a high risk of exactly the effect they ruled out, with weight gain and the…

If you are the therapist, hand the prescriber the profile and leave them the pick. What you hold that they do not is what this person is like across a week, and what they will absolutely not tolerate.

So write those two things down and send them: the presentation, in plain description rather than jargon, and the non-negotiables. Not a drug name.…

If a treatment reliably produces strange sensations, describe them beforehand. Expected strangeness is far easier to sit through than strangeness that arrives unannounced.

With esketamine, feeling oddly detached from your body or the room is the drug doing what it does, not a sign of harm, and it usually clears within a…

Stimulant medication does not install an ability you did not have. It raises how much signal is available at the junctions between nerve cells, so the circuits you already own can hold that signal long enough to use it.

Messages pass between nerve cells across a tiny gap, carried by chemicals that are released and then taken back up again. These medicines mostly slow…

These medicines have been in use since roughly the 1930s, so there is far more accumulated experience with them than with most psychiatric drugs. That does not settle every question, but you are not part of an experiment.

The length of that record is worth having in mind when somebody hands you an alarming claim about what stimulants do across decades. It is also worth…

Worry about height is one of the commonest reasons families hesitate. The answer is to measure: height and weight plotted at every review, so you are watching an actual line rather than guessing at one.

Growth speeds up and slows down for all sorts of reasons during the years a child might be medicated, and one measurement tells you almost nothing. A…