Practices

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…

The standing side-effect list is sexual difficulty, less appetite, an unsettled stomach, disturbed sleep and headache. Sexual side effects are common, and almost nobody raises them unprompted.

So ask directly, and ask about sleep while you are there. People do not usually announce these things. They quietly stop taking the tablet and say…

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…

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.

Read the comparison charts that way and they stop being lists of harms. They turn into a set of levers: this one settles, this one gets you moving,…

Two rough shapes of low mood are worth telling apart: the irritable, restless, crabby kind, and the flattened, heavy, nothing matters kind.

They ask for different things. The agitated version often tolerates and even welcomes something sedating, while the flattened version needs whatever…

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…

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.

This is worth knowing because it explains what a person actually feels. A drug with a second action brings a second set of effects, wanted 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…

Raising a dose does not simply raise the benefit. It raises everything the drug does, including the parts nobody was asking for.

As the amount climbs, a medicine begins touching things it barely touched before, which is why new side effects can appear at a higher dose of…

A newer version of a familiar medicine is usually a tidier version rather than a leap, and tidier is still worth something.

Desvenlafaxine is venlafaxine after the liver has done its work, given directly. The point of that is fewer differences between people who process…

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…

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.

Bupropion lowers the seizure threshold, and in someone who is purging, restricting or very underweight that risk climbs meaningfully. The therapist…

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…

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…

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…

For some young people self-harm carries something besides relief: belonging, recognition, a name for who they are among friends who do the same.

That is uncomfortable to sit with and it changes what helps. If a behaviour is the reason someone feels understood, taking it away without touching…

Ask what the behaviour does for them, and then ask how they would like to feel instead. Both questions open more than telling them to stop ever does.

The first question maps what is being managed: numbness, rage, panic, a need to make something visible. The second gives you a goal in their words…