Practices

Attention problems often travel with anxiety or low mood, and those two eat working memory as well. Settling that layer can make everything else look quite different.

If you are anxious most of the day you will lose track of things, forget what you came into the room for and struggle to hold a plan, whether or not…

Nobody sees the times you did not say the cutting thing, including you a week later. Put them somewhere you can look at: one sticky note on the wall for each.

Memory is unfair about this. The single evening you lost your temper stays vivid while thirty quiet successes disappear, and then it feels as though…

If you held back at four o'clock and then snapped at seven, the holding back still happened. A later slip does not reach backwards and cancel it.

All or nothing scoring is the quickest route from one lapse to giving the whole thing up: I lost it, so none of it was working, so why bother. Count…

The aim is not to stop feeling angry. It is to stretch the time between the feeling arriving and you doing anything about it, from no seconds to a few.

That target has the advantage of being honest and checkable. You can ask whether you got a moment this time that you did not get last time. The anger…

One move to interrupt, one to settle. Open your hand, then take the slow breaths: the first buys you the gap and the second gives you something to do with it.

An interrupt on its own leaves you standing there, aware and still flooded. A settling practice on its own never gets going, because the moment goes…

The old angry route does not get deleted. What you are building is a rival route beside it, and at the start the new one is small.

Expect the old path to show up when you are tired, ill or caught off guard, because it is still there and it is well worn. That is not proof the work…

This goes the way learning a bicycle went. You could not, then you could but only with all of your attention, then one day you rode without thinking about it. The middle bit is the ugly bit.

In that middle phase the skill works but it costs you everything to use, and it looks clumsy from the outside. That is where most people decide it is…

Some people get all the way to university before anything is named, then meet eighty pages of reading a night and cannot do it. Nothing broke that night. The volume simply outgrew a way of coping that had held for years.

The history reads the same way every time afterwards: always needed longer, avoided reading aloud, dreaded timed tests, stomach trouble in exam…

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…

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…

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…

If pain is part of what you are carrying, bring it into the same conversation as the low mood. They are not two separate appointments.

The pathways that dampen pain and the ones involved in mood overlap, and one of the antidepressants is licensed for nerve pain and long term…

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…

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…

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…

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…