Practices

Ask open questions that cannot be answered yes or no, then really listen to the answer.

Tell me the story of that opens the heart. Follow up on what you hear instead of waiting to talk.

Hold your advice until you fully understand, or until it is asked for. Understanding always comes before solutions.

Words of understanding must precede any words of advice. Always. Fix later, if at all.

Say back what you heard, then validate: I hear you saying this, and it makes sense you would feel that way.

Validation is not agreement. It is showing you understand even part of their experience.

Take your love needs to your partner, not outside the relationship. Going outside almost always makes it worse.

When something is missing, ask for it at home. Seeking it elsewhere deepens the wound.

You can say what an SSRI does in one sentence. It blocks the doorway that carries serotonin back out of the gap between two nerve cells, so more of it stays there for longer and is likelier to be picked up.

Worth being able to say plainly, because most people are carrying something vaguer and more frightening than that. It also sets a fair expectation.…

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…

Serotonin syndrome comes from stacking, and the second agent is usually something nobody thought to mention: a migraine tablet, a cough medicine, a herbal remedy for low mood.

Triptans, tramadol, dextromethorphan, linezolid and St John's wort all count, as do other antidepressants. Someone who mentions in passing that they…

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…

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…

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 a young driver in your house takes medication, the dose and the car keys belong together. Driving is the everyday task where one lost second costs the most.

The gap tends to open at weekends and in the holidays, when the dose gets skipped because there is no school and then someone drives anyway. Make it…

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…

Stand up slowly. Getting off the floor after an hour of gaming, or out of bed in the morning, is where the dizziness tends to catch people.

A drop in blood pressure on standing is common enough with these medicines and it frightens people, because a near faint feels like something serious…

If swallowing the capsule is the sticking point, ask whether yours is the bead type that can be opened and tipped onto a spoonful of soft food. The little beads go down unchewed and the medicine still lasts as long as it should.

Inside these capsules sit lots of coated pellets, some with thin coats that dissolve early and some with thicker coats that dissolve later, which is…

The skin patch comes with two things worth knowing before you start. Take it off several hours before bedtime or it keeps delivering and sleep goes, and around one person in six gets a rash bad enough to stop.

The upside is real control over the length of the day. Because the medicine stops arriving soon after the patch comes off, the removal time is yours…

There is now a version taken in the evening that only switches on around nine hours later, so it is already working when you wake. The point of it is the morning, not the night.

Most families know the first hour of the day as the worst one, because the tablet taken at breakfast has not started yet and everyone still has to…

With a bedtime dose, the clock is the dose. Give it too early and the medicine switches on in the small hours, which buys you a child awake at half past four and no appetite at breakfast.

The ordinary effects still apply: appetite tends to dip around the middle of the day and sleep can be harder to come by. What changes is that one…