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…

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…

Before going towards a hard feeling, decide what will hold you while you are inside it: a way of breathing, a way of standing, a sentence, a person you can picture or ring.

Going in with nothing is not brave, it is flooding, and it teaches your system that feelings really are dangerous. Pick two or three supports in…

Whoever is going to do the feeling picks what to work with. The tightness in the chest, the closing throat, the anger, the grief, whichever one they are ready for today.

Choosing keeps the person in charge of the dose, and being in charge is a fair part of what makes this different from whatever happened to them. If…

Say it out loud before you start: you decide how much of this you feel, and when. Stopping for a bit is part of the plan, not a failure of it.

Being in charge of the dial is most of what separates useful contact with a hard feeling from being flooded by it again. If you are helping someone,…