Practices

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…

Coming off an antidepressant is a piece of work in itself. Plan it slowly with the prescriber rather than stopping on the day you feel well.

Some, venlafaxine especially, leave the body fast enough that a missed dose is felt within a day: dizziness, strange electrical sensations, a mood…

When a feeling grips you, name it in one plain word: this is anger, this is fear, this is hurt.

Not a story about why. Just the name. Putting the feeling into a word loosens its hold.

Give the feeling a number from zero to ten, and watch the number instead of obeying it.

A rating turns a wave you are inside into something you are measuring from the shore.

Under the anger, name the softer feeling: often it is fear, or hurt, or feeling unseen.

Anger is a bodyguard. Name what it is guarding, and it begins to soften.

Going still and needing nothing is usually something a person worked out young, somewhere it was the sensible answer.

If reaching out met dismissal, or worse, then not reaching out is not a flaw of character. A child who stops asking, stops showing what they feel and…

Take the thought that is upsetting you and ask: what is another way to read this?

The event is fixed; the meaning is not. A second reading often fits the facts and hurts less.

Notice when you have jumped to the worst story, and hold it as a guess, not a fact.

They meant to hurt me, this always happens. Label these as theories, then look for evidence.

At the end of a stretch of thinking like this, ask yourself plainly what you believe about yourself now, and how that differs from an hour ago.

Shifts that go unnamed tend to have evaporated by the evening. Saying the new version aloud, or writing a single sentence of it, turns it into…

Name one hard thing today and ask what it might be growing in you: patience, humility, nearness to God.

Not denying the difficulty. Finding the meaning inside it that makes it bearable.

A belief you have carried since childhood will not fall over because you asked it a good question this afternoon. You are planting something, not winning an argument.

The temptation, once a thought starts to look flimsy, is to press harder, and pressing usually makes the belief dig in. Leave the question where it…

When an urge rises, neither fight it nor obey it. Watch it like a wave: it peaks and it falls.

The urge to snap, to check, to give in. Name it, breathe, and let it crest and pass.

Before acting on a strong impulse, wait ten slow breaths. Decide after, not during.

The peak of an urge is brief. A short, deliberate delay lets the thinking mind back in.