Colour in the evening

Some challenging clinical problems to deal with today. The last one was someone who has had a gradually worsening depressive illness for a couple of years. Despite medication. Someone has had him on what has been mischievously called California rocket fuel. A combination of two second generation antidepressants. Regarded by its advocates as the most powerful way to treat depression. Scientific evidence does not support that. I have discussed with him the reality that he has not had a response to this combination, and I have recommended an evidence-based approach, starting with the gradual withdrawal of one of the medications before then reducing the other one and replacing it.

Got home a little later than usual and still went out for a jog. Which is when I saw the rose that features in my blip.