Really? Adhoms and ignorance. Nothing to really reply to here.
How long have you been in the mental healthcare "game" and how many psych visits have you had? I've been in mental healthcare since 6 yrs old, and had 19 psych visits throughout my adult life, two were state hospitals which were 6 months and 8 months. So talk from "experience", not your ass.
The point I was trying to make about it being a sort of guess work as you have said, it's a complex interplay of all kinds of factors for each complex individual making it IMPOSSIBLE to adequately treat or even at times diagnose the source or deeper causes. So it is...guess work to a large degree. No matter what methods of practice are being used you cannot predict or determine how a drug like Zyprexa will interact with X person's brain chemistry and thusly side effects or even lifelong issues that will be caused by that drug...you can't 99% predict it. It is not a mathematical science, where you can predict things down to the exact decimal placement. So my advice was, it's guess work to a very large degree considering how the drugs are administered, overseen and even allowed into the market through the FDA. Surely you're aware of the scandals there. So please don't try to convince me that there's some secret methodology than what I've experienced in units and in doctor's offices firsthand. But my other point was, educate yourself first, you'll find a VAST storehouse of knowledge, firsthand accounts, side effects, drug interactions, and rare side effects simply by researching it yourself, rather than relying on a doctor to do it for you. That way, you can make more positive, well informed, proactive decisions about a drug or even just be able to ask the doctors the needed questions that most patients wouldn't know to inquire about.
And yeah, I've been a benzo addict for about 8 years now, heavily and prescribed by my psychiatrist. The consensus was, I was less of a danger to myself and others on them than without them, since my psychopathy and homicidal/suicidal tendencies are and have been medication resistant since I was a child. Nothing works, quite simply except getting me loaded. And even then, my "Prick levels" goes from 10 off benzo's/Ambien to about 7 on a good day with them. And yeah, I've been driving for years on benzo's they barely effect any kind of motor skills now, I'm that tolerant at this point. I'd need 20mg of Xanax to even start making me bump into walls anymore. And to sleep, I drink, or I pop a couple Seconals.
I don't know why you felt the need to establish your mental health cred with Filler. You don't know anything about him, A. B, is there a contest? Is the person with the most time in treatment the winner of any argument? We want to welcome all sorts of posters, with all sorts of experiences, and have great discussion, but we draw a line at ANY advice that is going to hurt people. We've been very prickly about it in the past. We'll be prickly about it in the future.
Your whole point about talking from experience is a real problem in healthcare. Patients with problems that are particularly difficult to treat (or with bad experiences with healthcare) can end up personalizing the disease(s) to an unhealthy degree. Your experiences are your own. They matter more than anything to you, but it's very frustrating when people who, say, responded poorly to Prozac, pop up in every fucking thread to go "NEVER TAKE PROZAC, BRO!" You get by on a level of benzos that most physicians would shit themselves about. It works for you? Alright. People got a little prickly when you made the leap to "ask me how to score benzos, that's really all that works." I'm not you. FillerB isn't you. No one else is you. When we advise from personal experience, we should be very clear about that. I try to wear the different hats of someone with some healthcare experience, who has done research in receptor biology and addiction, who just cares about people in here in general, and as a sufferer of depression. I TRY (but certainly fail at times) to say "The research demonstrates x," vs "My experience with x was...," vs. "x really worked for me, and based on what you've told me, I think it might be a good option for you..." vs. "In the clinic, we would do x..."
The suggestion that the complexity of psychiatric disorders makes them "IMPOSSIBLE" to treat or diagnose is ludicrous. If the standard for a drug is to be able to predict, with 99% certainty how it will affect you, healthcare is done for. Nothing is that good. Not even close. BUT! It's getting better in all areas of medicine. "Individualized medicine" is the buzzword. In some areas it's more a dream than anything, but even in psychiatry, genomic testing has come into standard practice. You can look at cytochrome p450 variations and know how their body will break down all sorts of drugs. Will the drug get rapidly degraded, meaning you need a higher dose? Or will it linger way longer than it does in the average person, meaning normal dosing is going to be a disaster? There's more work on genetic polymorphisms in receptors, enzymes, etc etc going on.
From my main research, which was on the receptor that nicotine binds to in the brain (we focused mainly on the form that your body uses to make your muscles work - the body reuses stuff like mad!), for hereditary myasthenic syndromes (basically inherited conditions in which the muscles fatigue very rapidly) it was once a crapshoot with the drugs. Interestingly, at the receptor level, two completely opposite problems give rise to the same phenotype. If you have a fast-channel syndrome, the drug that blocks your channels does wonders. If you have a slow-channel syndrome, we could potentially kill you. So...not great. Our lab developed a simple blood test for the particular polymorphisms you find in these families with these conditions. So now, you take a blood test and we give you the exact drug you need. It's pretty magical.
Beyond all this crazy awesome "THE FUTURE IS NOW!" stuff, there isn't any top-secret medical knowledge your doctor has, beyond intensive, broad training. A psychiatrist takes the same boards a neurologist does, which makes sense, but he or she also has to know, and spend time practicing in, all the other specialties.
Some doctors do just shoot from the hip, and they like prescribing certain drugs for whatever reasons (contrary to popular opinion, you are not paid based on the drugs you prescribe. Drug companies get up to some icky stuff, but the existence of scandals doesn't mean you write the whole enterprise off, does it?), but there are algorithms and tested methods. You can look at the Texas Drug Algorithm and the STAR*D methodology to start. In the podcast we made for this thread (which I'd like to revive, but it's taking some work), I talked about some papers discussing how you use the side effects of antidepressants to guide your prescribing. Paxil is notorious for increasing appetite. If low appetite is a problem, you use that to your advantage.
At the most basic level, you look at what meds have worked in close relatives. That doesn't give you 99% assurance of success or failure, but you're already well ahead of just rolling some dice.
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I'm in there most of the time, talking to anyone.