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.
Well, I am on a load of benzo's right now so excuse my lack of motivation in responding long windedly.
My main problem with what you said is that it's "My experience" which is true. But it's important to keep in mind also the advice of others who've had the felt presence of direct experience. There's a very different outlook there and you cannot dismiss those "experiences" just because you've had "medical training" or that the methodologies used to diagnose, treat and handle any negative outcomes are not at some level a roll of the dice. If you can't at least admit that, then we're just going around in circles, nothing more to discuss. That was my initial point anyway, I never said do not do this or believe that, I simply said educate yourself to make better choices in your life. To my mind as I've grown older, is that educating myself first and then asking the doctor for further instruction is the best avenue to take. Otherwise, your ignorant to what is not being told and don't know how to ask the questions that expose what drugs you really want in your body.
You see, the value of "experience" is second to none. If you've never been involuntarily committed to a institution and robbed of their liberty and freedom, forced to take drugs, see the doctor for 5-10 mins everyday, have retarded groups (including of course the religious guy who comes around every week), forced "bedtimes", and often uncomfortable roommates. Then you don't have a damn leg to stand on speaking about what it's like to be on the receiving end of that heresy. Same as a man who could read all the history of Germany's military campaign for 20 years, then somehow meets a old real vet of a man who marched in the Blitzkrieg, he'd probably tell the guy to fuck off and he has no idea what it was like or he's not viewing as it actually happened in reality. Because this is the point, unless you can
directly relate to a person's experience, than your really only going to be minimally effective. Same reason they pair recovering addicts with support from recovered addicts for that kind of support. That's a fundamental problem in psych unit and even doctor's in general in this field, they rarely can directly relate to your issues it's just a peripheral view of that person's pain not a "I totally know how that feels" view. And while that may be impossible in the medical field especially, It doesn't dismiss the fact that most doctor's you encounter see only the surface, the peripheral of your pain.
So yes, I'm speaking for "my own experience/s", but the older and wiser (non-academic) you get the more "experience" matters when you are talking to somebody about X or Y. And through my experiences I've been subjected to every medication for ADHD, Tourette's, Obsesive Compulsive Disorder, Anti-Social Personality Disorder, Paranoid Personality Disorder, depression, and near constant suicidal/homicidal thoughts. All which likely has accumulated to make me worse today than I would be if I had never taken them. My issues have proved totally medication resistant, so in order to keep me out of the hospital, my psychiatric just perscribes all the benzo's I want, Seconal, and Ambien, since I now refuse to take anything else. They just think and have good reason to think I'm less of a danger to myself and others on them than without. Plus, the fact that the judge has said that if I continue to be hospitalized for violent offenses and violence on unit staff I will become a ward of the state and never get out. My permanent home will then be Eastern State Mental Hospital, a hellhole I've been to twice, I'd rather jail or prison honestly.
And you want to "talk to me"...how's that going to go. It'll just become the same game I play with doctors a 99% success rate, haven't met a doctor yet I couldn't charm, lie or bend to my will just through listening and talking. Contrary to popular belief the most important part of manipulation is just listening, that's how you find the holes and know where to push buttons for reaction then build upon that. It's called engineered sociopathic manipulative mind games. But honestly I'm not motivated enough to stack the deck and toy with people, find their chinks and poke them. That's another "relief" on others that these benzo's give me, it's makes me less motivated and obsessive to manipulate people with mind games and all types of social engineering, that is set up like a mental chess match you cannot win, I'm 29 now so I've got lots of practice. So yeah, I'm just "don't care" as opposed to "I feel compelled to fuck with people and wreak mental havok", so for me, around the clock benzo's are kind of a good thing. Because you see, my OCD and sociopathy/psychopathy melt together like glue, so talking to me as sad as it might be to say, will get both of us absolutely nowhere. Socrates said "Know Thyself", and I'll take a person's "direct experience" over any academic who went through medical school. Lastly, going through all these meds all my life has cemented that idea for me that you don't want to listen to academics/doctors all the time, they may be very impressive with their credentials but they have prejudices, they are rigidly taught certain methodology, and they have a fixed view of the way patients/drugs and mental health itself should be treated, and are going to stick to that come what may. So I guess there's a victory in that after all these years.