Psychiatry is a legitimate medical discipline, but it's hamstrung by a lack of adequate testing mechanisms. One of the most widely used tests for antidepressant efficacy in animal models, for instance, involves hanging mice by their tails from a lever for six minutes and recording how long they struggle to get free. It's measuring the effect on the animal's behaviour, not the effect on its brain.
There is a blood test for serum serotonin levels, but it's not typically used for depression because the amount of serotonin in your system and what your brain is actually doing with it are two entirely different things. A person can have perfectly adequate amounts of serotonin in their brain, but if their brain is breaking it down (the "reuptake" in SSRI) too quickly, then depression is one common result.
That said, I know there's some way to test receptor saturation levels (e.g., the degree to which reuptake is being inhibited), because dose/saturation curves are published data. I just don't know how they measure it. Radiolabeling and an fMRI, maybe. I should really find out.
What I don't usually give psychiatrists any credit for, unless they can prove it to me otherwise, is understanding a goddamn thing about pharmacology. A lot of this has to do with how psych meds are marketed; drug A gets promoted as a "mood stabilizer", drug B gets promoted as an "antipsychotic", and half the time they affect the exact same set of receptors -- and the majority of psychiatrists don't know any better because they don't have enough biochemistry to read the dose-response graphs. (The other half of the time, drug A was marketed as a "mood stabilizer", but then its patent expired, so drug B, which is still on patent, gets promoted as a "mood stabilizer" too.)
Failure to understand basic psychopharmacology (http://thelastpsychiatrist.com/2007/07/the_most_important_article_on.html) often leads to really retarded combinations of medications (http://thelastpsychiatrist.com/2007/08/arent_two_antipsychotics_bette.html), and is why I make it a habit to do the math on my friends' med regimens if they'll let me. I know far too many people whose doctors just kept on stacking and stacking medications until they ended up with side effect profiles that were far worse than their original psych problems, including one person with tardive dyskinesia that's likely to be permanent. :-/
Relatedly, paradox_puree, you might find this post (http://thelastpsychiatrist.com/2009/10/how_am_i_going_to_get_paid_if.html) about the fucked-up relationship between official diagnoses and access to services interesting. I certainly did.
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timeasmymeasure
no subject
Date: 2009-11-04 04:38 am (UTC)There is a blood test for serum serotonin levels, but it's not typically used for depression because the amount of serotonin in your system and what your brain is actually doing with it are two entirely different things. A person can have perfectly adequate amounts of serotonin in their brain, but if their brain is breaking it down (the "reuptake" in SSRI) too quickly, then depression is one common result.
That said, I know there's some way to test receptor saturation levels (e.g., the degree to which reuptake is being inhibited), because dose/saturation curves are published data. I just don't know how they measure it. Radiolabeling and an fMRI, maybe. I should really find out.
What I don't usually give psychiatrists any credit for, unless they can prove it to me otherwise, is understanding a goddamn thing about pharmacology. A lot of this has to do with how psych meds are marketed; drug A gets promoted as a "mood stabilizer", drug B gets promoted as an "antipsychotic", and half the time they affect the exact same set of receptors -- and the majority of psychiatrists don't know any better because they don't have enough biochemistry to read the dose-response graphs. (The other half of the time, drug A was marketed as a "mood stabilizer", but then its patent expired, so drug B, which is still on patent, gets promoted as a "mood stabilizer" too.)
Failure to understand basic psychopharmacology (http://thelastpsychiatrist.com/2007/07/the_most_important_article_on.html) often leads to really retarded combinations of medications (http://thelastpsychiatrist.com/2007/08/arent_two_antipsychotics_bette.html), and is why I make it a habit to do the math on my friends' med regimens if they'll let me. I know far too many people whose doctors just kept on stacking and stacking medications until they ended up with side effect profiles that were far worse than their original psych problems, including one person with tardive dyskinesia that's likely to be permanent. :-/
Relatedly,