Sure, we have hypothetical mechanisms, like serotonin reuptake inhibition or NMDA receptor antagonism, which we can observe in a cell culture dish or sometimes in a PET study , but how these mechanisms translate into therapeutic effect remains essentially unknown.
As a clinician, I have noticed certain medications being used more frequently over the past few years. One of these is Abilify aripiprazole. It frequently but not always works.
Can one medication really do so much? And if so, what does this say about psychiatry? Abilify is a unique pharmacological animal. It can activate those receptors, but not to the full biological effect. Thus, Abilify can be seen, at the same time, as both an antipsychotic, and not an antipsychotic.
Consider the following conditions, all of which are subjects of Abilify clinical trials currently in progress thanks to clinicaltrials. Remember, these are the existing clinical trials of Abilify. Each one has earned IRB approval and funding support. The conclusion one might draw from this is that Abilify is truly a wonder drug, showing promise in nearly all of the conditions we treat as psychiatrists. This fact alone should lead us to ask what this says about psychiatry as a whole.
The fact that one drug is prescribed so widelyβowing to its relatively nonspecific effects and a good deal of creative psychopharmacology on the part of doctors like meβ and is so broadly accepted by patients, should call into question our hypotheses about the pathophysiology of mental illness, and how psychiatric disorders are distinguished from one another.
