The Unbearable Uncertainty of Psychiatric Medicine

I'd like to start this post by noting that I have the utmost respect for psychiatric medicine. Before the 1950s, someone suffering form a mental disorder would have been psychoanalyzed at best and burned at the stake at worst (or at least shunted off to a sanitarium). In just 60 short years we've taken the treatment of disorders like depression and OCD from laying on a couch talking about your dreams and your mom to SSRIs, SNRIs, anti-psychotics, and a host of other psychoactive medications. We

Still, being only 60 years old makes psychiatry a fairly young medical discipline, and the field is still going through some fairly obvious growing pains. Anyone whose been diagnosed with a mental disorder will be very familiar with how these pains manifest themselves. I was diagnosed with major depressive disorder about 7 months ago, and later that diagnosis was changed to "agitated depression". Psychiatric medicine has been making a big push recently to have the public view psychiatric disorders like OCD the same way they view diseases like diabetes and cancer. Diabetes, in fact, is the disease I've probably seen used most often in analogies. You wouldn't blame someone for their diabetes, so you should blame them for their (insert disorder here).

Such analogies are all well and good, and indeed are supported by substantial research on genetic and biological contributors to mental disorder. Still, there is one key difference between mental disorders and conditions like diabetes that makes being diagnosed with and treated for the former a harrowing and doubt-ridden process.

Suppose you were experiencing frequent urination and excessive fatigue. Plug those in to webMD, and you'll find that you could have (among other things) a urinary tract infection, type 1 diabetes, or mono. If your doctor suspects you have diabetes, one of the first things they'll do is prick your finger. If your blood-sugar level is too high, your doctor has a pretty solid reason to think it's diabetes (and not any of the other potential culprits). The diagnosis is unpleasant, but hey, at least you know for sure - and your doctor nows how to treat it, and why that treatment will work.

Now let's try a different scenario. You're feeling sad and you find yourself worried more often than not. You go to a psychiatrist or psychologist. They ask you some questions, then diagnose you with major depression (or dysthimia, or generalized anxiety disorder, or OCD, or any of several disorders that present those symptoms) and prescribe an SSRI. There's no blood test, no body scan, no X-ray. That's because, although researchers have some good ideas as to what might be going on inside your brain when you feel depressed or anxious, they don't know the specifics. For example, the standard medication for depression, GAD, and OCD is SSRIs like zoloft or prozac. This is because affecting neurotransmitters like seratonin seems to alleviate symptoms of anxiety and depression. The resulting assumption is that some dysfunciton in these transmitters causes mood and anxiety disorders.

What we don't know, though, is why this is the case. Monamines might play a role in both depression and OCD, but is this because they have a common biological cause that is split into different symptoms by environmental factors or because they stem from seperate biological processes that just happen to both affect monamines?

For me, I've really struggled with the uncertainty of my diagnosis. I was diagnosed with depression first. When I kept reporting atypical symptoms, such as racing thoughts, irritability, anxiety, and emotional numbness, I was diagnosed with "agitated depression", which is basically depression with mild psychotic/anxiety overtones. I still don't think that's an accurate diagnosis (during the trip I was diagnosed my therapist also screened me for schizophrenia and bipolar), but of course there's no way to know.

How about you? Have you struggled with accepting your diagnosis? Do you wish there was a blood test for mental disorders? Would you want to take it there was?