Pretty much any competent psych*gist knows "chemical I'm balance" is a total crock of shit. But, it is reassuring to (most) patients to have their lived experie

Pretty much any competent psych*gist knows "chemical I'm balance" is a total crock of shit. But, it is reassuring to (most) patients to have their lived experience explained in terms of an understood model. Pharmacological interventions are basically running through a list of candidates drugs and asking the patient how they feel. (Limited third party observation in inpatient settings, but really everyone is too overworked). There is a bit of a flow chart to determine what classes of drugs to prioritize in the search, but it is not nearly as deterministic as e.g. antibiotics; stuff is used off label all the time. For example, I knew a person who lived bipolar 1 with extremely pronounced psychotic features. She finally ended up stable on... Amphetamine, plus an snri specifically contraindicated in anything involving mania or suicidal ideation. That's like, absolutely inconceivable. Yet it's worked for the past ten years or so.