When drug-company representatives visit Richard Friedman, a professor of clinical psychiatry and the director of the psychopharmacology clinic of the Weill Cornell Medical College in New York, and ask him how he picks the right antidepressant for his patients, “I would take a quarter out of my pocket, flip the coin and say I’d let chance decide because their drug was no better or worse than their competitors,’” he wrote in The New York Times’ “Well” blog.
A common frustration among people with depression, ADHD, and other disorders is that their doctors must rely on a coin flip (or a die-roll, or another chance-metaphor of choice) to choose a medication to start their treatment. For example, a doctor might ask a patient to start taking a common antidepressant for a few weeks and see if it works. If it doesn’t, they start over with a different medication. The fraught process can mean weeks of suffering and false hope for the patient.
“The frustrating part about medication for me had been its trial-and-error style,” one depression patient wrote on Reddit a few months ago. “But there's no other way to do it yet.”
The reason, Friedman told me, is because two people who seem depressed might actually have different illnesses—one might have a problem with her serotonin system, and the other with his glutamate system. There’s no way for doctors to know the true culprit: “We can’t do what we do for someone with a sore throat and culture it,” he said. “And there is a huge downside: It’s called suffering, time, and money.”