I work as an EM scribe and routinely see patients experiencing psychotic episodes. My background is in neuroscience and I'm interviewing for med school right now.

> it was recently proven that there is little to no evidence that serotonin levels are linked to depression

This has been the consensus of the psychiatric community for the last 20+ years. The serotonin hypothesis was heavily pushed in marketing as a way to medicalize depression and convince people to seek treatment for it. Probably a net positive when it comes to reducing stigma, but few people have been seriously arguing the serotonin hypothesis. As it takes about a month for effects to kick in, most people believe that it's compensatory changes to the brain that happen in response to upregulation of serotonin, such as downregulation of 5ht2a which has an overdensity in people with depression.

> Since there is no chemical or biological test one can do to confirm a schizophrenia diagnosis, it's a subjective diagnosis by practitioners

This is true to some degree - we don't have a blood test or an fmri scan that will definitively point to schizophrenia, the diagnosis is (for now) based on DSM criteria and by thoroughly ruling out other causes of schizophrenia. We do have tests for a number of other causes of psychosis, like lumbar punctures for NMDA-receptor encephalitis.

I'd like to emphasize that there are MANY diseases and conditions that we treat empirically for based on subjective symptoms which are just as real as schizophrenia. There are no tests we can perform for concussions or migraines. The brain is very challenging to perform tests on because of the blood-brain barrier and the skull.

> Worse, we do not yet know whether these new drugs will be easy to get off of.

Cholinergic drugs are VERY well understood and used in the treatment of a number of diseases. This "new" drug is a drug that was discovered 20+ years ago and is being used in a creative way to mitigate its GI side effects. Everything so far points to this being more effective at treating the negative symptoms of schizophrenia (loss of motivation, cognitive impairment), with milder side effects (some mild GI issues which typically resolve after a few days), which is a huge deal considering how many people with schizophrenia quit dopaminergic drugs due to the side effects.

One of the biggest problems with our for-profit system is that schizophrenia is comparatively rare and largely affects those with a lower socioeconomic status, so there isn't a huge financial incentive to work on schizophrenia drugs. This one was being developed for another purpose entirely.

> Until Psychiatry can reform itself to become a real science, using the scientific method (repeatable, provable results and not just a "theory of how brain chemistry maybe works sorta but we're not sure"), it will continue to just be a big cash cow for Big Pharma while hooking many patients who do not need these drugs onto them for life, while failing to effect ANY cure on the things they are treating

It sounds like you have an ax to grind against the profession, but I can assure you that there is a huge need for it and that people largely see benefits from medication. For me, SSRIs got me stable and functional so I could better address the root causes of my depression. Psychiatric drugs aren't perfect, but for many people they're truly life-saving. There is evidence to support kindling in some diseases such as bipolar as well - that if you remain unmedicated, manic episodes become progressively worse as the brain becomes more damaged.

Additionally, psychiatrists treat more than just depression. Some specialize in sleep medicine, addiction medicine, toxicology. They are trained to tease apart primary depression from other non-psychiatric diseases masquerading as a psychiatric disease. I saw a patient once who had been treated with a number of antipsychotics by his PCP and mid-level providers for persistent visual hallucinations. He met with a psychiatrist who tried increasing his anti-seizure meds, which resolved what was likely a recurrent partial seizure.

Every drug (sans some off-label use) goes through an FDA approval process and is, over the course of several years and millions of dollars, shown to be effective and relatively safe. I can assure you that psychiatry is as scientific as any other field of medicine. It's still in its infancy compared to some other specialties - the brain is a very complex organ and difficult to study - but we have as good of an understanding of most psychiatric illnesses as we do neurodegenerative diseases such as Alzheimer's, which have been equally as difficult to study and treat.

Psychiatry is not even close to the most profitable area of American healthcare. Psychiatrists are one of the lower-earning specialties, and most people with mental illness never obtain treatment for it. Compare that to the 10% of all seniors who are on Eliquis to prevent blood clots, which costs a thousand dollars a month without insurance.

Trust me, if there was a way to permanently cure a psychiatric disease with one procedure or pill, we would all be in favor of it. Just because a diabetic needs to take insulin for life doesn't make endocrinology a scam.