Yeah everything I know is pretty much based on sz....from the little I know about BP it may be that if you get the mood component stable enough the psychotic component will be blocked but from what I understand the APs can help stabilize mood as well so it's very interwoven and the medication burden for people with bipolar(and I assume sza) is the highest of all the conditions. What I had was pretty easy to manage as I was only on one med at a time.

I don't think it's ties to pharma....pharma itself has been slowly cutting support for all MDs because they know it looks bad. 20 years ago even in GI they would shut down a zoo and throw a big party for the national meetings now almost everything is paid for by membership fees.....even five years ago they did the shuttle buses for the conferences...they would have purple pill ads across the sides. Now you have to go to the exhibit halls to even see them and you're lucky to get a USB drive with product info where like 10 years ago they would give out cool electronics like travel mice or personalized day planners or whatever that was way nicer than anything academics ever got.

So why do they do it....if all you have is a hammer everything looks like a nail. The really aren't all trained in talk therapy these days but some are but the style of therapy is often discredited. The pay they make for an hour of therapy is like the same they would make with 2 15 minute med management sessions so imagine 4 an hour vs seeing 1 patient to talk doubles $$$. My pdoc would bill for med management and therapy at a slightly higher rate and give a 30 minute appointment but hour appointments are rare except in cash practice. That's not to say they can't refer you to a psychologist and they will if the condition can be treated with therapy alone...like mild anxiety. So basically they are all trained in medicine and not talk.

Next thing they all start working at in-patient facilities so they can be supervised and they perform a service for the hospital and they are normally paid for by fellowships so hospital doesn't even have to pay them while they're learning. Anyway working inpatient you see people on a short term basis and meds are the only thing that works that fast and their job is to get you good enough to get out and not to permanently heal you but the you see an outpatient doc and he or she was trained the same way...get them stable...ok done. So meds are great the first couple of years you invariably do better on them. People that go off meds really don't need to see a pdoc so there is something called the clinicians bias....They never see the people who get better off the meds they really don't know they exist. They only see what happens in the short term when people come off the meds usually too quickly and it's a train wreck. So to a pdoc no meds tends to be bad. However the harrow study got mentioned in a book by Robert Whitaker and kind of exploded then there was a seven year study by wunderink that also showed a similar thing. Now the director of the NIMH has basically come out to say that maybe we shouldn't be keeping people on APs forever so things are changing within the system itself...

So that's great but he's head of research not actual practice of psychiatry so it will take a while for docs to come up with a new standard of care and the best way to taper people because really they don't have a standard way to take people off of medicine...heck a lot of pdocs don't even know you can get better from sz and that people living in developing countries actually do better because they never see meds...