Because PA time is cheaper to the provider than MD time. Give it a few years and a trip to the doctor's office will mean using a touch screen a-la-mcdonalds to describe your symptoms and then the first-line medication pops out of a drawer.
I'm pretty jaded with our (US) healthcare system. As long as you stay on the happy path it's fine, but if you stray from that, good luck. Over the last few years I was given antibiotics for a gut infection, a lung infection, and currently a sinus infection. None were improved by antibiotics, but no doctor was willing to do a culture to see what the infection was before prescribing antibiotics because that's the happy path (most infectious are bacterial). I think it might be a systemic fungal infection (I've also had bouts of what I think is thrush), but that possibility is immediately rejected without investigation because 'only immunocompromised people get fungal infections'. Similar for SSRIs. Asked the shrink why SSRIs versus something else - 'got to start somewhere'. Asked them why one SSRI over another, same answer.
Throwing shit at the wall to see what sticks is fine if the cost of being wrong is just the list time of needing to recompile your code. It's 100% not ok when being wrong means fucking up your tendons or making you suicidal.
> Similar for SSRIs. Asked the shrink why SSRIs versus something else - 'got to start somewhere'. Asked them why one SSRI over another, same answer.
At the risk of over-simplifying - and certainly not justifying blasé, ambivalent answers... the brain is a very complex organism. And we have barely scratched the surface of how it actually works. Most of it, we just don't know.
So, from this to psychiatric drugs - SSRIs, MAOIs, SNRIs. Read the drug information sheet in the packet. Not just the "standard" paragraphs on side effects and warnings. All prescription drugs are required to specify "how" the drug works.
For a startlingly high number of these drugs, this paragraph starts with the words:
> It is not understood precisely how [drug] works. It is believed that it does X, Y and Z...
(emphasis mine).
We know that they can work for some people and not others. But while we can perhaps make decent educated guesses, a lot of the time, we can't, because, hell, we don't really know how it even actually works, so we can't know it will work for you.
Disclaimer: while I am medically educated and work as a prehospital provider, I'm not a MHP, despite my use of 'we' in the previous para.
There's nothing actually stopping you from getting a fungal culture yourself. The turnaround time is over a month though. Unless you're at a huge hospital they just farm it out to Labcorp and the like and you can buy direct. Like it makes sense, if it's high-probability bacterial you might as well try the z pack first. It's faster to just treat it and see than to test if it's bacterial.
Also for SSRIs there's nothing to test, you just try them under medical supervision and if they help they help. There is an experimental DNA test that might be able to narrow down the antidepressant options but unless you're struggling to find one that works for you it's usually not worth bothering.
Medicine is crazy advanced in some specific areas but for the long tail we're not that far from leeches.
I'm pretty jaded with our (US) healthcare system. As long as you stay on the happy path it's fine, but if you stray from that, good luck. Over the last few years I was given antibiotics for a gut infection, a lung infection, and currently a sinus infection. None were improved by antibiotics, but no doctor was willing to do a culture to see what the infection was before prescribing antibiotics because that's the happy path (most infectious are bacterial). I think it might be a systemic fungal infection (I've also had bouts of what I think is thrush), but that possibility is immediately rejected without investigation because 'only immunocompromised people get fungal infections'. Similar for SSRIs. Asked the shrink why SSRIs versus something else - 'got to start somewhere'. Asked them why one SSRI over another, same answer.
Throwing shit at the wall to see what sticks is fine if the cost of being wrong is just the list time of needing to recompile your code. It's 100% not ok when being wrong means fucking up your tendons or making you suicidal.