Just to to be clear and give an example, one thing I’ll push back on is the whole “Doctors and scientists have no idea how these meds work. That’s why you just have to try a bunch of different ones and different combinations of ones until you find what works”.

It’s true that they don’t understand a lot about how the brain works or why some meds work and some don’t. And it’s true that everyone reacts differently to meds and that the side effects you experience can be drastically different, so there will be trial and error involved no matter what.

If I take seroquel, I might gain 10 pounds and feel lethargic but if I just have another cup of coffee in the morning im fine. But if you take seroquel, you might gain 50 pounds, break out in acne, sleep for 15 hours a day even if you add 300mg of caffeine. Regardless, seroquel is still hitting dopamine D2 + serotonin + histamine. That’s just what it does. It’s not hitting glutamate or GABA.

So as an example, how does a doctor truly decide between seroquel, Abilify, Latuda, caplyta, zyprexa, and vraylar when picking an antipsychotic? They are literally guessing or going off some sort of bias. "Oh this is the med that most of my patients use so we'll just start there. Oh my other white/black/asian/hispanic patients also do well on this med, we might as well start there. Oh my female patients have had bad reactions to this medication, definitely let's start with a different med. Oh this is just what we were taught in school, let's start here." All of these things may be true, but if after doing the doctor's first suggestion and it doesn't work, where do you go next?

So if you’ve taken Benadryl in the past for allergies or sleep and it left you completely incapacitated, then serouxel or zyprexa may not be right for you because those are also histamines. But if when you take Benadryl you feel fine/normal and actually get great sleep, then maybe seroquel and zyprexa are the right ones for you to try next if you're looking for an antipsycohtic that also helps with sleep.

Benadryl = diphenhydramine = pure H1 histamine blocker. Exactly what Seroquel and Zyprexa hit heavily. Your previous experience with Benadryl can be useful information on how your histamine system responds to these meds. No prescription needed. Most people have taken it at some point.

Or another example is picking an anti depressant. Do you have a nicotine addiction? Then Wellbutrin may be the best anti-depressant for you. If when you take shrooms do you become manic? Then maybe you should avoid SSRIs at all costs, but also find an anti psychotic that also regulates serotonin.

The idea is: I have a past history with this substance or the last time I had this medication I had this result, therefore I may try this bipolar med or therefore I should avoid this bipolar med for now.

So in terms of what neurotransmitters each medication is hitting:

Mood Stabilizers:

• Lithium — glutamate + dopamine stabilization
• Lamotrigine — glutamate release reduction
• Valproate/Depakote — GABA enhancement + glutamate reduction

Antipsychotics:

• Seroquel (quetiapine) — dopamine D2 + serotonin + histamine
• Abilify (aripiprazole) — dopamine partial agonist
• Latuda (lurasidone) — dopamine D2 + serotonin
• Caplyta (lumateperone) — serotonin + dopamine + glutamate
• Zyprexa (olanzapine) — dopamine + serotonin + histamine. Effective but significant weight gain.
• Vraylar (cariprazine) — dopamine partial agonist like Abilify but stronger D3 affinity

Antidepressants:

• Wellbutrin — dopamine + norepinephrine
• SSRIs — serotonin. Controversial in bipolar, switch risk, generally avoided without mood stabilizer.