Scott summarizes and responds to comments on his previous article about FDA approval of Paxlovid, acknowledging some valid points while maintaining his criticism of the approval process. Longer summary

This post summarizes comments on Scott's previous article about FDA approval of Paxlovid. It covers manufacturing challenges, FDA approval processes, production capacity, ongoing studies, and ethical considerations. Scott acknowledges some valid points raised by commenters about reasons for FDA delays, but maintains his criticism of the approval process, suggesting a need for different levels of approval and questioning the current drug approval system. Shorter summary

Scott Alexander provides a comprehensive guide on ketamine as a depression treatment, covering administration methods, effectiveness, safety, dosage, and potential side effects. Longer summary

This post is a comprehensive guide on ketamine as a treatment for depression, covering various aspects such as methods of administration, effectiveness, safety, dosage, and potential side effects. Scott Alexander explains the differences between IV ketamine, esketamine (Spravato), and oral/intranasal ketamine, discussing their relative costs and accessibility. He also delves into ketamine-assisted psychotherapy, the duration of ketamine's effects, and current theories on how it works. The post is written in a FAQ format, aiming to provide thorough and evidence-based information while acknowledging areas of uncertainty in the research. Shorter summary

Scott Alexander explains how the vastly higher doses taken by recreational drug users compared to psychiatric patients lead to misconceptions about drug safety in clinical settings. Longer summary

Scott Alexander discusses how recreational drug users consume substantially higher doses of drugs compared to psychiatric patients, which leads to misconceptions about drug safety in clinical settings. He provides examples of ketamine and amphetamines to illustrate this point. For ketamine, psychiatric doses are around 280 mg/month, while recreational users consume about 90,000 mg/month. Similarly, for amphetamines, Adderall patients typically take 20 mg daily, whereas methamphetamine addicts use the equivalent of 1000 mg oral amphetamine daily. Scott argues that many concerns about drug side effects in clinical settings are based on studies of recreational users, and that these concerns may not apply to patients taking much lower doses under medical supervision. Shorter summary

Scott Alexander investigates the optimal dosage of Lexapro, comparing it to other antidepressants and exploring the reasons behind its effectiveness at lower doses. Longer summary

Scott Alexander explores the question of the right dose for Lexapro (escitalopram), an antidepressant. He examines official recommendations, compares Lexapro to other SSRIs, and investigates why Lexapro might be effective at lower doses. The post delves into studies on antidepressant dosing, the unique properties of Lexapro, and the potential benefits and risks of higher doses. Scott concludes that while there's no strong evidence for high doses of any antidepressant being more effective, prescribing higher doses of Lexapro might be as safe as other SSRIs and potentially more beneficial in some cases. Shorter summary

Scott Alexander explores the history and mechanism of DNP, a dangerous but effective weight-loss drug, and discusses recent developments in safer mitochondrial uncoupling agents. Longer summary

Scott Alexander discusses 2,4-dinitrophenol (DNP), a controversial and dangerous weight-loss drug that works by uncoupling mitochondria. He traces its history from the 1930s to modern times, explaining its effectiveness and severe side effects. The post then explores recent developments in mitochondrial uncoupling research, including potential safer alternatives and therapeutic applications beyond weight loss. Shorter summary

Scott Alexander examines the history, chemistry, and efficacy of various amphetamine-based ADHD medications, comparing their strengths and weaknesses. Longer summary

Scott Alexander explores the history and differences between various amphetamine-based ADHD medications. He traces the origins of Adderall to a 1950s diet pill, then compares it to other drugs like Dexedrine, Vyvanse, Evekeo, and Desoxyn (methamphetamine). The post discusses the chemical differences, patient preferences, and effectiveness of these medications, noting that pure d-amphetamine (Dexedrine) seems generally superior to the Adderall mixture. Scott also touches on the controversy surrounding methamphetamine use in ADHD treatment, explaining that the main differences between therapeutic use and abuse are dosage and administration method rather than inherent properties of the drug. Shorter summary

Scott Alexander criticizes branded combination nootropics, explaining why they are often ineffective or harmful, and advises careful individual experimentation with single substances instead. Longer summary

Scott Alexander criticizes branded combination nootropics, arguing they are often poorly designed and potentially harmful. He begins by mocking the ridiculous names and exaggerated claims of many such products, then explains why even well-intentioned combinations are problematic. The post discusses how nootropics affect individuals differently, making one-size-fits-all approaches ineffective. Scott emphasizes the importance of careful individual experimentation with single substances, rather than relying on pre-made combinations. He also cautions against assuming synergistic effects between different nootropics, noting that even well-studied psychiatric drug combinations often fail to show benefits. The post concludes by advising readers to approach nootropics cautiously and individually, rather than relying on branded combinations. Shorter summary

Scott Alexander argues that the 33% rate of post-marketing safety events for FDA-approved drugs is not necessarily concerning and explains why post-marketing surveillance is a normal part of drug safety monitoring. Longer summary

Scott Alexander discusses a study showing that 33% of FDA-approved drugs in the past decade have faced post-marketing safety events. He argues that this doesn't necessarily mean the FDA is too lax, explaining that post-marketing surveillance is a normal and necessary part of drug safety monitoring. He points out that only 1.3% of drugs were actually withdrawn from the market, which he considers a good success rate. Scott explains why it's impossible to catch all potential side effects in pre-approval studies and gives examples of safety communications that range from important to seemingly trivial. He concludes that the 33% figure alone is meaningless without a broader cost-benefit analysis of FDA approval standards. Shorter summary