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 revisits his stance on SSRIs, discussing new meta-analyses, broader trends in psychiatric medication efficacy, and potential explanations for the discrepancy between statistical and clinical observations. Longer summary

Scott Alexander updates his views on SSRIs, addressing four key points: 1) A meta-analysis confirming the effect size of antidepressants is about 0.3. 2) The low effect size of SSRIs is part of a broader trend of low effect sizes in psychiatric medications. 3) A hypothesis to reconcile the small statistical effect with strong clinical observations, suggesting SSRIs might work very well for a subset of patients. 4) The possibility that SSRIs' efficacy for anxiety might contribute to their perceived effectiveness for depression. Shorter summary