Scott Alexander compares three gabapentinoid drugs (gabapentin, pregabalin, and phenibut), exploring their effects, mechanisms, and the mysteries surrounding their differing efficacies despite chemical similarities. Longer summary

Scott Alexander discusses three gabapentinoid drugs: gabapentin, pregabalin, and phenibut. He compares their effects, mechanisms, and mysteries surrounding their differing efficacies. Gabapentin is described as subtle at low doses and problematic at high doses. Pregabalin is noted for its effectiveness in anxiety treatment but its high cost. Phenibut, while not FDA-approved, is praised for its strong anti-anxiety effects but warned against due to addiction potential. The post explores possible explanations for the differences between these chemically similar drugs, including dosing discrepancies, absorption rates, and receptor interactions. Scott also touches on the broader implications for drug research and the complexities of psychopharmacology. Shorter summary

Scott Alexander compares the disconnect between American and Russian psychopharmacology to having different chemical elements, exploring why effective Russian psychiatric drugs are unknown in America. Longer summary

Scott Alexander discusses the stark contrast between American and Russian psychopharmacology, using an analogy of different chemical elements to illustrate the disconnect. He points out that many effective Russian psychiatric drugs are virtually unknown in America, despite having good evidential support. The post explores reasons for this divide, including FDA approval processes and legal concerns, and highlights the resulting limitations in treatment options for conditions like anxiety. Scott suggests that while the system's incentives lead to this seemingly irrational situation, a gray market for these drugs has emerged online. Shorter summary