Scott Alexander analyzes the potential role of psychopharmacology in the FTX crash, discussing medications used by SBF and others, and their possible effects on decision-making. Longer summary

Scott Alexander discusses the psychopharmacology aspects of the FTX crash, focusing on the medications Sam Bankman-Fried (SBF) and other FTX employees may have been taking. He examines claims about SBF's use of Emsam (selegiline), modafinil, and other stimulants, explaining their effects and potential risks. Scott also critiques the actions of FTX's company psychiatrist and discusses the broader implications of stimulant use in high-pressure work environments. The post ends with Scott's personal anecdote about testifying as an expert witness. Shorter summary

Scott Alexander explores a theory suggesting that complex features of human biology evolved as defenses against parasite manipulation, discussing its implications for understanding psychiatric medications and biological complexity. Longer summary

This post discusses a theory proposed by Marco del Giudice in his paper 'Brain Evolution Through The Lens Of Parasite Manipulation'. The theory suggests that many complex features of human biology, particularly in neurotransmitter systems, evolved as defenses against parasite manipulation of host behavior. The post outlines various strategies that organisms might use to defend against such manipulation, including complicated signaling cascades, feedback loops, pulse-based communication, individual variability, and the use of antimicrobial substances as neurotransmitters. Scott Alexander explores the implications of this theory for understanding psychiatric medications, tolerance effects, and the complexity of human biology. He concludes by discussing the strengths and potential weaknesses of the theory, noting that while it's an interesting perspective, it's too early to determine its full validity or impact. Shorter summary

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 reviews a theory about serotonin receptors that explains how they help cope with stress, and discusses its implications and limitations. Longer summary

This post reviews a theory about serotonin receptors proposed by Robin Carhart-Harris and David Nutt. The theory focuses on two key receptors: 5-HT1A and 5-HT2A. It suggests that 5-HT1A promotes 'passive coping' (stoicism, bearing stress), while 5-HT2A promotes 'active coping' (increasing brain plasticity to find new solutions). The author finds the theory plausible and explains how it accounts for various effects of antidepressants and psychedelics. However, he also points out some remaining questions and potential biases in the theory. The post combines a detailed explanation of the theory with critical analysis and broader reflections on brain function and drug effects. Shorter summary

Scott Alexander explores why recreational drugs like ketamine and MDMA have shown more promise in treating mental health conditions than intentionally developed pharmaceuticals, suggesting a new direction for drug research. Longer summary

Scott Alexander discusses the surprising effectiveness of ketamine and MDMA in treating depression and PTSD respectively, noting that these recreational drugs have shown more promise than intentionally developed pharmaceuticals. He speculates on why this might be, suggesting that drugs with strong effects on the brain, even if originally used recreationally, might be more likely to have significant therapeutic benefits. Scott proposes that pharmaceutical research might be more productive if it focused on chemicals with powerful psychoactive effects, rather than prioritizing minimal side effects. He acknowledges potential counterarguments, including the possibility that ketamine's antidepressant effects may come from a non-psychoactive metabolite. 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

Scott explores how antibiotics and antiprotozoal drugs unexpectedly affect mental health, suggesting that random chemicals may frequently influence mental processes. Longer summary

Scott Alexander discusses how antibiotics and antiprotozoal drugs can have unexpected psychiatric effects, using examples like suramin for autism, minocycline for schizophrenia, iproniazid for depression, and cycloserine for anxiety disorders. He argues that this phenomenon suggests random chemicals may often affect mental processes, implying that base rates for psychiatric effects of drugs might be higher than commonly assumed. The post starts with recent research on suramin, moves through historical examples, and concludes with reflections on the implications for drug discovery and toxicity claims in psychiatry. Shorter summary