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