Scott Alexander critiques the FDA approval of esketamine for depression, discussing issues with drug development, efficacy, cost, and administration requirements. Longer summary

This post discusses the FDA's approval of esketamine for treatment-resistant depression, highlighting the issues with the pharmaceutical industry's approach to drug development and approval. Scott Alexander explains how companies often make minor changes to existing chemicals to patent them, as in the case of esketamine (a left-handed version of ketamine). He critiques the high cost of esketamine compared to regular ketamine and the FDA's stringent requirements for its administration. The post also questions the efficacy of esketamine based on clinical trials and discusses the inconvenience of the approved delivery method. Scott expresses disappointment that this approval may set a precedent for future psychedelic medicines, making them equally inconvenient and bureaucratic to access. Shorter summary

Scott Alexander argues for the broader use of guidelines instead of simple recommendations in fields outside medicine, explaining their benefits and why they're underutilized. Longer summary

Scott Alexander discusses the value of guidelines over simple recommendations, using medical guidelines as an example. He argues that guidelines are underappreciated in many fields outside medicine. Guidelines offer multiple recommendations, tailor advice to specific circumstances, acknowledge individual differences, provide criteria for success or failure, and show correlations between options. Scott suggests that experts in fields like nutrition and self-help should create similar guidelines, but notes that doing so might be seen as too strong a claim to authority. He expresses frustration at the lack of such guidelines in areas like dieting, nootropics, and self-help, where they could be particularly useful. Shorter summary

Scott Alexander critically examines a major meta-analysis on antidepressant efficacy, noting potential biases and comparing its surprising drug rankings to his own previous analysis. Longer summary

This post reviews a major meta-analysis by Cipriani et al on the efficacy of antidepressants. The study claims to definitively show antidepressants work, but Scott notes it doesn't actually refute previous critiques about their effectiveness. He examines potential biases and methodological issues in the study, particularly around industry funding of trials. Scott also discusses the study's ranking of different antidepressants, noting some matches with conventional wisdom but also some surprising results. He compares these rankings to his own previous analysis, finding major discrepancies, and concludes by urging some caution in interpreting the study's results despite its impressive scope. Shorter summary

Scott provides answers to a dermatology quiz, discussing skin cancer risks, a quiz correction, and the surprising effectiveness of Botox in treating depression. Longer summary

This post provides answers to a dermatology quiz from the previous day. It covers three main points: 1) The increased risk of left-sided skin cancer for American drivers due to UV exposure, 2) A correction to a false statement in the quiz, and 3) The effectiveness of Botox in treating depression. The author then speculates on the implications of using Botox as a happiness-boosting intervention, comparing it to other utilitarian approaches like poverty relief and malaria nets. Shorter summary

Scott Alexander examines a study showing no significant difference between CBT and psychodynamic therapy, challenging the idea that CBT is superior and exploring the possibility that most psychotherapies work through non-specific factors. Longer summary

Scott Alexander discusses a recent study in the American Journal of Psychiatry comparing the efficacy of cognitive-behavioral therapy (CBT) and psychodynamic therapy for depression. The study found no significant difference between the two therapies, challenging the common belief that CBT is superior. Scott reflects on how this contradicts the 'foundation myth' of psychiatry, which claims that evidence-based therapies like CBT replaced less scientific approaches like Freudian psychoanalysis. He explores the possibility that most psychotherapies work through non-specific factors rather than their specific theories or techniques, a concept known as the Dodo Bird Verdict. Scott suggests that CBT's reputation as evidence-based may be due to its proponents conducting more studies, rather than superior efficacy. He concludes by stating his belief that only very basic, targeted therapies have specific effects, while more complex theories of the mind likely rely on non-specific factors. Shorter summary