Scott Alexander evaluates silexan, a lavender-based anxiety supplement, finding promising but potentially biased evidence, and recommends cautious trial use. Longer summary

Scott Alexander reviews the evidence for silexan, a lavender-derived supplement claimed to be highly effective for anxiety. He examines the studies, noting that most are by one researcher with conflicts of interest, but finds the methodology generally sound. He also considers circumstantial evidence, including animal studies and anecdotal reports. While cautioning about the lack of independent research, Scott concludes that silexan is worth trying due to its low risk and potential benefits, and predicts a 50% chance it will prove as effective as SSRIs for anxiety in future independent studies. Shorter summary

Scott Alexander argues that doctors should prescribe fluvoxamine for COVID-19 despite FDA inaction, urging them to overcome discomfort with off-label use when evidence supports it. Longer summary

Scott Alexander discusses the use of fluvoxamine (Luvox) as a potential treatment for COVID-19. He argues that despite strong evidence from clinical trials showing its effectiveness, many doctors are hesitant to prescribe it due to it being off-label use. The FDA has not added COVID-19 to the drug's label, citing bureaucratic issues. Scott criticizes this inaction and suggests that doctors should be willing to prescribe off-label when evidence supports it, even if it feels uncomfortable. He relates personal experiences of hesitating to prescribe off-label medications due to social pressure and encourages doctors to critically examine their reasons for not prescribing fluvoxamine for COVID-19. Shorter summary

Scott Alexander investigates the optimal dosage of Lexapro, comparing it to other antidepressants and exploring the reasons behind its effectiveness at lower doses. Longer summary

Scott Alexander explores the question of the right dose for Lexapro (escitalopram), an antidepressant. He examines official recommendations, compares Lexapro to other SSRIs, and investigates why Lexapro might be effective at lower doses. The post delves into studies on antidepressant dosing, the unique properties of Lexapro, and the potential benefits and risks of higher doses. Scott concludes that while there's no strong evidence for high doses of any antidepressant being more effective, prescribing higher doses of Lexapro might be as safe as other SSRIs and potentially more beneficial in some cases. Shorter summary

Scott Alexander reviews his intellectual progress in the 2010s across various fields, crediting his blog for accelerating learning. Longer summary

Scott Alexander reflects on the intellectual progress he made in the 2010s, largely tracked through his blog posts. He discusses major updates in his understanding of topics like predictive coding theory, psychedelics, mental health, SSRIs, genetics, willpower, nutrition, x-risk, AI, scientific progress, cost disease, the replication crisis, placebo effect, ethics, politics, cultural evolution, social justice, game theory, and enlightenment. He notes that while some were major shifts in position, many represent 'deconfusion' - gaining a better map of the problem space. Scott credits his blog and reader interactions for accelerating his learning in the latter half of the decade. Shorter summary

Scott Alexander presents results from an SSC Survey on SSRI usage, covering effectiveness, side effects, and discontinuation experiences among 2,090 users. Longer summary

Scott Alexander presents the results of an SSC Survey on SSRI usage, covering their effectiveness, side effects, and discontinuation experiences. The survey included 2,090 SSRI users and explored various aspects of SSRI use. Key findings include: most users found SSRIs helpful, with Lexapro rated highest and Paxil lowest; SSRIs seemed more effective for anxiety than depression; 70% of users experienced side effects, with sexual difficulties being most common; 15% reported persistent side effects after discontinuation; and discontinuation difficulty varied among different SSRIs, with Prozac being easiest to discontinue. The survey largely confirmed existing psychiatric consensus, with the high rate of persistent side effects being the main surprise. 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

Scott Alexander examines the rise, fall, and alleged resurrection of the antidepressant NSI-189, expressing skepticism about its efficacy and the broader challenges in developing new antidepressants. Longer summary

Scott Alexander discusses the disappointing results of NSI-189, a promising new antidepressant, in FDA trials. He explains how the drug initially failed to outperform placebo on the primary endpoint, leading to a stock crash for Neuralstem. However, the company later released positive secondary endpoint results, causing their stock to rise again. Scott expresses skepticism about these new results, suggesting they may be due to statistical manipulation rather than true efficacy. He reflects on the challenges of developing new antidepressants and the tendency to get overly excited about new drugs, ending with a sardonic hope for another new antidepressant, SAGE-217. Shorter summary

Scott examines how rare but severe drug side effects often lead to underprescription compared to drugs with common but less severe side effects, potentially resulting in suboptimal patient care. Longer summary

This post discusses the issue of rare but severe side effects in psychiatric medications versus common but less severe side effects. Scott uses two main examples: nefazodone vs SSRIs for depression, and modafinil vs Adderall for stimulants. He argues that drugs with rare but spectacular side effects (like nefazodone and modafinil) are often underprescribed compared to drugs with more common but less severe side effects (like SSRIs and Adderall). The post explores the reasons for this, including doctors' risk aversion, lawsuit concerns, and media coverage of rare side effects. Scott suggests that this pattern may lead to suboptimal treatment choices for patients. Shorter summary

Scott Alexander defends his stance on the 'chemical imbalance' theory of depression, arguing that Mad In America's critique actually supports his view of a more nuanced understanding in psychiatry. Longer summary

Scott Alexander responds to a critique of his previous post about the 'chemical imbalance' theory of depression by Mad In America. He argues that the critique misses his point and actually supports his thesis. Scott analyzes each example provided by Mad In America, showing how they generally present a nuanced view of depression and serotonin's role, rather than promoting a simplistic 'serotonin deficiency' model. He criticizes Mad In America for quoting out of context and misrepresenting the sources. Scott concludes that while the 'chemical imbalance' theory has been simplified in public discourse, the psychiatric community has generally been responsible in presenting the complexities and uncertainties of depression's causes and treatments. Shorter summary

Scott analyzes various criticisms of antidepressants, concluding they have modest but real benefits over placebo, with important considerations about side effects and efficacy. Longer summary

This post examines various criticisms of SSRIs and antidepressants, addressing claims about their efficacy, side effects, and comparisons to placebo and psychotherapy. Scott analyzes studies on antidepressant effectiveness, discussing issues like publication bias, effect sizes, and the meaning of 'clinical significance'. He explores side effects, particularly sexual dysfunction, weight gain, and emotional blunting. The post concludes that while antidepressants are not miracle drugs, they do have a modest but statistically significant benefit over placebo and can be a reasonable option for many people with depression, especially if they understand and prepare for potential side effects. Shorter summary

Scott Alexander explores the idea that people might be missing universal human experiences without realizing it, using examples from various senses and personal anecdotes. Longer summary

Scott Alexander explores the concept of missing universal human experiences without realizing it. He starts with Galton's experiments on visual imagination, then discusses a conversation about food preferences, and shares stories about anosmia and color blindness. He reflects on his own experiences with asexuality and emotional blunting from SSRIs. The post concludes by questioning whether differences in experiences, like appreciating jazz music, might have biological roots rather than just social ones. Shorter summary