Scott Alexander examines a study challenging ketamine's effectiveness as an antidepressant, discussing potential confounding factors and maintaining his belief in ketamine's utility despite the study's results. Longer summary

Scott Alexander discusses a recent study on ketamine's effectiveness as an antidepressant when administered during anesthesia. The study found no significant difference between ketamine and placebo groups, challenging previous beliefs about ketamine's antidepressant properties. Scott analyzes the study's methodology and results, pointing out several factors that might have influenced the outcomes, such as the strong placebo effect, the antidepressant properties of anesthetics, and the potential impact of surgery on depression symptoms. He concludes that while the study raises questions, it doesn't completely invalidate previous research showing ketamine's effectiveness, and he maintains his belief in ketamine's potential as an antidepressant for some patients. Shorter summary

The post challenges the notion that effect sizes below 0.50 for medications are clinically insignificant, using antidepressants as a case study and comparing them to other common drugs. Longer summary

This post discusses the interpretation of effect sizes in medical studies, particularly for antidepressants. It challenges the common notion that effect sizes below 0.50 are clinically insignificant. The author presents a Danish study that simulates various hypothetical medications, showing that even drugs that cure or significantly improve depression in a large percentage of patients might not meet traditional effect size thresholds. The post explains why these thresholds might be unrealistic due to factors like the placebo effect, high standard deviations in placebo groups, and patient dropouts. It also compares antidepressant effect sizes to those of other widely accepted medications, concluding that many common drugs would be considered 'clinically insignificant' by strict effect size standards. The author suggests that claims about 'meaningless effect sizes' should be given less weight compared to other evidence, such as clinical experience. Shorter summary

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 discusses a replication of his nootropics survey, expressing skepticism about the results due to potential placebo effects and biases in participant ratings. Longer summary

Scott Alexander discusses a replication of his 2020 nootropics survey by the blog Troof, which gathered data from 1981 subjects using a recommendation engine. While the results largely align with Scott's original survey, he expresses some skepticism about the findings. He notes that addictive or illegal substances, difficult lifestyle interventions, and fancy high-tech chemicals tend to rank higher, which could be due to both actual effectiveness and placebo effects. Scott highlights concerns about psilocybin microdosing's high ranking despite studies showing its ineffectiveness, and the low ranking of SAMe despite its proven effectiveness in clinical trials. He suggests that a simple model based on factors like difficulty of obtaining the substance and perceived novelty could largely predict the survey results, questioning whether any findings truly stand out beyond these factors. Shorter summary

Scott Alexander conducts a personal randomized controlled trial of a sleep supplement, finding no significant effect over placebo, but gains insights into his sleep patterns. Longer summary

Scott Alexander conducts a personal randomized controlled trial to test the effectiveness of a sleep supplement called Sleep Support. Initially, he experiences a dramatic improvement in his sleep patterns, but decides to rigorously test this effect. He designs an experiment using placebo pills and blind administration over 24 nights. Surprisingly, the results show no significant difference between the Sleep Support and placebo nights in terms of sleep duration, wake-up time, or subjective measures. Scott concludes that his initial perceived improvement was likely due to the placebo effect and the act of not checking the clock upon waking. Despite the supplement not outperforming placebo, Scott considers the experiment a success as it led to improved sleep habits. Shorter summary

Scott Alexander critiques therapy books, highlighting their exaggerated claims and questioning the validity of their approaches, based on his clinical experience and historical misdiagnoses in psychology. Longer summary

Scott Alexander reviews the common patterns in therapy books, noting their tendency to promise miraculous results and criticize previous methods. He observes that while these books claim extraordinary success, his clinical experience doesn't match these claims. The post explores the concept of 'historicism' in therapy, where current problems are linked to past traumas, and questions the validity of this approach. Scott expresses skepticism about the dramatic transformations described in therapy books, comparing them to past misguided theories about mental health conditions. He concludes by warning readers to be cautious when evaluating individual therapy books, as they can be convincing in isolation but problematic when viewed as part of a larger trend. Shorter summary

Scott Alexander introduces an 'Anxiety Sampler Kit' for testing various anxiety supplements, aiming to personalize treatment and gather data through self-experimentation. Longer summary

Scott Alexander introduces an experimental 'Anxiety Sampler Kit' designed to test the effectiveness of various supplements for treating anxiety. The kit contains 21 boxes with six different supplements and placebos, arranged randomly. Users try a box when feeling anxious, rate their response, and after completing all boxes, determine which supplement worked best for them. This approach aims to personalize treatment and gather data for a small placebo-controlled trial. Scott discusses the rationale behind personalized medicine and the challenges in predicting individual treatment responses. He invites Bay Area residents to participate in this self-experimentation project, with the condition that they share their results. Shorter summary

Scott Alexander reports on a survey about nighttime ventilation interventions, finding modest overall improvements but some individual success stories. Longer summary

Scott Alexander presents the results of a survey on nighttime ventilation conducted after his previous post on carbon dioxide levels. The survey, with 129 participants, explored various interventions to improve sleep quality by reducing CO2 levels. While the overall results were modest, with an average improvement of 1.4 on a 0-5 scale, some participants reported significant benefits. The most common intervention was sleeping with an open window. Despite the underwhelming results, most participants planned to continue their interventions. Scott concludes that the results are essentially negative, both for nighttime ventilation and for the reliability of informal blog surveys in producing confident data. Shorter summary

Scott Alexander explores research on how high indoor CO2 levels may impair cognition and sleep, suggesting simple solutions like better ventilation. Longer summary

Scott Alexander discusses recent research on the effects of high indoor carbon dioxide (CO2) levels on cognitive function and sleep quality. He describes how his housemates discovered high CO2 levels in their home and improved their symptoms by increasing ventilation. The post explores studies showing cognitive impairment at high CO2 levels and the potential impact on sleep quality. Scott suggests that nighttime CO2 levels in bedrooms can be particularly high and may affect sleep. He recommends simple solutions like opening windows or using certain plants to reduce CO2 levels. The post ends with a call for readers to participate in an informal experiment on nighttime air quality. Shorter summary

Scott Alexander examines Vinay Gupta's ideas on enlightenment, comparing them with other sources and discussing the challenges of interpreting mystical experiences from a scientific viewpoint. Longer summary

Scott Alexander discusses Vinay Gupta's views on enlightenment, comparing them to other sources like 'Mastering The Core Teachings Of The Buddha'. He notes similarities in descriptions of meditation and consciousness across different sources, but also highlights Gupta's assertion that everyone experiences enlightenment differently based on their cultural context. The post explores the challenges of understanding enlightenment from a scientific perspective and the potential relativism of mystical experiences. Scott also touches on the concept of the Bayesian brain and how it might relate to enlightenment experiences. He expresses skepticism about claims linking Western alchemical traditions to Eastern enlightenment practices and concludes with Gupta's personal account of achieving a state of no internal dialogue through meditation. Shorter summary

The post examines research suggesting placebos are largely ineffective, explores exceptions, and proposes explanations for observed placebo effects based on brain function and study design. Longer summary

This post discusses the placebo effect, focusing on Hróbjartsson and Gøtzsche's research which found that placebos have little benefit over no treatment in most conditions. The author explores the reasons behind this, suggesting that regression to the mean may have been mistaken for placebo effects in earlier studies. The post also discusses exceptions where placebos seem more effective, such as pain and nausea, and offers a potential explanation for the placebo effect based on the brain's predictive processing model. The author concludes by speculating on why depression might not show strong placebo effects in clinical trials despite common assumptions. 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 Alexander reviews 'Surfing Uncertainty' by Andy Clark, exploring the predictive processing model of brain function and its wide-ranging explanatory power. Longer summary

Scott Alexander reviews the book 'Surfing Uncertainty' by Andy Clark, which explains the predictive processing model of how the brain works. This model posits that the brain is constantly making predictions about sensory input and updating its models based on prediction errors. Scott explores how this theory can explain various phenomena like attention, imagination, learning, motor behavior, and even psychiatric conditions like autism and schizophrenia. He finds the model compelling and potentially explanatory for a wide range of cognitive and perceptual processes. Shorter summary

Scott Alexander criticizes branded combination nootropics, explaining why they are often ineffective or harmful, and advises careful individual experimentation with single substances instead. Longer summary

Scott Alexander criticizes branded combination nootropics, arguing they are often poorly designed and potentially harmful. He begins by mocking the ridiculous names and exaggerated claims of many such products, then explains why even well-intentioned combinations are problematic. The post discusses how nootropics affect individuals differently, making one-size-fits-all approaches ineffective. Scott emphasizes the importance of careful individual experimentation with single substances, rather than relying on pre-made combinations. He also cautions against assuming synergistic effects between different nootropics, noting that even well-studied psychiatric drug combinations often fail to show benefits. The post concludes by advising readers to approach nootropics cautiously and individually, rather than relying on branded combinations. Shorter summary

Scott examines psychological phenomena attributed to the unconscious mind, noting many have failed to replicate, and suggests a shift away from the power of the unconscious in psychological research. Longer summary

This post explores the concept of 'voodoo death' and its parallels in psychology, suggesting that many psychological phenomena previously attributed to the power of the unconscious mind may be less significant than once thought. Scott examines several examples, including the placebo effect, stereotype threat, self-esteem, and social priming, noting that many of these effects have failed to replicate in recent studies. He proposes a pattern of shifting away from the power of the unconscious in psychological research, while acknowledging the limitations of his analysis. The post concludes by considering the implications for Freudian psychology and suggesting a need to reevaluate our understanding of the unconscious mind. Shorter summary

Scott reviews 'Unlearn Your Pain', finding its psychosomatic theory of chronic pain intriguing but overstated, while acknowledging the book's techniques may still be helpful via placebo effects. Longer summary

Scott reviews the book 'Unlearn Your Pain' by Dr. Howard Schubiner, which argues that most chronic pain is psychosomatic and can be cured through psychological techniques. While Scott finds some of the book's claims intriguing, he is skeptical of its more sweeping assertions about the psychological origins of pain. He examines the evidence for and against psychosomatic theories of chronic pain, concluding that while psychological factors likely play a role, the book overstates its case and ignores contradictory evidence. Scott suggests the book's techniques may work primarily through placebo effects rather than by addressing repressed trauma as claimed. Shorter summary

Scott Alexander presents results from a survey of 850 people rating various nootropics, showing a range of perceived effectiveness and exploring addiction potential for some substances. Longer summary

Scott Alexander presents the results of a survey on nootropics, substances that claim to improve mental function. The survey gathered ratings from 850 participants on various nootropics. The results show a range of effectiveness, with prescription drugs like Adderall and Modafinil scoring highly, along with LSD microdosing and Phenibut. Some less well-known substances like tianeptine, Semax, and ashwagandha also performed well. The survey also explored addiction potential for certain substances. Scott notes that while the survey lacks placebo control, the large sample size and consistency with previous results lend some credibility to the findings. Shorter summary

Scott Alexander explores the declining effectiveness of Cognitive Behavioral Therapy, proposing that its core ideas have become part of popular culture, potentially explaining its decreased impact. Longer summary

The post explores the declining effectiveness of Cognitive Behavioral Therapy (CBT) over time. Scott Alexander compares his experience with CBT to that described in a book by a prominent CBT therapist, noting a stark difference in patient responses. He then proposes a theory that CBT's core ideas have become part of popular culture, making the therapy less novel and potentially less effective. The post discusses how this 'CBT in the water supply' phenomenon might explain the therapy's decreasing impact, while also considering other factors like changes in study quality or patient populations. The author speculates on how this cultural absorption of CBT principles might affect its placebo effect and overall efficacy. 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 explores the fascinating etymology of 'placebo' from medieval funerals to medicine, then discusses the controversial placebo effect in depression treatment. Longer summary

This post explores the etymology of the word 'placebo' and its journey from funeral rites to medical terminology. Scott starts by debunking the common medical school explanation and delves into its medieval origins as part of funeral rites. He then discusses various theories on how it became an insult and eventually a medical term. The post then shifts to discussing the placebo effect in depression treatment, highlighting the controversy surrounding its effectiveness and the importance of understanding its true nature for patient care. Shorter summary

Scott Alexander reports on a survey of nootropics users, finding mixed results for various substances and discussing methodological challenges in assessing their effectiveness. Longer summary

Scott Alexander presents the results of a survey on nootropics, substances claimed to improve mental functioning. The survey, taken by 162 respondents from online nootropics communities, asked about experiences with 28 different substances. Key findings include: caffeine and modafinil were rated most effective; some newer substances like phenylpiracetam and coluracetam showed promise; traditional medicines had mixed results; dose-response relationships were mostly inconclusive except for high-dose vitamin D; and there were unexpected correlations between effects of different substances. Scott discusses limitations of the survey and plans for future iterations. Shorter summary