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Cymbalta (Duloxetine)
Medications · 9 min read

Cymbalta (Duloxetine)

Cymbalta is the drug I reach for when the depression has a physical component...

Feb 1, 2025
Social Anxiety Disorder
Conditions · 7 min read

Social Anxiety Disorder

Social anxiety isn't shyness, it's an anxiety disorder run by avoidance. Here's how dodging makes it worse and how exposure, CBT, and meds fix it.

Jan 30, 2025
Lexapro (Escitalopram)
Medications · 10 min read

Lexapro (Escitalopram)

Lexapro is the SSRI I start with most of the time, and the reason is boring...

Jan 29, 2025
When to switch antidepressants, and when to stay
Comparison · 9 min read

When to switch antidepressants, and when to stay

Half the antidepressant switches that happen shouldn't have happened, and the other half should have happened six months earlier.

Jan 27, 2025
Choosing between SSRIs, SNRIs, and what comes next
Comparison · 10 min read

Choosing between SSRIs, SNRIs, and what comes next

The decision tree for picking an antidepressant in 2026 isn't really a tree, it's more like a workflow, and the workflow is a lot simpler than the size of…

Jan 24, 2025
Adderall vs Vyvanse: side by side
Comparison · 9 min read

Adderall vs Vyvanse: side by side

Both are amphetamines, both work, the differences are real but not enormous, and the right answer for any given patient depends on factors that the rep…

Jan 22, 2025
Belsomra (Suvorexant)
Medications · 8 min read

Belsomra (Suvorexant)

Belsomra (suvorexant) blocks the brain's wake signal instead of forcing sedation. Best for staying asleep, and the dependence math beats the benzos.

Jan 22, 2025
ADHD meds for adults: the questions I get most
Q&A · 11 min read

ADHD meds for adults: the questions I get most

Adult ADHD is everywhere now, which means I get the same set of questions from people considering a stimulant, in slightly different fonts, over and over.

Jan 19, 2025
How long does an antidepressant actually take to work?
Q&A · 9 min read

How long does an antidepressant actually take to work?

Eight to twelve weeks at a real dose.

Jan 16, 2025
Does Wellbutrin actually not cause sexual side effects?
Q&A · 11 min read

Does Wellbutrin actually not cause sexual side effects?

The short version: mostly true, the marketing is shading it slightly cleaner than it actually is, and the most useful clinical move with Wellbutrin in…

Jan 14, 2025
Finasteride (Propecia, Proscar)
Medications · 9 min read

Finasteride (Propecia, Proscar)

Finasteride (Propecia, Proscar): how it holds onto your hair, the sexual side effects, the contested post-finasteride question, and the PSA catch.

Jan 14, 2025
What the men’s mental health movement gets wrong
Off Script · 9 min read

What the men’s mental health movement gets wrong

There are basically two wings of the men's mental health conversation in 2026 and both of them are selling stuff, which is most of the problem.

Jan 11, 2025
Schedule II is doing more harm than good
Off Script · 9 min read

Schedule II is doing more harm than good

Stimulant medications are currently Schedule II, which is the same legal category as fentanyl, oxycodone, and morphine.

Jan 8, 2025
The Adderall shortage isn’t what you think it is
Off Script · 10 min read

The Adderall shortage isn’t what you think it is

The Adderall shortage that's been going on for the last three-plus years isn't caused by telehealth mills, not caused by hoarding anxious parents, not…

Jan 6, 2025