Effect of No drugs

After taking fluoxetine and supradyn recharge for about 6 months, I felt the following effects.

Positive effects:

• Less stuttering
• Overall good mood
• No depressive thoughts
• Almost no anxiety on any of the previously known anxiogenic circumstances

Negative effects:

• Motivation is significantly reduced
• Unable to motivate myself - need to plan well ahead to execute a simple task
• Concentration is reduced significantly - unable to remain in a task for longer period of time
• Affection towards the family members is reduced.
• Sore throats due to throat infection occurred every month and it spread to all family members. Here, the mechanism may be considered as follows. Fluoxetine has some opposing effects to the stress hormone cortisol in the body. When fluoxetine is taken at the night time, it may suppress the release of cortisol during the night time. Less cortisol means less anti-inflammatory effects in the body since cortisol is a steroid and has good anti-inflammatory property. While taking lectures, due to the loudness of voice and continuous speaking, throat muscles may get injured. This injury will heal normally if there is enough cortisol in the body. Since, fluoxetine suppressed the night time cortisol release, this injury may not heal during the night time thus making it prone to the harmful effects of tooth paste in the next morning. Also, there is a possibility of infection occurring. 

Although the positive effects of this combination (fluoxetine and supradyn recharge) is highly beneficial to me, the negative effects did affect my progress in my career and in my personal life.  Hence, I decided to try something different. I thought that this is the time to stop my treatment. So, I decided to stop fluoxetine and supradyn recharge completely. I devised a plan to stop these two drugs.

First, I stopped supradyn recharge only. I continued with fluoxetine 1 capsule at night. Initially for two weeks, I had few headaches due to low serotonin. So, I took 4 bananas (2/morning and 2/night) to replace supradyn recharge's pyridoxine HCl (5 mg). Because each banana contains approximately 0.5 mg of pyridoxine HCl. This helped me a lot not to feel any sudden depressive feelings. Slowly I reduced the number of bananas to 1 per day. During this time, I took ginger coffee also to relieve my headache. I took ginger coffee (1 cup in morning and 1 cup in evening) for almost 40 days. Ginger coffee was prepared by adding 1 teaspoonful (~5 ml) of ginger extract (prepared by squeezing cut pieces of ginger in a mortar and pestle) to regular coffee. Ginger coffee helped me a lot in avoiding paracetamol tablets for my headaches. Sometimes the headache disappeared within 10 minutes of taking ginger coffee.

After 4-6 weeks of stopping supradyn recharge, I stopped taking fluoxetine completely. No tapering of doses. This time also I was continuing my ginger coffee. Also, I took green tea in the night. Green tea has EGCG, which has good anti-anxiety effect. I think it enhances the GABA function. So, I could sleep well in the night without fluoxetine. This was really something great for me. So, I had good sleep. I could get up in morning with some refreshed mind and energy. I took green tea for 1-2 weeks. Then I stopped taking green tea also.

After these things, I did not feel any low mood, depressive thoughts and less motivation. I felt good mood, somewhat increased motivation, no head aches etc.

Positive effect of no drugs:

• Good mood
• Good energy
• No significant effect on stuttering - stuttering was there but since no anxiety was there, I could speak to some extent by using filler words like "something like that" "Actually" etc.
• Good improvement in concentration
• Good improvement in motivation
• Good bright night vision
• Apparently no effect on driving
• Libido - initially improved but later stabilized - but better than that observed with fluoxetine

Negative effects:

• Although no appreciable anxiety is there, gasping for breath while talking occurred - indicating oxidative stress
• Frequent dizziness spells - increased while taking non-dairy creamer and decreased while taking milk for coffee.
• Premature ejaculation

Then, I focused on my diet. Because, my last blood check up revealed that I had increased LDL cholesterol, decreased HDL cholesterol, increased total cholesterol and increased uric acid. I used to take more proteins like fish, eggs, chicken and mutton to maintain my neurotransmitter levels. This excessive protein intake might have led to increased levels of uric acid. So, I decided to reduce my protein intake.

I took only rice in the night time. I completely avoided any protein rich food like chicken or fish. Occasionally I took 1 egg. This gave me the following results. I restricted protein intake to my breakfast /lunch time.

Positive effect of no drugs:

• Good mood
• Good energy in the morning - I could get up early in the morning - No residual sleepy mood.
• No significant effect on stuttering - stuttering was there but since no anxiety was there, I could speak to some extent by using filler words like "something like that" "Actually" etc.
• Good improvement in concentration.
• Good improvement in motivation.

Now, since I have gasping for breath while talking, it seems to due to the oxidative stress in the body. So, I am trying some antioxidants like Vitamin E and Vitamin C.

Effect of fluoxetine and supradyn recharge

Although I could achieve better results with the previous treatment plans I and II, still I had stuttering while talking on phone and to strangers. Sometimes the telephonic conversation occupy vital part of talking (like transaction negotiation or making an appointment) and stuttering at those timings gave me very worst embarassing.

So, I wanted to try fluoxetine again.

I took fluoxetine 20 mg once daily in the morning along with executive B multivitamin tablets. This combination gave me the following.

Positive effects:

• Moderate energy and motivation
• No effect on sexual function (good erections and good libido)
• Less stress, anxiety and depression

Negative effects:

• More pronounced stuttering.
• Heavily sleepy during day time especially after lunch.
• Heavy and profuse sweating.

Mechanism explanation:

• The Executive B multivitamin contains pyridoxine (Vit. B6) 10 mg. This amount might have catalysed the synthesis of huge quantity of serotonin.
• Increased serotonin synthesis might have led to increased 5-HT neurotransmission and subsequently increased dopamine neurotransmission in the speech area of brain thus producing more stuttering. 

So, I decided to reduce the amount of Vit. B6. Supradyn recharge naturally came as a first choice since it contained 5 mg of Vit. B6. So, I took fluoxetine 20 mg and supradyn recharge 1 capsule in the morning after breakfast. It produced less stuttering in the evening and more sleepiness and stuttering in the morning. Then I decided to change the timing of these two drugs. I took fluoxetine in the night after dinner and supradyn recharge capsules in the morning after breakfast. This combination produced wonderful effects on my stuttering.

Positive effects:

• Almost no stuttering and very clear speech except for the rare occurrence of mispelt words.
• Good loudness of voice without gasping for breath.
• Greater reduction of anxiety
• No feelings of depression - no negative feelings and worrying
• Very good judgement of space while driving car.
• Very good memory recall of routes while driving.
• Good sense of well being
• Almost no effect of food on stuttering - earlier if i consume protein in the lunch, my stuttering used to be worse. Now, whatever food I consmed did not affect my stuttering. So, I removed restrictions on my food type.
• Good sleep in the night.
• Good self control.
• Good control of blood pressure - 128/87 mm Hg with 86 pulse rate.

Negative effects:

• Motivation to start and remain in a task is reduced significantly
• Concentration to sustain in a task is also reduced significantly.
• Libido is also reduced significantly. But erections used to be slow onset and not much of a problem. Orgasm was delayed or did not occur in some instances. Libido was increased if supradyn recharge was not taken in the morning.
• Heavy and profuse sweating.
• Music is not enjoyable as before.

Suggestions:

• Either Vitamin C or DL-phenylalanine may be added in the morning or in the lunch time to increase concentration and motivation. However, care should be taken not to disturb the achieved fluency levels.  

Effects of serotonergic neurotransmission enhancers

After the treatment with lot of nutraceuticals and drugs for the past 1.5 years, I feel that my serotonergic system is unable to buffer itself against even little variations. If I take any food/drug which has effect on serotonergic system, my serotonergic system has a profound effect thereby suppressing the dopamine and noradrenaline systems. If I don't take anything, I used to feel worthlessness and anxious indicating the relapse of depression.

The foods/nutraceuticals which produced profound effect on my serotonergic system are given below.

Food/Nutraceutical	Positive Effects	Negative Effects
Instant Oats - Morning breakfast	Less anxious but not much when I started stutter	Tiredness, stomach bloating, increased stuttering
Supradyn recharge multivitamin capsules - 1 capsules per day	Less anxious, Alertness while driving	Tiredness
GTF (Glucose tolerance factor) chromium 200 - 400 micrograms per day	Great reduction of anxiety, music is enjoyable, can do tasks if already programmed like a robot	Tiredness, unable to focus or concentrate on a particular task (concentration dependent jobs required more time to finish), less clarity in thinking, mental cloudiness, unable to pursue reward oriented tasks even though the reward is known already, confusion in decision making

I feel that the enhanced serotonergic system suppresses the dopamine and noradrenaline systems thereby affecting my focus, concentration and reward circuitary. But I feel that the combination of Supradyn recharge and GTF chromium is very much suitable for reduction of stuttering and reducing anxiety. However, to increase the focus, attention and reward seeking behaviour, either vitamin C (500mg-1g/day) or DL-phenylalanine can be added.