Antidepressants

Hip

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I find selecting the right antidepressant can be tricky when you have ME/CFS, as often the benefits of a drug you take can wear off after some months. ME/CFS is a funny condition where patients often report the benefits gained from some medication will disappear after some weeks or months.


These are the antidepressants I take (and these have continued working for me):

Effects kick in within a couple of hours:
  • Amitriptyline 10 mg — TCA antidepressant, a reuptake inhibitor of serotonin and norepinephrine
  • Manganese 3 mg — needed for dopamine synthesis. I find this one increases enthusiasm for doing things
  • Spanish saffron 100 mg twice daily — increases dopamine (shown to be as effective as antidepressant drugs).
  • Moclobemide 75 mg — MAO-A inhibitor, increases dopamine
  • Low-dose amisulpride 12.5 mg — this dopamine stabilizer antipsychotic drug acts as an antidepressant
Note that technically you should not take amitriptyline with moclobemide, as there is a major drug interaction between these two. However, because I use low doses of both, I do not worry too much about this.


Effects kick in within 12 hours:
  • High-dose inositol 12 to 18 grams day — increases serotonin

Effects kick in after a few days:
  • High-dose cod liver oil or fish oil (taking a dose containing at least 300 mg of EPA)
  • Folinic acid 200 mcg


I had moderate to severe generalized anxiety disorder (GAD) for years, but finally managed to bring it under control using certain supplements which I believe work by targeting the brain inflammation I suspect underlies many cases of GAD. See this thread:

Completely eliminated my severe anxiety symptoms with three supplements!
 
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Yes, Avoid if you can. I know from personal experience how devastating anxiety and depression are, and how driven we can be to just STOP it ....

Drs who are honest will admit that they really have no idea how anti-D's truly work, or what they really work on, and even less about their short and long-term effects on the brain, the CNS, the Enteric Nervous System, and neurotransmitters.

And most Drs have only the thinnest level of understanding of the brain itself, the most complex and critical system in our bodies ....

But anti-D's are an easy answer, at least for the prescribing Dr. It makes it look like they're engaged and doing something. The results for the patients are .... varied-to-dismal.

And once you're on them. getting off can be an interesting ride, which is not to be confused with fun, tho few who've been thru that cheese-grater would.

Worse, many Drs actually believe that a brief 2 week taper is sufficient. It isnt. It will devastate your nervous system, and can leave you with really unpleasant side effects for years to come. Sometimes for life.

Please, please, please do some research. Don't rely solely on input from other members on this site or any other, we all have our own views that may or may nor work for you.

Good luck, and hang in. Keep posting, keep reading, keep researching, here and elsewhere :thumbsup::thumbsup: :hug::hug:....
 

Hip

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I forgot that I also take very-low dose amisulpride for depression. This drug also helps my ME/CFS symptoms like sound sensitivity, and helps anhedonia (anhedonia is a major problem for me), the ME/CFS irritability symptoms, and ADHD.

Interestingly, in spite of the fact that amisulpride is an antipsychotic drug, the antidepressant effect I get from amisulpride feels the most "natural" and nice out of all the antidepressants I have tried, both supplements and drugs. It has a very balanced and normal feeling.

But antipsychotics, even in very low doses, should not be taken without understanding the serious risks (eg, they can permanently trigger diabetes or extrapyramidal symptoms).

My thread on amisulpride is here.


More recently, many ME/CFS patients have been finding that a similar antipsychotic called irritability has quickly lead to major improvements in their health level (eg, moved them from severe to moderate ME/CFS).
 
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With deepest respect, none of the more naturally oriented things that @Hip listed worked for me and several of them made me infinitely worse. I need to add that I took those long before I ever got to these threads, so it most definitely wasnt @Hip's fault or recommendation that precipitated all that. And again, I have to stress that we're all different, as are our reacti0ns to everything from orange juice to aspirin ...

And fiddling your brain with mono-amine-oxidase inhibitors, etc, is a sort of Russian Roulette that I personally wouldn't undertake myself. But that's just me.

The anti-psychotic that's being tested on ME patients at Stanford, Abilify, has a mixed record: some patients feel much better for one, two, or three months, at which point the drug stops workig entirely dumping tham back into a pit deeper and blacker than the one it briefly pulled them out of. Other patients dont respond at all. A few others have very bad experiences with it. And still a very few others have longer term beneficial effects. It's a crap shoot.

Which only goes to underline the fact that we're all incredibly different. The inositol, which I;d been taking for years before bedtime turned on e viciously and made e suicidal. Ditto any form of B-vits, and then all vits, regardless, including Vit A (cod liver oil).

And @Hip has pointed out something very important: there are many forms of anxiety, from Generalized Anxiety Disorder to Seasonal Affectional Disorder to transient anxiety/panic, to anxiety produced by social interaction, etc etc etc.

For some reason, the ME populatin is more prone to anxiety disorders than the general population, at least it seems to be the case.
 
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Hip

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none of the more naturally oriented things that @Hip listed worked for me and several of them made me infinitely worse. And fiddling your brain with monoamineoxidase inhibitors, etc, is a sort of Russian Roulette that I cant recommend.
If like me you are prone to various mental health symptoms, it can be tricky in selecting the right antidepressants. It is a very individual thing, which requires a lot of trial and error.

I took just one low-dose pill of an SSRI antidepressant called citalopram, prescribed by my doctor, and within an hour my depression became immeasurably worse, and my suicidal ideation became the most intense I have ever experienced.

The antidepressant supplement SAM-e also made me feel worse, but only slightly so.


Yet I seem to do quite well on TCA antidepressants (I have tried both amitriptyline and imipramine), although their mood boosts for me feels a little unbalanced (like part of my brain is in a good mood, but other areas of my mind are still depressed).


I also do well on MAO inhibitors, in fact even when I was healthy I found the MAO-B inhibitor selegiline (which is famous in cognitive enhancement circles) really great for generating a zesty enthusiastic mood and increased creativity.

Unfortunately I found since getting ME/CFS that selegiline makes my ME/CFS feel worse, and no longer boosted my mood, so I stopped using it. It was a mystery to me why a dry like selegiline which used to make me feel so great stopped working once I was hit with ME/CFS.

Eventually I learnt that selegiline boosts the inflammatory cytokine IL-1beta, which is a major cytokine driving brain inflammation. Since brain inflammation is an issue in ME/CFS to begin with, you would not want to increase IL-1beta and further. So I think this explains why selegiline started making me feel worse.

So then I switched to another MAO inhibitor, moclobemide, which is an MAO-A inhibitor, and I was fine with that.

I like moclobemide because in one study on the sexual side effects of antidepressants, moclobemide came out as having the lowest risk of these side effects (only a 4% chance of getting these side effects, whereas for SSRIs, it's typically around 60%).


Another issue, especially with SSRI antidepressants, is the emotional blunting they often cause. Emotional are often blunted in ME/CFS, so we don't really need any extra blunting.

And if like me you also experience anhedonia (loss of the feeling of pleasure and reward) along with the emotional blunting, then it is even worse. Very hard to treat anhedonia.
 
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If like me you are prone to various mental health symptoms, it can be tricky in selecting the right antidepressants. It is a very individual thing, which requires a lot of trial and error.
Agreed, but I was only referencing the 'natural' supps, not prescription anti-d's, of which Celexa, citalopram, is one of the worst, as you mentioned ....


Everything comes with a price-tag. Sometimes it's not immediately apparent, but it's always there, just patiently waiting. This is particularly true of anything that messes with brain function in a more profound way than, say, inositol or folinic acid.

It's a hard road when you're looking for answers, with so many of them bringing infinite difficulties, in the form of side effects (some of them long-term) and potential material damage, in their wake .... I'm so glad that you;ve found things that work for you :woot::woot: :thumbsup::thumbsup::thumbsup: :hug::hug: !!!!
 

Judee

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I'm going through a time of grieving the loss of my Mom. She was my best friend and we were pretty much constant companions for the last 5-6 years of her life as I was her 24/7 caregiver so it's been kinda rough.

Somethings that are helping me through: Prayer and fasting, joining a grief group on FB, coming here and visiting my PR friends, and taking something called D-Phenylalanine.

The D-Phenylalanine is an amino acid and it does bring my mood up for a few hours and helps me through the weepiest times. Julia Ross talks about it in her Mood Cure book for pain but she also mentioned a client who was grieving the death of her husband and struggling and started to take this and found it helped.

There is also a DL form that Julia says also works but she said it can make people feel wired and I do find it does that for me which I don't like so I am sticking to the D form. I understand that the L form doesn't work for pain--physical or emotional.

A good fish oil cap has also sometimes helped with my mood but the D-Phenylalanine is the natural supplement that helps the most right now.

Anyway, you have to find what works for you because we are all different physiologically but I have always preferred trying the natural route first. Some of the herbals sounded scary to me even but I think this amino acid is okay.
 

Hip

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Agreed, but I was only referencing the 'natural' supps, not prescription anti-d's, of which Celexa, citalopram, is one of the worst, as you mentioned ....
I have found both supplements and drugs to be tricky, in terms of trying to find things which do not make my depression and mental health worse.

Quite a few supplements substantially worsen my depression, usually anything that boosts the immune system (which makes sense, given the latest theories on depression suggest it may be underpinned by inflammation and immune activation in the brain). Echinacea strangely I am fine with.

But the yeast supplement Epicor (Saccharomyces cerevisiae) makes me miserably depressed, and I also get depressed from the immune boosters beta sitosterol, transfer factor and BioBran MGN-3. I am not sure if other people with pre-existing low mood are made further depressed by these supplements, but if depression is a common side effect, perhaps there should be warning labels on the jars. So now I approach any immune booster with caution.
 
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I have found both supplements and drugs to be tricky, in terms of trying to find things which do not make my depression and mental health worse.
I agree. Like I said, everything has a price tag hidden somewhere, and that's true for 'natural' options, too, tho I have to admit a preference for that route as opposed to masses of prescriptions that produce side effects that require another prescription, that produces side effects that require another prescription, that produces side effects .... etc etc etc .....
usually anything that boosts the immune system (which makes sense, given the latest theories on depression suggest it may be underpinned by inflammation and immune activation in the brain
I think that the danger in boosting the immune system (which actually isn't particularly easy to do ... supps that claim to 'boost' it generally just fiddle around with it and annoy the crepe out of it) is that it also messes with the microbiome, since anywhere from 75 to 90% of your immune system is in your gut, depending on the source of information. ANd our gut is also known as the Enteric Nervous System, so it's as critical, and as poorly understood and treated, as our brain functions.
Echinacea strangely I am fine with.
I used to be, but now .... anathema.
perhaps there should be warning labels on the jars.
Ha !!! Like that'll happen :D:D :eek: :rolleyes::rolleyes: ....
So now I approach any immune booster with caution.
Very wise.


I'm even leery of the current fad for overusing probiotics without reference to which genus strains have been thoroughly researched and tested. And even so, you really need to know what you're doing and what you're trying to accomplish or affect, becasue introducing even just a few billion CPU's of an antagonistic-to-your-particular-system bunch of bacteria can be like opening the gates of Troy to the Greeks. Not fun, followed by murder and mayhem.

Life just seems to get more and more complicated and complex.
 

Boba

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@Hip & @YippeeKi YOW !! Thanks for your reply!!

It is really interesting how some things. that work for on person might not work for the other. My anxiety and panic due to me really bad coping with the situation I'm in now. I'd never commit suicide, but I get thoughts about it thinking of my life being changed forever. Yesterday I took 1 Ativan that helped me to calm down. Ativan is dangerous drug, therefore I will continue with a natural product called dystologes. recommended from my GP.

I was also offered escitalopram (Lexapro) from my GP this afternoon and took 5mg of it. So far no big side effects. I think it'S somehow trial and error for everybody right? Find what works for you. I will continue to take it for a while and see what happens. I really need something for my mental state right now.

Another issue, especially with SSRI antidepressants, is the emotional blunting they often cause. Emotional are often blunted in ME/CFS, so we don't really need any extra blunting.
I'm not emotionally blunted, it's more the opposite. I'm really emotional and would like be bit more blunted.

For sleep I take Doxepin 10mg, but I'm not convinced by it. May switch to Melatonin.

Another drug I recently got is Abilify. Both of you mentioned it. I might start that soon to see if works for me.

Yes, Avoid if you can. I know from personal experience how devastating anxiety and depression are, and how driven we can be to just STOP it ....
I know about the risks, but just can dow without these days. I'm grieving for my old life. Really want it back. I hope Tim improve from my last crash to s stage where I can at least go out for walk. The rest I'll see from there.

The interesting is that I got a little better during the last couple of days in terms energy, but my mood changed with that. Did anyone of you experience sth like that? It could be that energy comes from additional B12 or some probiotics I just started at the same day. I will test this in the near future.

@Judee I'm so sorry for you loss!
Anyway, you have to find what works for you because we are all different physiologically but I have always preferred trying the natural route first. Some of the herbals sounded scary to me even but I think this amino acid is okay.
As I'm pretty new in the game I'll need to get some quick fixes. The natural route will take a little time for me to check out, but will do 4 sure.

Thanks!!
 
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There is also a DL form that Julia says also works but she said it can make people feel wired
the 'D' and 'L' personifications stand for 'Dextro' and 'Levo' rotary, or chirality, assignations.

The 'L', or levorotary, form of proteins and some other sups indicates that its the closest to, or even identical to, what's produced in our own bodies, while 'D' are sometimes bound to other materials and also have different effects based on their reversed chirality.

The amino acids that make up the proteins in our bodies are all L-amino acids, which is why they're generally the most recommended. But some of the 'D' forms, with their different mechanisms of action, can have benefits as well.

The 'DL' forms are generally rubbish, for what that's worth, with a very few exceptions.


And VOILA !!! I've now renewed my Friendly Neighborhood Pedant license for at least the next two months !!! Soooooo relieved. It was near expiration .....
the D-Phenylalanine is the natural supplement that helps the most right now.
Then that's the one to stick with.


That's helpful info that hopefully @Boba can use. And it's safer to experiment with than Anti-D's or anti-psychs or benzos .... but in the end, 'ya gotta do what 'ya gotta do, and none of us here have a definitive answer, worse luck:meh::meh: ....
 

Howard

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I was also offered escitalopram (Lexapro) from my GP this afternoon and took 5mg of it. So far no big side effects. I think it'S somehow trial and error for everybody right?
I have three family members (non-CFS) who've recently begun taking Lexapro, starting slowly and increasing the dosage accordingly. Few, if any, side effects thus far. Based upon my own limited research, Lexapro does seem to have the fewest associated issues. A low dosage helps with anxiety, and higher dosages assist with depression.

Everyone is different. These days, I refuse to take any meds of this kind, focusing instead on mindfulness and meditation to get me through. I was on Paxil for a few years.. and it took me 18 months to titrate down to virtually nothing (bad side effects/after-effects etc.). But sometimes we all need a little help. :)

H
 
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Ativan is dangerous drug,
All benzos are dangerous beyond belief, and worse, they're still dispensed by Drs like party favors at a birthday celebration. They're deadly.
I will continue with a natural product called dystologes.
That's a homeopathic, yes? Created by Dr. Loges? I hope it helps ....
I was also offered escitalopram (Lexapro) from my GP this afternoon
Despite what a number of people report, often based largely on what their Drs told them, it's not without side effects, some of them pretty nasty, and getting off it is difficult and unpleasant exept for a fortunate few who mostly backed out of it pretty fast ....
I will continue to take it for a while and see what happens.
I know you're desperate right now and need relief, but believe me, things can get a lot worse ....
Another drug I recently got is Abilify. Both of you mentioned it. I might start that soon to see if works for me.
NO NO NO NO NO NO !!!! You need to do some research. Stanford uses Abilify in very small doses and under relatively close supervision. Google 'Stanford Abilify' and develop some more info before you start taking it. ANd dont take it with Lexapro until you research contraindications, of which Im oretty sure there'll be a boatload with that combination.
I'm grieving for my old life. Really want it back.
We all are, and we all do. Every one of us on this site and in theses threads. We all left things behind that we loved and thought were ours forever, whether a career or talent or friends or a settled, happy life, or hope ... we lost a sense of value and worth, we lost our place in a world that isnt known for waiting for anyone to catch up, or particularly generous with second chances.


Life's like that, the little bustard ....

It's brutal, and we all grieve. Not sure grieving with numbing drugs is helpful, but then again, I'm in my shoes, you're in yours. And pain is pain.
As I'm pretty new in the game I'll need to get some quick fixes.
Quick fixes are the most expensive in terms of side effects and difficulty cycling off .... be wary .... be careful .... dont be too desperate .... give the DystoLoges time to work .... homeopathic cures aren't as speedy as aspirin, but they can be quite effective ....
 

Boba

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@YippeeKi YOW !!

I know you're desperate right now and need relief, but believe me, things can get a lot worse ....
I really want to use an AD for now. Coping is quite hard. I will try it for 2 weeks and see how it feels. A friend of mine backed out pretty easy. I'm not a fan of consuming a lot of drugs at the same time.

NO NO NO NO NO NO !!!! You need to do some research. Stanford uses Abilify in very small doses and under relatively close supervision. Google 'Stanford Abilify' and develop some more info before you start taking it. ANd dont take it with Lexapro until you research contraindications, of which Im oretty sure there'll be a boatload with that combination.
No worries, A read a lot about Abilify (Stanford study as well) and talked to some people in a FB Group. My Psychiatrist is supporting me in a very good way. She doesn't know about the escilatopram (from GP) yet, because she's on holiday, but I will realign with her when she's back. I will take max 2 drugs at a time. Therefore I'm considering to tap off the doxepin for sleep. I already checked contraindications. Lexapro can amplify the effect of Abilify but it is highly unlikely to happen due to the low dose of Abilify. My first priority right now is mood and anxiety (with whatever drug or herb). As soon as I think that I'm in a stable state I will trial Abilify.

I need to work on my grief and give my body time to heal. I'm so short in this and hope that I still have a good window of recovery or remission if I don't overdo things. Trials are secondary to a good state of mind. I got better the last couple of days and hoping to improve more while working on my mood.

Thank you so much for your Input. I really appreciate it :)
 

Boba

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SSRI's come with the side effect: dry mouth.

This is a serious symptom- as our bodies are by definiton- Very Dried Out. Perhaps it does' t always occur- but be WARNED.
@Rufous McKinney thanks, I will have an eye on my mouth. Why is it a problem? The only thing that comes to my mind is that it represents being in a sympathetic state.

How do you recognise that your body is dried out? Dry skin?
 
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@Rufous McKinney thanks, I will have an eye on my mouth. Why is it a problem? The only thing that comes to my mind is that it represents being in a sympathetic state
Well, I go to chinese herbalists and thats a key in the diagnosis of Yin deficiency (we are overheating, we are out of balanced, build the Yin Feed the Yin).

We vary, but in my case, my eyes are sick- I likely have Sjogrens. So my mouth- its really bad and throat and lungs. Oh the skin too.

I actually asked about the dry mouth symptom because in my case, any pill with that : causes me to choke and gag and I can't tolerate it.

What happens later is your teeth get horrible. That happened to my mother. She took tons of pharma drugs. Her teeth crumbling.

I asked specifically and the doctor said- no, not a side effect. I read the label when I got back: side effect.

So I was choking on Day 3 of Zoloft, and threw it out.
 
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Thank you so much for your Input. I really appreciate it :)
You're very kind, @Boba .... I'm not having my best day and Ive been expresing myself with less wit and more forcefully than I usually would. As you can tell, I feel pretty strongly about this, but that's me, and has nothing to do with your reality ....


And I do know what your current reality feels like. Been there, done that, hated it, was bedbound and suicidal, definitely dont recommend it ....
read a lot about Abilify (Stanford study as well) and talked to some people in a FB Group. My Psychiatrist is supporting me in a very good way.
That's good news, and eases my fear a bit .....
She doesn't know about the escilatopram (from GP) yet, because she's on holiday, but I will realign with her when she's back.
There are worse combos than Lexapro ad Abilify, but whippin up an anti-psychotic and a fairly dicey anti-d (I don;t care what Drs say, since they're still denying tht benzos are all that bad, or require long careful tapers) into a tasty daily brain-hammering cocktail just sounds like a real crap-shoot ....
Lexapro can amplify the effect of Abilify but it is highly unlikely to happen due to the low dose of Abilify
Who knows? All our systems are different, carry different genetic penalties, and react differntly and either more or less sensitively to drug combos ....
I really want to use an AD for now. Coping is quite hard.
Like I said, 'ya gotta do what 'ya gotta do. But please, please, stay in touch here in this thread and let us know how you're doing, cause I'll continue to be concerned :nervous::nervous::nervous::nervous: :) ....
I will try it for 2 weeks and see how it feels
The faster you get off it, the less likely that you'll have an unpleasant experience .... take careful note of how your body and brain are reacting, keep track of what you eat or otherwise take into your system, drink LOTS of water ....
A friend of mine backed out pretty easy.
A friend of mine died trying to back out after a fairly short period of about 3 1/2 or 4 months of Lexapro and Dr supervised multi-drug 'therapy'. And one of the Drs was a psych who specialized in psychopharmacology, particularly depression and anxiety treatment.


So go know, as they say with a gallic shrug ....
I will have an eye on my mouth. Why is it a problem?
Well, as @Rufous McKinney mentioned, it'll destroy your teeth, and can cause various forms if deterioration in vision, usually associated with being older.


But the most serious effect is on your kidneys and liver. The drugs you're considering all clear thru the P450 hepatic cytochrome, specifically, the CYP 2D6, 2C19 and 3A4 for Lexpro, and CYP2D6 and CYP3A4 for ABilify. If you have a genetic polymorphism that affects either the induction or inhibtion of those drugs it can create unanticipated problems.

And believe me, Drs NEVER anticipate those problems. They ust hand you your script, report it to the particualr BigPharma tha makes that drug and figure their job is done. I'm not sure they even consider them, beyond the now obvious warning that grapefruit juice might be a problem, which it also might not be, depending on the drug and the enzyme pathway, but hey !!! Details.

Which is why I urge a LOT, and I mean buckets-worth, of water while you're ingesting powerful drugs. It's not a cure-all, but it can definitely head off some problems, or make them far less serious. If you can manage 3 liters a day, tht wold be very very good.
[UOTE="Boba, post: 2340653, member: 42987"]How do you recognise that your body is dried out? Dry skin?[/QUOTE]
Kidney failure is always a pretty good hint ....


God, I'm such a total bore .... I'm stepping down off my soap box now, and just wishing you the best of luck (and caution) in your efforts to stabilize, along with the deeply sincere hope that you're successful, too, in your efforts to put this crappy little head-banger of an llness in your rear-view mirror :thumbsup::thumbsup: :hug::hug::hug:.

Onward and upward, eh :rocket::rocket::rocket:.....

And remember, we're here for you, pretty much 24/7 ....
 
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the kind of dried out I am referring to cannot be rectified by drinking water.

God, I'm such a total bore .... I'm stepping down off my soap box now, and just wishing you the best of luck (and caution
Your providing an important public service here pointing out the serious nature of taking these drugs, so its a valuable soap box. And since the doctors are not forthcoming on side effects, generally.

Insert Cheerleader Emoji.

When in doubt, talk to your pharmacist, who is far better trained.