Sibutramine Side Effects: Understanding the Hidden Dangers of a Weight Loss Drug

Sibutramine, once marketed under brand names like Meridia, Reductil, and Sibutrex, was a prescription drug developed for the treatment of obesity. Designed to help individuals lose weight by suppressing appetite, it worked by altering brain chemistry—specifically by inhibiting the reuptake of serotonin, norepinephrine, and dopamine. Though it initially showed promise, Sibutramine was eventually withdrawn from most global markets due to mounting concerns about its safety profile, particularly regarding cardiovascular health.

In this essay, we’ll explore the side effects of Sibutramine, ranging from mild discomfort to life-threatening complications. Understanding these effects helps paint a complete picture of why the drug became one of the most controversial weight loss medications of its time.

1. Cardiovascular Side Effects

The most serious and ultimately career-ending issue for Sibutramine was its impact on the cardiovascular system.

Increased Blood Pressure and Heart Rate

Sibutramine consistently elevated systolic and diastolic blood pressure in users, along with resting heart rate. These changes could be dangerous for individuals with underlying conditions.

Heart Attack and Stroke Risk

Clinical trials revealed a significant increase in the risk of heart attacks, strokes, and cardiac arrest, particularly in patients with pre-existing heart conditions. This led to the large-scale withdrawal of Sibutramine from the U.S., European Union, and many other regions.

2. Central Nervous System (CNS) Side Effects

Sibutramine acts on neurotransmitters that influence mood, attention, and alertness. As such, it can cause:

Insomnia and Restlessness

Due to its stimulant-like effects, many users reported trouble sleeping, jitteriness, and a constant sense of nervous energy.

Anxiety and Panic Attacks

The drug could exacerbate underlying anxiety disorders or trigger panic episodes, especially at higher doses or when combined with other stimulants.

Headaches and Dizziness

These were common, especially during the first few weeks of treatment, as the body adjusted to altered brain chemistry.

3. Gastrointestinal Side Effects

Because Sibutramine alters appetite and affects digestion indirectly, some users experienced:

• Dry mouth

• Constipation

• Nausea

• Indigestion or abdominal discomfort

These side effects were often temporary but could be bothersome enough to disrupt compliance.

4. Psychological and Mood-Related Side Effects

Altering levels of serotonin and dopamine can have unexpected emotional consequences.

Depression and Mood Swings

Some users reported low mood, irritability, or mild depressive episodes, especially during withdrawal or after stopping the drug.

Suicidal Thoughts

Though rare, the drug carried a warning for increased risk of suicidal ideation, particularly in younger users or those with a history of mood disorders.

5. Hormonal and Sexual Side Effects

While not the primary concern, some users experienced:

• Loss of libido

• Erectile dysfunction

• Delayed orgasm or sexual numbness

These effects were likely related to shifts in neurotransmitter levels, particularly serotonin and dopamine, which influence sexual function.

6. Allergic Reactions and Hypersensitivity

Though uncommon, some individuals experienced:

• Skin rashes

• Swelling of the face, lips, or throat

• Difficulty breathing

These symptoms required immediate medical attention and are indicative of a potential allergic reaction to the medication.

7. Withdrawal and Rebound Effects

Stopping Sibutramine—especially abruptly—could lead to:

• Rebound weight gain

• Fatigue or low energy

• Return of binge-eating habits

• Mood drops or irritability

This is partly because the body becomes accustomed to the drug’s impact on appetite and neurotransmitter balance.

8. Dangerous Drug Interactions

Sibutramine could interact negatively with:

• MAO inhibitors (used in depression): Risk of serotonin syndrome, a potentially fatal condition

• SSRIs or SNRIs: Increased risk of serotonin overload

• Decongestants and stimulants: Elevated blood pressure and heart rate

• Certain migraine medications: Neurological toxicity risk

Combining Sibutramine with these substances significantly increased the severity of side effects.

Why Sibutramine Was Withdrawn

In 2010, the SCOUT trial (Sibutramine Cardiovascular Outcomes Trial) confirmed what many clinicians feared: the cardiovascular risks outweighed the benefits, especially in patients with a history of heart disease.

As a result, major health agencies like the FDA (U.S.), EMA (Europe), and regulatory bodies in Canada, Australia, and Asia pulled the drug from the market.

Conclusion: A Case Study in Risk vs. Reward

Sibutramine was developed with good intentions—to help patients struggling with obesity achieve better health outcomes through weight loss. And for many, it delivered on that promise. However, its side effect profile proved too dangerous, particularly for those with undiagnosed cardiovascular conditions or psychiatric vulnerabilities.

Today, Sibutramine serves as a powerful case study in the importance of long-term safety over short-term results. It reminds us that pharmacological weight loss, while effective in the short term, must always be approached with caution, medical oversight, and informed decision-making.

Sibutramine Interactions: What to Know Before Combining Medications

Sibutramine was once a widely prescribed weight-loss drug, popular under brand names like Meridia, Reductil, and Sibutrex. It worked by suppressing appetite through the inhibition of serotonin, norepinephrine, and dopamine reuptake in the brain. This mechanism helped users feel full sooner and eat less, making it a tool in the management of obesity.

However, Sibutramine’s effect on neurotransmitters and cardiovascular function also made it prone to dangerous drug interactions. These interactions became a significant concern and ultimately contributed to its withdrawal from the global market.

This essay explores the key interactions of Sibutramine, how they occur, and why caution was essential when using this medication.

1. Interactions with Antidepressants and Mood Medications

Sibutramine acts on serotonin and norepinephrine, just like many antidepressants. When combined, the risk of serotonin overload becomes dangerously high.

Serotonin Syndrome

When Sibutramine is used alongside other serotonin-enhancing drugs, it can lead to serotonin syndrome, a potentially life-threatening condition characterized by:

• Agitation and confusion

• High fever and sweating

• Muscle rigidity or twitching

• Rapid heart rate and high blood pressure

Dangerous Combinations Include:

• SSRIs (e.g., fluoxetine, sertraline)

• SNRIs (e.g., venlafaxine, duloxetine)

• MAO inhibitors (e.g., phenelzine, isocarboxazid)

• Tricyclic antidepressants (e.g., amitriptyline)

Because of these risks, Sibutramine was contraindicated with almost all antidepressants.

2. Interactions with Other Weight Loss or Stimulant Drugs

Sibutramine has stimulant-like properties, which can be magnified when combined with other similar substances.

Risky Combinations:

• Amphetamines (including ADHD medications like Adderall or Ritalin)

• Caffeine-heavy fat burners

• Decongestants (like pseudoephedrine)

• Clenbuterol or ephedrine (used illegally for fat loss)

Risks Include:

• Dangerously high blood pressure

• Irregular or rapid heartbeat

• Nervousness, insomnia, or anxiety

• Heatstroke from elevated body temperature

Stacking Sibutramine with stimulants was a common practice in the underground fitness world, but it significantly increased the risk of cardiac complications.

3. Interactions with Migraine Medications

Certain migraine drugs, particularly triptans, also influence serotonin. Using them alongside Sibutramine increases the risk of serotonin syndrome and neurological toxicity.

Risky Drugs:

• Sumatriptan

• Zolmitriptan

• Rizatriptan

Symptoms of interaction may include:

• Tingling or numbness

• Dizziness and confusion

• Chest pain

• Nausea or vomiting

These symptoms require immediate medical attention.

4. Interactions with Blood Pressure and Heart Medications

Sibutramine was known to increase heart rate and blood pressure, so combining it with medications meant to control cardiovascular function could be counterproductive—or even harmful.

Risky Interactions:

• Beta-blockers (e.g., propranolol, metoprolol)

• ACE inhibitors (e.g., lisinopril, enalapril)

• Diuretics (e.g., furosemide)

Sibutramine could blunt the effectiveness of these drugs, resulting in uncontrolled hypertension or cardiac stress.

5. Alcohol and Recreational Drug Interactions

While not a drug-on-drug interaction in the pharmaceutical sense, the combination of Sibutramine with alcohol or recreational stimulants posed serious risks.

Combining with alcohol could lead to:

• Increased drowsiness or dizziness

• Poor decision-making and increased risk of overdose

• Heart strain due to conflicting effects on the CNS

Recreational drugs like cocaine, MDMA, or methamphetamines:

These all stimulate neurotransmitters and vastly increase the risk of heart attack, stroke, or serotonin syndrome when used with Sibutramine.

6. Herbal and Over-the-Counter Interactions

Even non-prescription substances could interact negatively with Sibutramine.

Examples:

• St. John’s Wort: Can cause serotonin syndrome when combined with serotonin-affecting drugs

• Yohimbine: Increases heart rate and blood pressure

• 5-HTP: A serotonin precursor that raises the risk of serotonin overload

• Caffeine: May intensify stimulant effects, leading to restlessness and palpitations

Many people took these alongside Sibutramine unknowingly, especially in fat-loss supplement stacks.

7. Impact on Drug Metabolism

Sibutramine is metabolized primarily by the cytochrome P450 3A4 (CYP3A4) enzyme. Drugs that inhibit or induce this enzyme can affect Sibutramine’s activity.

CYP3A4 Inhibitors (can increase Sibutramine levels):

• Ketoconazole

• Erythromycin

• Grapefruit juice

CYP3A4 Inducers (can reduce effectiveness):

• Carbamazepine

• Rifampin

• St. John’s Wort

This interaction can result in either toxicity or reduced effectiveness, depending on the combination.

Conclusion: Interactions Were the Hidden Danger

While Sibutramine was intended to help people lose weight, its impact on neurotransmitters and cardiovascular activity made it highly sensitive to drug interactions. These interactions weren’t just inconvenient—they could be life-threatening. In fact, many of the severe adverse events linked to Sibutramine use occurred when it was taken alongside other medications or supplements.

Sibutramine’s story underscores a critical truth in medicine: a drug is only as safe as the context in which it’s used. And in the case of Sibutramine, that context became too dangerous to justify its continued use.

Sibutramine Overdose: Understanding the Risks of Excessive Appetite Suppression

Sibutramine, once marketed under brand names like Meridia and Reductil, was introduced as a promising solution for treating obesity and weight-related conditions. By altering the balance of neurotransmitters such as serotonin, norepinephrine, and dopamine, Sibutramine suppressed appetite and helped individuals control their caloric intake. However, with its stimulant-like effects and cardiovascular impact, Sibutramine carried a real risk of overdose—especially when misused for rapid weight loss.

Though banned in many countries due to safety concerns, Sibutramine continues to appear in illicit weight loss supplements and underground fat burners. This makes understanding the signs, dangers, and treatment of a Sibutramine overdose more relevant than ever.

What Constitutes a Sibutramine Overdose?

A Sibutramine overdose occurs when an individual consumes more than the recommended or safe amount, either intentionally or unintentionally. This can happen in several ways:

• Taking high doses for faster weight loss

• Combining Sibutramine with other stimulants or appetite suppressants

• Using counterfeit supplements containing undeclared Sibutramine

• Lack of medical supervision or underlying health conditions

A standard therapeutic dose was 10–15 mg daily, and anything beyond this—especially above 30 mg—can push the body into dangerous territory.

Common Causes of Overdose

• Self-medicating without prescription

• Belief that “more equals better” in weight loss efforts

• Combining with other drugs (e.g., amphetamines, caffeine, ephedrine)

• Accidental ingestion via mislabeled supplements

• Underlying heart or neurological conditions

Unlike overdoses from opioids or sedatives, Sibutramine overdose often presents cardiovascular or neurological symptoms first.

Symptoms of Sibutramine Overdose

The symptoms of overdose may appear rapidly and can range from moderate to life-threatening. Common signs include:

Cardiovascular Symptoms

• Rapid heartbeat (tachycardia)

• Elevated blood pressure (hypertension)

• Irregular heart rhythm (arrhythmia)

• Chest pain

• Shortness of breath

Neurological and Psychological Symptoms

• Agitation and restlessness

• Severe anxiety or panic attacks

• Headache or dizziness

• Tremors or muscle spasms

• Confusion or disorientation

• In severe cases: seizures or loss of consciousness

Systemic Reactions

• Profuse sweating

• Nausea and vomiting

• Flushed or overheated skin

• Blurred vision

• Serotonin syndrome (when combined with serotonergic drugs)

If left untreated, these symptoms can escalate into stroke, cardiac arrest, or death—especially in individuals with pre-existing heart conditions.

Serotonin Syndrome: A Deadly Complication

One of the most serious risks associated with Sibutramine overdose is serotonin syndrome, particularly when combined with other medications like SSRIs, SNRIs, or MAO inhibitors.

Symptoms include:

• High fever

• Mental confusion

• Muscle rigidity

• Tremors or seizures

• Unconsciousness

This is a medical emergency requiring immediate intervention.

Emergency Treatment for Sibutramine Overdose

If a Sibutramine overdose is suspected, emergency care is crucial. Treatment focuses on stabilizing the cardiovascular and nervous systems.

Emergency Protocols:

• Activated charcoal (if ingested recently) to limit absorption

• IV fluids to manage hydration and flush the system

• Beta-blockers to control heart rate and blood pressure

• Sedatives or anticonvulsants if seizures occur

• Cooling measures for hyperthermia

• Continuous ECG monitoring and neurological observation

There is no specific antidote for Sibutramine overdose, so supportive care and early response are critical.

Long-Term Consequences of Overdose

Even if the immediate crisis is resolved, a severe Sibutramine overdose can lead to lasting damage, including:

• Cardiac arrhythmias or heart disease

• Neurological complications like chronic headaches or mood disorders

• Hormonal and metabolic imbalances

• Psychological trauma, including anxiety or panic disorder

• Weight rebound and dependency behaviors

Preventing Sibutramine Overdose

Because Sibutramine is now banned in many countries, the biggest risk lies in unregulated supplements that contain it secretly. Prevention is based on education and smart consumer habits.

Prevention Tips:

• Avoid purchasing weight loss products from unverified online sources

• Check for updated health alerts or recalls regarding banned substances

• Always consult a licensed healthcare provider before starting any weight loss medication

• Read supplement labels carefully—but remember, not all ingredients may be listed

• Never combine multiple stimulants or appetite suppressants

Conclusion: A Hidden Threat in the Quest for Weight Loss

Sibutramine may be a name from the past, but its impact—and its dangers—still persist today, especially in counterfeit or illegal diet pills. Overdose is not only possible but potentially fatal. Understanding the signs, symptoms, and outcomes of a Sibutramine overdose is essential in preventing harm, especially as people continue to search for “quick fixes” in weight management.

Whether you’re a health practitioner, fitness enthusiast, or someone on a weight loss journey, remember: safety must always come before speed. Effective weight loss should empower your health, not jeopardize it.

Sibutramine Precautions: What You Must Know Before Using This Former Weight Loss Drug

Sibutramine was once considered a breakthrough in medical weight loss. Marketed under brand names such as Meridia, Reductil, and Sibutrex, it worked by suppressing appetite through the inhibition of neurotransmitter reuptake—namely serotonin, norepinephrine, and dopamine. Designed for use in people with obesity or weight-related health risks, it helped many individuals shed excess pounds.

However, Sibutramine’s use was eventually discontinued in most countries due to serious cardiovascular risks and a high potential for misuse. Despite its ban, it continues to circulate in some unregulated supplements, making it essential to understand the precautions necessary when considering or encountering Sibutramine in any form.

This essay outlines the most critical precautions associated with Sibutramine to ensure safe use—or, more importantly, to avoid unintended harm.

1. Medical Screening Before Use

Before starting any weight loss medication—especially one with central nervous system activity—it is crucial to undergo a comprehensive medical evaluation.

Must screen for:

• Cardiovascular disease (past or present)

• Hypertension (high blood pressure)

• Arrhythmias or tachycardia

• History of stroke or heart attack

• Mental health disorders (depression, anxiety, bipolar disorder)

• Liver or kidney impairment

Sibutramine has been shown to raise heart rate and blood pressure, making it particularly dangerous for individuals with heart-related risks.

2. Avoid Use with Certain Medications

Sibutramine interacts with many drugs that affect brain chemistry and cardiovascular function.

Never combine Sibutramine with:

• SSRIs, SNRIs, or tricyclic antidepressants

• MAO inhibitors

• Migraine medications (triptans)

• Other stimulants (e.g., amphetamines, ephedrine)

• Decongestants like pseudoephedrine

Combining Sibutramine with serotonergic drugs can cause serotonin syndrome, a life-threatening condition. It can also amplify stimulant effects, putting stress on the heart.

3. Monitor Blood Pressure and Heart Rate Regularly

Even at therapeutic doses, Sibutramine may cause:

• Elevated systolic and diastolic blood pressure

• Resting heart rate increase

Precaution:

• Check blood pressure and pulse weekly

• Discontinue use if blood pressure increases significantly

• Avoid if you already have uncontrolled hypertension

Undiagnosed cardiovascular conditions are a major reason why Sibutramine became dangerous for some users.

4. Mental Health Awareness

Because Sibutramine affects dopamine and serotonin, it can impact mood, emotion, and mental stability.

Possible psychological side effects:

• Anxiety or nervousness

• Irritability or mood swings

• Insomnia or restlessness

• Depression or suicidal thoughts (especially if discontinued abruptly)

Who should avoid it:

• Individuals with a history of depression or bipolar disorder

• Anyone currently taking psychiatric medication

• People with poor sleep patterns or untreated insomnia

Sibutramine may exacerbate these issues due to its stimulant-like activity.

5. Be Aware of Hidden Sibutramine in Supplements

Though Sibutramine was banned in many countries, it still appears illegally in “natural” or imported weight loss products, especially those purchased online.

Look out for:

• Supplements promising rapid fat loss or appetite control

• Products with no listed active ingredients

• Pills labeled as “herbal” but causing stimulant-like side effects

How to stay safe:

• Buy supplements only from reputable, regulated brands

• Check FDA or regulatory agency warnings for flagged products

• Report any suspicious reactions or ingredients to health authorities

6. Avoid During Pregnancy and Breastfeeding

Sibutramine has not been proven safe for use during pregnancy or while breastfeeding.

Risks include:

• Unknown effects on fetal development

• Potential transfer through breast milk

• Impact on maternal heart rate and blood pressure

Women who are pregnant, planning to become pregnant, or nursing should never use Sibutramine.

7. Do Not Combine with Alcohol or Recreational Drugs

Sibutramine’s stimulant nature can clash with other substances, leading to unpredictable or dangerous effects.

Avoid combining with:

• Alcohol (increased risk of drowsiness, heart strain)

• Cannabis or depressants (risk of impaired coordination and sedation)

• Cocaine, MDMA, or party drugs (serotonin overload, heart attack risk)

Mixing Sibutramine with any psychoactive substance amplifies the risk of overdose, psychological distress, or cardiovascular crisis.

8. Gradual Discontinuation Is Key

Abruptly stopping Sibutramine after prolonged use can lead to:

• Fatigue

• Rebound hunger

• Weight regain

• Low mood or depression

If discontinuing, a gradual tapering process under medical supervision is recommended to minimize withdrawal effects and mood crashes.

9. Watch for Overdose Symptoms

Accidental or intentional overdose can be life-threatening. Early warning signs include:

• Rapid heart rate

• High blood pressure

• Agitation or confusion

• Severe headache

• Nausea and sweating

Seek emergency medical help if any of these symptoms appear—especially after taking high doses or combining with other substances.

Conclusion: Safety Before Slimming

While Sibutramine once showed promise in helping people overcome obesity and related health risks, its potential for serious side effects and interactions led to its removal from the global pharmaceutical market. Today, it survives in black market supplements and mislabeled pills—often without users realizing the risks they’re taking.

Understanding and respecting the necessary precautions around Sibutramine can prevent harmful outcomes. Whether you’re managing weight medically or exploring supplements, always prioritize your long-term health over short-term results.

Sibutramine Cycles: Strategic Use and Structured Precautions in Weight Loss Management

Sibutramine, once widely prescribed under names like Meridia and Reductil, was originally designed to help people struggling with obesity and metabolic syndrome. As a centrally acting appetite suppressant, it worked by altering levels of neurotransmitters—specifically serotonin, norepinephrine, and dopamine—in the brain to reduce hunger and promote a feeling of fullness. While it is no longer legal in most countries due to cardiovascular risks, Sibutramine continues to appear in underground markets and unregulated fat loss products.

In certain circles, particularly within fitness and competitive bodybuilding, Sibutramine has been used in structured patterns known as “cycles” to maximize fat loss while minimizing side effects. While not medically endorsed or legally safe, it’s worth understanding how Sibutramine cycles are approached, what their goals are, and the risks involved.

1. What Is a Sibutramine Cycle?

A Sibutramine cycle refers to the planned use of the drug in timed phases, typically combined with calorie-restricted diets and sometimes stimulant-based training supplements. The idea is to use Sibutramine during cutting phases, helping users control appetite, reduce body fat, and preserve lean muscle mass while in a caloric deficit.

These cycles often mimic traditional steroid or supplement cycles in structure—short-term, high-impact usage followed by breaks to allow the body to reset.

2. Common Goals of a Sibutramine Cycle

• Accelerated fat loss without muscle loss

• Appetite control during aggressive diets

• Mental clarity and energy boost for workouts

• Short-term physique prep (photoshoots, competitions, summer shred)

• Breaking weight-loss plateaus

Sibutramine’s appetite-suppressing and thermogenic effects can give users a mental and physical edge during extreme fat loss periods.

3. Example of a Basic Sibutramine Cycle (Not Medical Advice)

This is for educational awareness only. Sibutramine is banned or restricted in many countries and poses significant health risks.

Cycle Duration: 4–6 weeks (max 8 weeks)

Dosage: 10–15 mg per day

Timing: Taken in the morning to avoid insomnia

Diet: Low to moderate carbs, high protein, calorie deficit

Training: Resistance training 3–5x/week, cardio 3x/week

Cycle Support:

• Blood pressure monitoring

• Liver and kidney support (e.g., milk thistle, hydration)

• Mood and sleep tracking

• Electrolyte management (due to sweating and appetite reduction)

Post-Cycle (2–4 weeks):

• Gradual reintroduction of calories

• Appetite monitoring (to prevent rebound overeating)

• Cardio tapering

• Focus on mental well-being (mood swings are common post-cycle)

4. Advanced Sibutramine Cycle (Underground Use)

Some advanced users stack Sibutramine with other thermogenic or appetite-suppressing compounds—often to dangerous effect.

Example Stack (NOT recommended):

• Sibutramine: 10 mg/day

• Clenbuterol: 20–40 mcg/day

• Yohimbine HCL: 5–10 mg pre-cardio

• L-carnitine: 1–2 g/day

• Caffeine: 200 mg/day (through pre-workouts or coffee)

This type of stack may be used during peak cutting phases, but the risk of heart palpitations, anxiety, dehydration, and insomnia is extremely high.

5. Precautions When Using a Sibutramine Cycle

Sibutramine cycles, particularly when done outside medical supervision, require careful planning to reduce risks.

Essential Precautions:

• Do NOT exceed 15 mg/day

• Avoid use if you have any history of heart disease, high blood pressure, anxiety, or depression

• Never combine with SSRIs, MAO inhibitors, or other serotonergic drugs

• Avoid alcohol, energy drinks, or other stimulants during use

• Stay hydrated and monitor resting heart rate and blood pressure weekly

• End the cycle immediately if symptoms like chest pain, dizziness, or insomnia appear

6. Risks of Long-Term or Excessive Use

Sibutramine was never meant for long-term or continuous use. Prolonged or excessive cycling can result in:

• Heart complications: Arrhythmias, hypertension, cardiac arrest

• Neurological issues: Mood swings, irritability, insomnia, paranoia

• Rebound weight gain: Appetite may return stronger after the cycle ends

• Neurochemical imbalances: Serotonin syndrome if combined with other medications

• Dependency behaviors: Psychological reliance on stimulants for motivation or appetite control

This is why cycling off and taking extended breaks between uses (if used at all) is considered critical.

7. Post-Cycle Recovery and Rebound Management

Ending a Sibutramine cycle can be just as important as running it. A post-cycle plan should include:

• Gradual calorie increases to avoid binge eating

• Sleep restoration strategies (e.g., melatonin, sleep hygiene)

• Mood stabilization with natural serotonin boosters (e.g., 5-HTP, exercise)

• Adaptogen support like ashwagandha or Rhodiola rosea

• Cardiovascular rest and evaluation

Tracking your physical and emotional health for 4–6 weeks post-cycle is essential for avoiding complications.

Conclusion: The Power and Pitfalls of Sibutramine Cycles

Sibutramine cycles are often used as a last-resort fat-loss strategy among competitive athletes, physique models, and underground dieters. While its effects on appetite suppression and body composition are undeniable, the potential for cardiovascular damage, mood disturbances, and long-term metabolic disruption is significant.

Anyone considering Sibutramine for fat loss should understand that this compound is no longer approved for safe use in most countries, and cycling it without medical guidance adds layers of risk.

If fat loss is your goal, focus on sustainable methods first: whole foods, proper training, and lifestyle balance. If pharmacological help is necessary, it should always be pursued under medical supervision.