So this might get a bit complicated (and long) but basically I’m seeking help for dpdr and anxiety (mostly existential anxiety/ocd and anxiety about dpdr symptoms), and I am struggling to find something to trial that would work for me due to other medications I already take, and medical conditions I have.

Context: I have multiple medical conditions, notably POTS and Long Covid. I take propranolol for both migraine prevention and to manage my pots. I originally wanted to try Fluvoxamine, as it has helped a lot of people with long covid (even if they didn’t have anxiety or depression), and it’s theorised to be due to its sigma-1 receptor agonism qualities. And it also can help reduce neuroinflammation. 3 other SSRIs also are sigma-1 receptor agonists, fluoxetine, citalopram and escitalopram, but fluvoxamine having the greatest effect on this receptor.

The problem is that fluvoxamine interacts with my propranolol. It inhibits a liver enzyme that breaks down the propranolol, basically meaning it increases the effects of it (like I took a double dose or more). Fluoxetine also does. Escitalopram and citalopram inhibit it to a lesser extent. I was prescribed Lexapro (escitalopram) for this reason, but I had to discontinue it after one dose due to side effects. I don’t know for sure of course but I suspect I could have had long QT syndrome from it, or low sodium levels or something. It made me incredibly dizzy and my heart was fluttering and going up and down and I had to lay down with my legs up for over an hour. Anytime I tried to sit up I would almost pass out. I also had really big pupils. So I could only try citalopram next, but due to the side effects from escitalopram I’m worried it will just be the same.

I did consider that I could take sertraline, as I took this in the past so I atleast know I should tolerate it. But sertraline is a sigma-1 receptor antagonist. Basically the opposite of the others. And if the agonists help long Covid patients, I’d prefer to try something that might help my long Covid symptoms as well.

So then I thought about supplements. I already take magnesium, vitamin d, vitamin c, and iron. I did take a b-complex in the past but I didn’t notice any benefit from it at all.

I’m considering saffron or l-theanine. Saffron specifically because it is also a sigma-1 receptor agonist. But I can’t seem to find much information about if it’s safe to take it with propranolol or not. It just says it can interact with hypertension drugs (which propranolol technically is), but doesn’t say through which mechanism.

My only other option would be to go off my propranolol, and find an alternative medication for migraine prevention, and try fluvoxamine or fluoxetine. And hope it helps my pots as well (or go on another different medication as well for the pots). But a lot of migraine preventative medications have a lot of side effects of their own and their own medication interactions.

Are there any other options or supplements/medications that could possibly help that I haven’t considered? I know there are other ssris and snris but I don’t really know which ones would be preferable outside of the ones I talked about. And specifically I want something that can help with dpdr as well as anxiety, and apparently the sigma-1 receptor agonists should be superior for that too.