OTC Glutamatergic Augmentation Resolves Adolescent Refractory Somatic Symptoms

Background: Persistent physical symptoms can trap adolescents in a cycle of pain, worry, and lost school time—especially when standard antidepressants provide only partial relief. This report describes a 17-year-old girl whose disabling somatic symptom disorder lifted after we tried a simple, fully oral "ketamine-like" combination.Case Summary: She had taken duloxetine 60 mg daily for more than a year yet still woke with pounding headaches, gasped for air without warning, and scratched her nails raw because they felt full of grit. Beginning 2 September 2025 we layered four medicines, one at a time: dextromethorphan (eventually 60 mg/day), fluoxetine 10 mg/day to slow its breakdown, piracetam (up to 1 200 mg/day), and L-glutamine 500 mg/day. She was seen monthly, her mood scored with the PHQ-9 and GAD-7, and her own account of day-to-day functioning recorded.Outcome: By the third visit the change was hard to miss. Headaches came only after late-night study, breathing was easy, the scratching habit had stopped, and she was back at school full-time. Her PHQ-9 dropped from 23 to 11, GAD-7 from 9 to 6, and the only side-effect she recalled was a brief spell of dizziness during the first week.Conclusion: One case cannot prove cause and effect, yet the speed and depth of her recovery suggest that an oral mix targeting NMDA blockade, AMPA support, and glutamate replenishment may deserve a closer look for stubborn somatic symptom disorder.