Clearing the Fog with the Cheung's Regimen: A Case of OTC Glutamatergic Augmentation in a Student with Depression, Somatic Symptoms and Cognitive Dysfunction

Background: Young adults with mood and anxiety disorders often remain hamstrung by "brain-fog," headaches, and other bodily complaints even after standard antidepressants or sedatives take the edge off their mood. An inexpensive OTC oral augmentation stack proposed by Cheung (2025)—dextromethorphan for NMDA blockade, low-dose fluoxetine to slow its metabolism, and piracetam to boost AMPA signalling—may reproduce ketamine's rapid neuroplastic effects without an infusion suite.Case: A 25-year-old law student arrived with severe depression (PHQ-9 = 23), generalized anxiety (GAD-7 = 15), daily tension headaches, cramping abdominal pain, episodic breathlessness, and crippling cognitive fog that had already cost her an exam. A sedative‐heavy regimen (risperidone 0.5 mg, alprazolam 0.25 mg prn, lemborexant 1.25 mg, flupentixol/melitracen 1 tablet) eased the physical distress and improved sleep, yet panic and mental slowdown roared back when the new term began.Intervention: In early September the medication plan pivoted to the Cheung Glutamatergic Regimen: fluoxetine 10 mg each morning plus dextromethorphan 30 mg and piracetam 600 mg once daily. Somatic and anxiety symptoms calmed within days, but heavy fatigue and poor concentration lingered until the DXM–piracetam pair was given twice daily.Outcome: Within a week of the dosing change the patient reported a sudden "lights-on" clarity, sustained focus, and return to full study hours. By late November her scores had fallen to PHQ-9 = 15, GAD-7 = 8; headaches and abdominal pain were rare and alprazolam use had nearly stopped.Conclusion: This report suggests that pairing oral NMDA antagonism with AMPA potentiation—especially in a morning-and-evening schedule—can quickly lift refractory cognitive and somatic symptoms where serotonergic and sedative strategies fall short. The approach merits systematic study.