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[12] [13] Pharmacological options are more limited, with NICE advising caution: Antidepressants : A course of duloxetine, amitriptyline, citalopram, or other antidepressants may be considered after discussion of potential benefits and harms

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Psyllium should only be added if constipation persists and under provider guidance to avoid worsening nausea or bloating

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