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Option (Evidence Strength: Grades B, B, C, and B) Amitriptyline (Evidence Strength: Grade B ) One randomized controlled trial reported efficacy of oral amitriptyline (25 mg daily titrated over several weeks to 100 mg daily if tolerated) to be superior to placebo (63% of treatment group clinically significantly improved compared to 4% of placebo group) at four months

A precursor to S-adenosylmethionine (SAMe) and the antioxidant glutathione, which protects liver cells from oxidative damage during accelerated fat metabolism

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Meta-analyses of randomised controlled trials (RCTs) also confirm that energy-restricted MD interventions yield greater weight loss than control or low-fat diets, particularly when combined with increased physical activity [116]

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