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Alternatively, sebaceous gland atrophy may be a parallel symptom that appears alongside defective corneocyte shedding, with both symptoms being preceded by disrupted keratinocyte maturation and differentiation

Onset and adaptation: Appetite suppression effects appear within weeks, though side effects (nausea, fullness) may be stronger during dose escalation

Some microdosers even add 3ml of water to create a 3.33mg/ml concentration, making extremely low doses easier to measure

The administration of high doses of lipoic acid by injection to rats decreased the activity of two biotin-dependent enzymes by about 30%-35% (122), but it is not known whether oral or intravenous lipoic acid supplementation substantially increases the requirement for biotin in humans (123)

Here's my honest assessment

None of these are drop-in replacements for fluoxetine in moderate to severe cases