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justeat

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Reply with quote  #1 
So, I haven't posted here in about a year and a half, as, thankfully, my daughter (now 12 yeas old) has been doing well, growing and thriving and happy. However, she's started a subtle backward slide since about Christmas, and it has become a major problem over the last month or so, with a huge spike in anxiety and, of course, difficulty eating. She has been taking zoloft for about 2 years now, so her pediatrician increased her dose from 75mgs to 100mgs initially, then increased it to 150mgs a week later, as it seemed to be helping. However, since the latest increase in her dose, she has been feeling tired all the time, with no energy, and has been getting headaches and feeling dizzy. Her trigger has always been her fear of getting sick, and now she is certain that she is getting sick because she is so tired, and I cannot convince her otherwise despite my best efforts. Argh! So, her anxiety is up, she's terrified to eat in case she gets sick, and I can't see that this is helping! Should we just weather this as best we can, hoping that her body will adjust to the dose increase? Has anyone else had a similar experience? She has grown 4 inches in height in the last 6 months, and has lost 1lb, so I know she's got some catching up to do also, and that's what we're focused on at the moment. Thank you all for being here!
myson

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Reply with quote  #2 
Hi, I have no advise on the tablets I'm afraid. My son won't take them. But I just want you to know that I'm sorry to here this has happened.
I'm a new member and they are all helping me with their wealth of knowledge.
Wow she's done a lot of growing and I'm sure that's because you have kept her safe.
Keep strong they will soon be able to help you xx
Foodsupport_AUS

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Reply with quote  #3 
We only used Zoloft/sertraline here briefly. D did have side effects similar to what you describe but at a much lower dose. 

As to what are causing D's symptoms at present, it could be the weight loss whilst growing, it could be the meds. Since the anxiety is going up and she has previously tolerated the Zoloft I would be wondering if it is the loss of weight whilst growing. That suggests a fairly dramatic back slide in weight, she is likely to be at least 20lb less than she ought to be. That is a lot of catching up. Hopefully you will find when things get back on track weight wise it all settles. The more I read your post I wonder, does the zoloft dose need to change at all, or should she just be gaining weight? 

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D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
hertsmum

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Reply with quote  #4 
My daughter has been on sertraline for over a year and takes 200mg, and I haven't seen any negative side effects. I think it has helped ease her depression and anxiety, but she saw a new psychiatrist at CAMHS this week who would like to reduce the dose as he feels she shouldn't stay on such a high dose. Also she is still very anxious, which he says may be an indication that the medication isn't working. She did not respond well to CBT (tried with many different therapists over 2 years) and so I think the medication is still important and I'd prefer to continue with this dose at least until after exams this summer
Calm_USA

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Reply with quote  #5 
I agree with Foodsupport that the behavior you are seeing has much more to do with growth with no weight gain than it does with Zoloft.  In the midst of her battle with ED my d's anxiety med was switched to Zoloft which she found helpful.  The fact that your d has grown 4" and has lost a lb really raises the red flag.  Get out the heavy whipping cream and the canola oil and push to get weight up.  I think you will finds will slowly improve.  As you d is still fairly young you may see this again.  I'm sorry you have to keep battling but I assure you it is worth it! 
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Torie

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Reply with quote  #6 
Keeping in mind that I'm not a doctor, here are my thoughts as I read your post:

>However, since the latest increase in her dose, she has been feeling tired all the time

I think it's OK if she feels tired all the time.

>with no energy,

Being underweight can do that to you

>and has been getting headaches

Have you noticed any connection between the headaches and, say, time of day? Proximity of meal? Getting out of bed?  Anything like that would be helpful for when you speak with the doc

>and feeling dizzy.

If this is just when she first stands up, my bet is that it's from being underweight.  So, again, would help to have specifics.

>Her trigger has always been her fear of getting sick

Hmmm.   It never works to try to reason with them, but I'd be hard pressed to keep from pointing out that she will definitely get sick if she doesn't eat.  I'm sure it won't help, but maybe if you respond enough times with a mantra of that type, she'll stop saying it. so she doesn't have to hear that anymore.

Best of luck and please be sure to keep us posted.  xx

-Torie

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Torie

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Reply with quote  #7 
P.S.  Are they keeping tabs on her orthostatic pulse and blood pressure?  As FoodSupport noted, your d is almost certainly at least 20 pounds underweight, and the deficiency has accumulated fast.  

And is she drinking plenty of fluids?  Getting dehydrated can cause headaches and dizziness.  Just a thought.  xx

-Torie

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"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
EC_Mom

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Reply with quote  #8 
Definitely agree that the growth should be accompanied by lots of weight gain.

My d was on Zoloft for awhile when she was first sick. Doctors chose that one over other meds in the same family (Paxil, Prozac) because I take it and it works well.

It seemed to help some, but when they increased the dose after a few weeks she became suicidal. They immediately switched her to Lexapro/escitalopram, which has antidepressant AND anti-anxiety effects. It has worked much better for her. 
justeat

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Reply with quote  #9 
Thanks so much for all your advice, and yes,I do now realize that she has a lot of catching up to do weight-wise. How did we miss that? It just sneaks up, unnoticed, until suddenly it's a problem....darn it. So, we have taken over all her meals and snacks again (she had started making her own school lunch), and yes, we are fortifying every meal with oil, cream and butter. I think we got complacent when she was doing well. I honestly think that the zoloft is not helping at the moment, certainly not at the higher dose; she needs to get some weight on. Thanks for telling me what I needed to be reminded of!  
Kali

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Reply with quote  #10 
Hi Justeat,

Sorry your d. is having a hard time with the meds. Have you spoken with her dr. and let him/her know about the side effects? Is it possible that it is too high a dosage for her?

My d. had a similar experience with fatigue when she was put on a higher dose of a different ssri and the dr. put her back on a lower dose which turned out to be better for her. 

Best wishes,

Kali

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justeat

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Reply with quote  #11 
H Kali,
Yes, I called her pediatrician again today, and made an appointment for tomorrow morning. I'm inclined to think that the lower dose of 100mgs is all she needs, and a definite increase in her food intake. I think she needs weekly weight checks again until she is stable. She is scared all the time now....it breaks my heart.

Torie, she says her headaches are always there (for the last few weeks), but she describes them as "swimmy" headaches....I think she means that she's lightheaded. She's reluctant to drink anything between meals, though she drinks well with her meals, in case it makes her throw up (irrational, I know!).

I feel like I'm watching a slow motion train wreck [frown]
Kali

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Reply with quote  #12 
Hi Justeat

When my d. became very tired taking the SSRI, I did some reading about SSRI's and fatigue and it turns out that the SSRI's can affect or suppress REM sleep. That can lead to vivid dreams or fatigue during the day. How is your daughter sleeping at night?

This doesn't have to be a slow motion train wreck although it is hard to see our kids suffering. Can you up her food intake—visit the high calorie thread on this board for some ideas, and see if the med adjustment can help? If she was doing well before you can get her back to that place.

Kali


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berry75

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Reply with quote  #13 
Hi just eat,so sorry your daughter is not doing so well.My daughter has had an ed for 18months now, we were weight restored but she is having a relapse at the moment with a substantial weight loss and a return of the ed thoughts.Her relapse started of with a massive anxiety attack and vomiting that followed soon after. Naturally I panicked as our mantra has always been 'nothing happens without full nutrition'which is all good if the food stays down.I had not experienced this level of anxiety it was so bad it activated her gag reflex, she would get the food down but while eating it would come back up.She has never been one to bring up her food on purpose,I monitor her to much after eating to consider that.So for the first time in this long journey we put her on medication.She did feel a little tired and a bit light headed for a few days but I am not sure if it had to do with medication or weight loss.I think keeping a track of when she is tired ,when she feels lighted headed, is a good idea,so as to see if there is a pattern.Maybe persist a bit longer.Good luck and please let the forum know how you go.
ooKoo

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Reply with quote  #14 
Hi Justeat,

Sorry that things arent going so well at the moment.

A 75mg increase in a relatively short space of time is quite a jump! Was the increase phased in gradually? ie when my D increased from 100mg to 150mg of Sertraline (Zoloft), we initially broke a 50mg tablet into half and gave her 125mg a day for a week. And then upped it again once we were sure there had been no ill effects. Or you can give the exrtra 50mg every other day, because it has a long half-life (amount of time it stays in the system) with the same effect.

Funnily enough, the symptoms you describe are exactly the symptoms my D gets when she misses a dose.

Hopefully your doctor will listen to your D and adjust the dose. Again, any reductions to dosage must be done gradually or else your Ds anxiety will spike and she will start to feel more unwell.

Hopefully once dosage is sorted out, everything else will fall into place. My D is doing really well on her dose of Sertraline - it has been a game changer for us! Good luck!


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UK - South East

17.5 yo D

Dx AN Feb 2015 (Aged 15). Pre-existing low self-esteen and high anxiety. 

2015: 3 x medical hospital admissions. 1 month in IP which she self discharged from [eek].
2016: 3 x hospital admissions.
2017: Currently attending CAMHS CBT. WR, at college, living life to the max.

On particularly rough days when I am sure I can't possibly endure, I like to remind myself that my track record for getting through bad days so far is 100% and that's pretty good. [Author Unknown]
justeat

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Reply with quote  #15 
Well, thankfully, we have an awesome pediatrician who listens to my daughter and hears her concerns! He cut her zoloft back to the 100mg dose, and added a low dose of Zyprexa, and she is already doing so much better. She's back on the meal plan, finishing her portions, and she's a lot less stressed. I hate the fact that she needs medication, but she suffers without it, and that's not fair, so we'll do what we need to do to help her thrive. Thanks for all your great advice, it really, really helps!
Torie

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Reply with quote  #16 
Yay!  Thanks for letting us know.  xx

-Torie

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"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
momon

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Reply with quote  #17 
I am glad the medication adjustment helped! That's wonderful news.

On the failure for her weight gain to match height gain:  my daughter, who fell ill at age 10, and who at 14  is still growing in height --at times rapidly--, seems to have required much more long-term weight monitoring and plating of her meals than I would have expected. We stopped weighing and backed off on supervision for a month a year ago and she dropped enough in that month to have some dizziness symptoms. We went back to high supervision.  

I think for young onset kids who  are still significantly growing in height and pubertal growth, more intensive support for weight maintenance may typically be required than what treatment providers may suggest. I believe extended supervision is not part of the standard treatment regimen for the young onset kids as the general gist is that they want to return kids to not being supervised on food as soon as possible. I suspect that for the young onset kids, this is often, though not always, a mistake.  

That's a long-winded way of saying "no wonder you got a surprise on the weight lagging height" as you were probably not coached to stay very vigilant as time went on. I think the treatment protocol needs to change for young onset kids.
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