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Around the Dinner Table
Support forum for parents and caregivers of anorexia, bulimia and other eating disorder patients
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Registered: Nov 24, 2012
Posts: 207
Reply with quote  #1 
My d is struggling with a relapse. She has lost weight and is now of a pretty low mental state. She says she is just frightened of everything ..
She takes fluoxetine 20mg per day but I wondered if any anti anxiety medication may help too? I know it's not ideal - I'd prefer her not to be taking any tablets but sometimes if it helps access positive behaviours ... Then it's ok?

Any advice would be great. Thank you x

In this for the long haul .....
Mum to 14 year old D diagnosed with AN in May 2012 aged 12

Registered: June 24, 2013
Posts: 242
Reply with quote  #2 
There is a new natural supplement called CALM that two people, dietician and psychiatrist, have referred to my d but she is 23. The fact that it is natural, though, should make it ok. it is an anti-stress drink, dietary supplement. You can check out or call them at 866-416-9216. my d is trying to get off Ativan and go natural. Hope this helps a little. My d became depressed first when she was and downs in the past ten years. She has one more semester of college. Keep the faith...I know how scary it can be.
Denise holmes

Registered: March 19, 2013
Posts: 431
Reply with quote  #3 
Our d was prescribed serteline (zoloft) and it really helped her with anxiety. I am not keen on meds but she needed it, it helped hugely, and I believe we don't want our young ones to get stuck in a negative brain rut.  I encourage you to explore the options with a psychiatrist if that is an option.

Registered: May 8, 2012
Posts: 5,885
Reply with quote  #4 
My understanding is that if weight is too low, then medication for anxiety or depression doesn't work because it can't fix the impact of malnutrition on the brain.

That being said, I have two kids with anxiety disorders. My daughter (OCD) does well on fluoxetine. My son (autism and anxiety disorder-NOS) does well on citalopram. My daughter needs a much higher dose than my son, because OCD requires higher dosages in order to be effective in reducing obsessions/compulsions. My kids are 9 and 12. My daughter started on fluoxetine after her weight was in a very good place (a few months before she turned 8). My son has no ED, and has been on citalopram since the age of 8, with excellent impact on the quality of his life.

"YP"--a mom of one of the "little ones"

Registered: Sept 17, 2011
Posts: 1,106
Reply with quote  #5 
My D does better anxiety wise on Sertraline than she did on fluoxetine.
But a lot of it will be due to your Ds lower weight.
Poor thing, being scared the whole time.
You having any professional help?
Sorry you're going through this again x

Purple 
Where there's a will there's a way.

Registered: Sept 17, 2011
Posts: 1,106
Reply with quote  #6 
Had another think about this.
Forgot about Risperidone, worked very well as an anti anxiety medication for my D.
Good to combat exercise compulsion too.
Helps with sleeping if nothing else.

Purple 
Where there's a will there's a way.

Registered: Sept 23, 2013
Posts: 148
Reply with quote  #7 
Really sorry to hear your D is struggling. 

My D tried 4 different combinations and eventually Mirtazapine used in conjunction with Aripiprazole seems to have done the trick.  But it has been trial and error, is different for each individual, and I hope you have access to a good Psychiatrist who can explore the options with you.

As I mentioned to you at our last lunch D had to go in-patient and one of the ( many ) reasons for this was to sort out her Meds safely and quickly.  Unfortunately on an out-patient basis everything is painfully slow.  You will have to be an annoying squeaky wheel to get this reviewed promptly.  Good luck. xxx


Registered: April 14, 2012
Posts: 180
Reply with quote  #8 
Zyprexa has been tremendous in helping with my son's anxiety. He also takes Prozac.
Be Still...

Registered: April 29, 2008
Posts: 1,991
Reply with quote  #9 
Hi cobham,

UK psychiatrists are really reluctant to offer any meds for under sixteens, but I would be asking for diazepam very short term for d to take around a half hour before meals so you can get the weight gain going again.  They may be willing to supply a small dose for around ten days to this end.  I asked for trials with refeeding but I don't know if anything has been done.  The benzos are fast acting in a way that other meds aren't, which is maybe what d needs right now.  Her mood should improve with weight gain.  My own d found Sertraline better than Fluoxetine.  Also, Olanzapine is often used with an in the UK too as an anti-anxiety medication.

I am a huge believer in medication - and I think it is underused in teenagers, who are under so much stress these days.  I totally agree with momom and YP that if medications help with negative mood and improve quality of life, it really does not matter that they are on meds.  Anorexia nervosa is the biggest psychiatric killer of all mental health illnesses and I find it strange that psychiatrists don't routinely use medication as soon as the diagnosis is given, to alleviate suffering and help the patient turn things around.

Our brains are no different to the rest of our bodies - you would not deny a diabetic insulin, would you?  When we have brains that are not functioning as they need to, then medications can help.  I believe that our lives are so stressful now, and that our brains were never geared to deal with this chronic onslaught of stress, that for many many people, our brains are taking the impact, as much as our hearts and other body parts.

I myself have been on an ssri for over twelve years now - I just wish I could have been given one in my teens.  My life would have been so much less painful.  I ensured my d got the treatment she needed early on in her life and I can see the difference it has made, in spite of her an.

Believe you can and you're halfway there.
Theodore Roosevelt.

Registered: Feb 1, 2011
Posts: 4,840
Reply with quote  #10 
where is the data on long term effects of giving young kids these meds? I am speaking specifically about during a time of malnourishment and in refeeding. How much is the placebo effect- maybe even more for the parents than the kids? The parents then feel like they are " doing" something???? So much of the OCD and depression and anxiety can be alleviated with weight gain and maintenance in many...,

I know that some kids like yogurt parfait's have preexisting things and that medication can benefit.... But I am not in agreement that meds for kids are underused.

I don't understand why meds are not avoided for longer while focusing on refeeding and weight gain. Starvation causes the brain to not work correctly....these are very powerful drugs.

They wanted to put my ten year old on Prozac. My husband is a doctor and I am a nurse- we could not find any medical studies to support that. We said no and she never needed a med. for my daughter, ALL of her OCD, depression etc lifted with weight and time.

Again- not trying to be argumentative- but I just don"t see it the same way.

The medication debate is an ongoing one. I just wanted to represent another viewpoint.

Persistent, consistent vigilance!

Registered: Nov 9, 2012
Posts: 793
Reply with quote  #11 
I don't know mamabear - I know that for Abby, even though she weighed a mere 60 pounds when we admitted her, couldn't eat or drink ANYTHING until medication (Zyprexa) was started.  So I do think that some medications have an effect, before weight restoration.  I don't think it was placebo effect - a whole team of some of the best experts in the country couldn't get anything past that kids lips.  She'd even take the Zyprexa dry to avoid the water.  As soon as she had some built up in her system, she started eating.

Of course, I don't think it "cured" anything long term.  We took her off of it recently, and now I'm staring a possible relapse in the face.  Ugh.

Like YP, my daughter had pre-existing OCD, and she takes Zoloft at a high dose (100mg) to control that.  I think it has some effect on her general anxiety, but it's really hard to tell how much.  I actually hope that at some point, she is able to develop the cognitive development to really implement some coping skills, and we could at least reduce the dose.  I don't know though. I'm prepared for that to never happen.

New Mexico USA | Daughter dx. AN on 10th birthday, severe OCD from birth | Home from ERC FINALLY!!

Registered: May 21, 2013
Posts: 1,282
Reply with quote  #12 
Our d (15 yrs) is taking fluoxetine for anxiety and depression. For people younger than mid twenties, it needs to be carefully monitored and stepped up (and down) gradually and carefully. We began with 10 mg. 20 mg is still considered a fairly low dose. She is now on 30 mg and it obviously helps with anxiety and depression. It does not help with actual ed thoughts/behaviors unfortunately. But her mood is much better, and she rebounds more quickly from ed thoughts. Her anxiety predated ed, tho, and she was wr when she began taking medication. So our experience may not be relevant to your situation.

Talk to your doc about increasing the dosage, and about what you should look for during the 3-4 days after the dosage is upped. (If your doctor doesn't know, umm....consult someone else...?)

SSRI's work to help the brain access serotonin. It is hoped that after a while of having a better level of serotonin, the brain will get used to that level and be able to produce (or access ) it on its own. So that anti-depressants are not only helping the brain work better in the short term but can also help it reestablish health so that SSRI's may not be needed long term. That's my understanding, anyway.

That being said, the best medicine for someone of low weight is of course most definitely FOOD.
(And yes, I think anti-d's may not work as well on a person of low weight because they are not as well absorbed somehow?)

best wishes,

D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms have gradually lessened and we've been re-teaching her how to feed and care for herself, including individual therapy and family skills DBT class. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats compliantly and semi-independently but not intuitively, and is enjoying school and friends and sports and thinking about the future.

Registered: Feb 1, 2011
Posts: 4,840
Reply with quote  #13 
Again- all I am saying is we need to be very careful. It needs to be based on what really is the best decision for the individual. I do not like herd mentality... And that was my experience when my daughter was hospitalized.
Persistent, consistent vigilance!

Registered: July 21, 2013
Posts: 142
Reply with quote  #14 
I am now a huge believer in the benefits of medication to help in this fight. When my D was first diagnosed, we began refeeding and she went into a severe depression, said she wanted to die, had thoughts of suicide,  had fibromyalgia induced by anxiety, and could not sleep. After a couple weeks I reluctantly took our therapist's and pediatrician's advice to start meds. They put her on Lexapro and within a few weeks the change was apparent. Her mood was so much better and eventually it helped her to sleep. She started this medication while refeeding, and not yet WR'd and it still helped. 

She is still on 20 mg Lexapro, which I think is both for anxiety and depression, -it seems to help with both. While meds are not a cure for the ED itself, they can ease some of the horrible symptoms, like suicidal thoughts. The decision to put her on meds was not made lightly, but at the end of the day, I would rather have a D on meds, than a D who had committed suicide because she felt so horrible.

D diagnosed with anorexia in May 2013 at age of 13. She is 15, WR and doing very well in her recovery

Registered: April 10, 2009
Posts: 5,492
Reply with quote  #15 
I agree with you Mamabear.   Doctors made the mistake of giving my D medication from a very young age.  A few different SSRI's and later added Welbutrin to give her energy.

No one set her weight accurately.  No one made sure she was menstruating without B/C pills from 13 on.

When she finally got WR at age 23, she tried to taper off of the SSRI (Lexapro) and welbutrin and had such a serious case of discontinuation syndrome, that she needed to go back on a small dose of prozac to avoid that.

It did nothing for her depression or anxiety.

The only thing she benefited from was rTMS and it turned out that the depression was brought on by new birth control pills.

I think the moral to my D's story is that any young person put on these medications - it needs to be monitored closely and they need to be tapered off ASAP

Most of their anxiety and depression will get alleviated from getting weight restored, maintained and their brains healed.

If not, then they can look at the possibility of medication or better yet, some good therapy to help with managing anxiety.

I really believe that my D being on all those medications for almost ten years, altered her brain chemisty and she was not able to produce enough of her own serotonin. 

The exception is that some benefit from Zyprexa so they can eat if their anxiety is too off the charts, but that should not be a long term drug either.

WenWinning (formerly wenlow) - a Mom who has learned patience, determination, empathy, and inner strength to help her young adult daughter gain full remission after over a decade of illness and clinician set inaccurate weights

Registered: Sept 26, 2013
Posts: 122
Reply with quote  #16 

I have an open mind about medication. Our d took olanzapine for 3 months during refeeding and we believe that it helped with her ED thoughts and allowed her sleep. 


I do agree with Mamabear about being very very cautious about meds and children. My question to James Locke was about how I could manage my daughters anxiety.  She has been a healthy weight for a few months but she has started to restrict other things like her TV and computer use and she has high anxiety about social gatherings and around her clothes and whether she might 'look silly'. He advised that in his opinion medication should ideally only be used for co-morbid conditions after a child has been weight restored for 6-12 months. This gives the brain chance to recover and helps us to know whether they are conditions that are part of the ED or not. He also said that eventually 'life' should replace the ED. This makes a lot of sense to me and we are being patient. We are encouraging our d to participate in the things that she enjoys at her pace. As our d is at a healthy weight for longer we are seeing improvements all the time in her mood and her logic. It is early days but I believe that her anxiety is lessening slowly.

Mum of recovering 15 year old girl with AN. Approx 2 years into this difficult journey.

Registered: Nov 24, 2012
Posts: 207
Reply with quote  #17 
Thanks so much to everyone for their contributions - I've been to work today and just checked my posting and am thrilled that so many of you have put your thoughts down. I know that food is the answer, but wondered what other things may be work considering. One size doesn't fit all, after all!
Off to the medical review tomorrow with the psychiatrist - just wanted to be a little prepared as to options available. Thanks so much x

In this for the long haul .....
Mum to 14 year old D diagnosed with AN in May 2012 aged 12

Registered: Sept 27, 2013
Posts: 654
Reply with quote  #18 

I have seen what a huge difference meds have made in my own life and now that my niece has accepted trying some, I have seen a huge decrease in her anxiety and need to move all the time.  I agree with mamabear that each case has to be evaluated individually.  I am all for any help in any way, shape or form at this point!!  Good luck tomorrow.

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