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Support forum for parents and caregivers of anorexia, bulimia and other eating disorder patients
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6cobhamUK

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
KinteacherUSA

Registered: June 24, 2013
Posts: 225
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 ww.naturalvitality.com 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 13...ups and downs in the past ten years. She has one more semester of college. Keep the faith...I know how scary it can be.
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Denise holmes
momon

Registered: March 19, 2013
Posts: 306
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.
YogurtParfait_US

Registered: May 9, 2012
Posts: 5,312
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.

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

Registered: Sept 17, 2011
Posts: 1,071
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

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

Registered: Sept 17, 2011
Posts: 1,071
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.
peony

Registered: Sept 23, 2013
Posts: 95
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

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Peony
Hollyhill_USA

Registered: April 14, 2012
Posts: 175
Reply with quote  #8 
Zyprexa has been tremendous in helping with my son's anxiety. He also takes Prozac.
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Be Still...
melstevUK

Registered: April 29, 2008
Posts: 1,868
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.
mamabear

Registered: Feb 1, 2011
Posts: 4,424
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.
SamHeinous

Registered: Nov 9, 2012
Posts: 773
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!!
kbs

Registered: May 21, 2013
Posts: 1,006
Reply with quote  #12 
Hi,
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,

__________________
Psycho Mom
mamabear

Registered: Feb 1, 2011
Posts: 4,424
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.
skechers

Registered: July 21, 2013
Posts: 93
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 RAN in May 2013 at age of 13. She is 14, WR and continuing to recover
wenWinning

Registered: April 10, 2009
Posts: 5,088
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
Radcliffe

Registered: Sept 26, 2013
Posts: 89
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.
hannabeatsanaUSA

Registered: Dec 6, 2013
Posts: 209
Reply with quote  #17 
I too am open to medication. Both of my children, myself, and my husband all take it. But cautiously. My husband takes Luvox for OCD and Xanax for anxiety, my son takes Cymbalta for depression, Adderall for ADHD, and Vistaril for anxiexty. I take Lexapro for depression. My d takes Prozac for depression and Vistaril for anxiety, but has been on a laundry list of medications in the past. We will be much more careful in the future. She started with Celexa (headaches...), then Zoloft (suicidal ideation...), then Lamictal (worked!!!!) and Klonopin (her dad wasn't happy with her taking a benzo so she went off...), added Effexor on top (still working!!!), then she got an ED. Then they added Abilify (couldn't stay awake...), switched to Latuda (no effect...) and added Buspar (also no effect...). At this point, we stopped seeing her psychiatrist. All of the children I know who see him are taking 5-6 medications at a time... not USUALLY effective for kids! Not to mention that many of those meds aren't approved for teens. She went into the hospital and her meds got fixed and she gained enough weight for it to be continued at home pretty effectively. 
We will NEVER see that psychiatrist again!! Zyprexa would have probable been helpful for her... but he was insistent on Abilify and all of these other meds. I will proceed with much more caution in the future. 
Back to my point..... She now takes 10 mg of Prozac for depression and anxiety, as well as 25 mg of Vistaril as needed for anxiety. We could not be happier with the Prozac. She has an OCD diagnosis, but that was managed fairly well with EXRP when she was hospitalized. If we had to up the Prozac to OCD dose, we would be willing. The vistaril doesn't do much except make her tired. Klonopin really helped her, but her father and I aren't crazy about her taking such a heavy hitter. It just took the edge off her. I think the Prozac helps the anxiety, and it is fairly safe and well- tested. Good luck! I hope you find the right solution! 

__________________
My daughter, Hanna, is 17 and recovering from Anorexia Nervosa Purging Subtype, depression, anxiety, and PTSD (pre/co- morbids). She now eats freely and is happier than she has even been!
6cobhamUK

Registered: Nov 24, 2012
Posts: 207
Reply with quote  #18 
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
katysaunt

Registered: Sept 27, 2013
Posts: 598
Reply with quote  #19 

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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