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HateEDwithApassion

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Reply with quote  #1 
Hi all,
18 Yo ED D, WR. Depression and anxiety. Has been on Prozac - 30 mg and Wellbutrin 300 XL. Still dealing with deep sadness, not super motivated but tiny bit better with Wellbutrin. Not doing dramatically better depression wise with the meds than without other than suicidal thinking is way down. She feels Wellbutrin helps.

She saw psych today without me (18 years old!) and shared that she sleeps so-so. He now added Seroquel to the cocktail - 25 mg at night.  Three drugs. The reading I'm doing on Seroquel freaks me out when it's for insomnia. Seems like overkill to me. She's not bi-polar. She does go to DBT for emotional deregulation, but not DX with borderline as too young for that.

Thoughts from others with their kids on med cocktails? Does this seem like a lot? An anti-psychotic drug for sleep? I am beginning to feel we should get a second opinion. I also find myself wondering - what if this is finally the right combo? Unsure what to think...

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17 yo D. Diagnosed in July 2013. W/R in Sept. 2013 and has remained so. Roller coaster on and off since, mainly with ED under control but co-morbid depression and other negative coping mechanisms making our life hell. Trusting in God for daily strength and wisdom.
Francie

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Reply with quote  #2 
Hi HateED, my d has been on seroquel for about 5 months now. It helps her sleep. She has had sleep problems (unbeknownst to me) for years where her mind will not stop racing. Her dad is the same way. I don't know what you read about seroquel that frightens you -- please share with me if you wish either on this thread or email. My d had been on a higher dose but she was having trouble waking in the morning so they reduced it. The one thing I can say about seroquel is she has vivid dreams that she enjoys talking about in the morning. I am actually relieved knowing that she can get a good night's rest now where for years she could not.

My get-a-good-nights-sleep advice to my d had been to get reasonable exercise during the day, fresh air, turn off the computer one hour before bedtime, keep a regular bedtime schedule and cozy up with a book to help her fall asleep but she is still at an age where she rejects advice like that from me so seroquel it is.

The scarier drug for me is the effexor my d takes in the daytime for depression. I learned after she was put on it that withdrawal from this drug is pretty awful. I wouldn't mind getting her off of that drug, or at least have it reduced and to that end I am meeting with her team tomorrow to bring it up. 

I hated the idea of putting our d on medication but when ED first arrived in 2012 I was so frightened that I agreed to it almost in a panic when it was suggested. I hope some day she can be taken off of them if she so desires and if she can manage her emotions and moods better at a future time.

I hope you are doing well. XO



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Francie

abby

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Reply with quote  #3 
I replied to another post with this info, but I want anyone and everyone to see this. Wellbutrin is known to cause weight loss that may lead to ED relapse. A diagnosis (past or present) of AN or BN is a direct contraindication for prescription. Wellbutrin is known to cause weight loss and decrease appetite. This isn't a rare or unknown effect of Wellbutrin; it's actually bolded in my drug guide (I'm in training to be a nurse practitioner). Psychiatrists often prescribe it for weight loss.

Source: https://www.drugs.com/disease-interactions/bupropion,wellbutrin.html

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22 y.o. sister to a 20 y.o. sister with RAN b/p-subtype who's been struggling for 7 years. Never recovered fully---never been weight restored let alone pre-ED weight. Gonna start Maudsley for a "grown-up" with ED?

“Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes?
" Matthew 6:25
mjkz

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Reply with quote  #4 
Quote:
Wellbutrin is known to cause ED relapse.



No.  Wellbutrin has been shown to lower the seizure threshold so is relatively contraindicated in people who actively purging.  That is the only contraindication to Wellbutrin being prescribed.  Not eating is the only thing absolutely known to cause ED relapse.


As you progress with your training, hopefully you will learn that nothing is blank and white but rather many shades of gray.
abby

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Reply with quote  #5 
Please, see my source (a drug guide). Having a ED diagnosis is a contraindication to Wellbutrin, just as having advanced renal disease is a contraindication. Putting someone who has an ED on a medication that is known to cause >5 pounds weight loss in ~30% of patients (according to the pharm. company that produces it) is very risky decision.
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22 y.o. sister to a 20 y.o. sister with RAN b/p-subtype who's been struggling for 7 years. Never recovered fully---never been weight restored let alone pre-ED weight. Gonna start Maudsley for a "grown-up" with ED?

“Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes?
" Matthew 6:25
Torie

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Reply with quote  #6 
Thanks for posting this.  Most definitely I would not want my ED kid taking a medication that so often causes weight loss.  At a minimum, I'd expect the doc to point this out when considering: (From link posted by abby)

"[disease interactions
 with Wellbutrin (bupropion)]: Moderate

"Bupropion (Includes Wellbutrin) ↔ Weight Loss

"Applies to: Malnourished, Weight Loss/Failure to Thrive, Anorexia/Feeding Problems

"The use of bupropion is associated with weight alterations. Both weight gain and weight loss may occur, although the latter is much more common. The incidence of weight loss greater than 5 pounds is approximately 28%, which may be undesirable in patients suffering from anorexia, malnutrition or excessive weight loss. Weight change should be monitored during therapy if bupropion is used in these patients."

-Torie


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

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Reply with quote  #7 
Thank you Abby for the link about Wellbutrin /Buproprion. 

I would just like to remind everyone that on this site we are not posting as practitioners but rather as caregivers. We all can have our own points of view. It is always useful to hear of information that may be relevant to our loved ones. In Australia this medication is only has an approved indication for smoking cessation. Please be kind to each other. 

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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.
abby

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Reply with quote  #8 
Yes. I am not saying this as a HCP or psychiatrist in any way. The only reason I mentioned my schooling was to explain why the heck I would have a drug guide [smile]. I just want people to be aware that of this medication's specific risk to ED sufferers, not as any kind of specific, individual health advice.
__________________
22 y.o. sister to a 20 y.o. sister with RAN b/p-subtype who's been struggling for 7 years. Never recovered fully---never been weight restored let alone pre-ED weight. Gonna start Maudsley for a "grown-up" with ED?

“Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes?
" Matthew 6:25
mjkz

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Reply with quote  #9 
My point is making sweeping declarations like that is dangerous.  Any medication can cause weight loss or weight gain.  When we come on here and present ourselves as medical professionals (training to be a nurse practitioner) and make sweeping generalizations like that (Wellbutrin is known to cause ED relapse.-although I notice now abby has edited that statement now), what do you think is going to happen?  Someone is going to get scared and pull his/her kid off Wellbutrin probably without checking with the prescribing psychiatrist or physician.  We all know not to pull our kids off a med without tapering but that can get lost in the fear that the Wellbutrin prescribed has been THE thing that keeps that kid sick.

Yes, we know that there is no one thing other than not eating that keeps our kids sick but we are all searching for the magic bullet too (rightly or wrongly) that will make them well.  It is great to share information like that but not when you are presenting yourself as a medical professional and telling scared parents that the medication their kid is causing or will cause a relapse.
HateEDwithApassion

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Reply with quote  #10 
Hi,
Thank you, Abby, for your concern. And thank you mjkz for reminding us all that even general statements that are often true aren't always true. That being said, I do believe that the addition of Wellbutrin to my daughter's regimen has been the cause of this relapse. She was at her highest weight in recent memory this fall during cross country (I know - crazy!) and was eating really well, very intuitively. I didn't worry about the ED then. 

He started her on Wellbutrin in late September, however, because the Prozac alone was not enough with depression. Here's the dilemma. The Wellbutrin has helped the depression and the tiredness and zombie feeling my daughter hates, but she lost a decent amount of weight on it and doesn't eat as well. She's putting it back on slowly under the direction of the dietician, but she's also resisting us more this time. All we do is fight now. About everything. 

I've decided to call the Pdoc and ask him if there's something like Wellbutrin that doesn't have the appetite suppression issues. So, Abby, I believe we have experienced what you describe as a dangerous side effect, but I don't think it necessarily happens to everyone.

The crazy thing is that we used to work with an ED doctor for several years. She was pushing the Pdoc to prescribe Wellbutrin with the Prozac.  She felt my D had issues with dopamine and that was why she wanted to try that combination. I read the same contradictions you mention, but thought if the ED doctor was recommending it, it must be a rare occurrence to affect appetitle. Why would she even think to recommend it, if not?? Gosh.

I think our pdoc is out of ideas on how to help my daughter. He's asked us to get blood work done to measure some other levels to see if there's another biological reason for the depression. I know it's probably weight related, but she's digging her heels in now. We'll see what the next few weeks bring. She's 18 and just told us she's taking a gap year, not going to college, and instead moving to another state to work in a Buddhist meditation center. My husband is at the end of his rope and heartbroken about the decisions and attitudes of this child. 



__________________
17 yo D. Diagnosed in July 2013. W/R in Sept. 2013 and has remained so. Roller coaster on and off since, mainly with ED under control but co-morbid depression and other negative coping mechanisms making our life hell. Trusting in God for daily strength and wisdom.
mjkz

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Reply with quote  #11 
Quote:
The crazy thing is that we used to work with an ED doctor for several years. She was pushing the Pdoc to prescribe Wellbutrin with the Prozac. 


I think part of the reason that people use Wellbutrin in eating disorders is because it is more weight neutral than other meds and with weight being such a sensitive issue, people tend to stay on it longer to see if it works VS other meds that can cause weight gain and people just go off without giving them a fair trial.  Even people who don't have eating disorders really don't want to take a med if they know they will gain weight.  While it may be beneficial to have weight gain as a side effect in those who need to gain weight, it is still scary.  My daughter will not take Zyprexa under any circumstances.  She has even added it to her allergy list so that no one gives it to her.  Yes, she still needs weight gain but if it is Zyprexa she would rather go medication free even knowing how much she needs meds.

Is that why your doc put your daughter on Wellbutrin?  Who knows?  You'll have to ask him about that and I'm really sorry that you have seen problems with it.  He might have seen that she was at a higher weight and wanted to help the depression without weight gain so he chose Wellbutrin.  I think too it can be hard depending on where the person is in recovery because my daughter doesn't have an appetite to begin with and any med that changes that is not going to lead to weight loss. She eats because she has too and it is not at all appetite driven.  For your daughter, it might be an issue.
melstevUK

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Reply with quote  #12 
HateEDwithApassion,

Having checked out US name equivalents, the atypical antipsychotic used most frequently with an patients  in the UK is Olanzapine (Zyprexa).  But it is usually offered to low weight patients rather than those who are at a better weight, when resistance to eating is extreme in the early stages. However, I have read that it is a good combination for treatment resistant depression. Wellbutrin is not often prescribed over here for any condition, as far as I can make out and is similar in action to drugs used for ADHD, I believe, which is probably why it has the potential to cause loss of appetite.  

The other med which I see having been used for an patients in the US is Effexor, which is an snri.  (Venlaxafine in the UK)

The Wellbutrin evidently (according to my quick online research done just now) does not actually have that much of an action on the dopamine system but if your d is doing well on it apart from eating as much as she needs, maybe the Effexor would be worth a try as an alternative?

Of course, as mjkz says - her own d will not take it  because of the potential for weight gain, but if your d has not tried it - would it be worth suggesting?

It really is difficult getting a balance.  From my own (gut reaction) point of view, I would be very reluctant to have my d on any more than two medications at a time.  She has only ever needed an ssri and the occasional anxiolytic or sleeping tablet.   In fact, if getting hold of diazepam and sleeping tablets was not like trying to get hold of gold dust here in the UK, we would both use them on an occasional basis to manage our own health issues - but it is easier to get hold of street drugs than these meds in the UK.

I was on Remeron (Mirtazapine) for a while and it was great for helping me sleep and have more energy.  But the weight gain was an issue.  With psychotherapy in my thirties and life experience I am now fine on just an ssri.  

I hope these names at least give you some room for discussion with the psychiatrist.   Ultimately they are only trying to play around with neurotransmitter levels and getting the brain to its optimal balance, while other therapy can be delivered.  But psychiatrists in the US seem to take a pretty gung-ho attitude a far as I can make out.  I would certainly not be happy with a third med of a different kind being added to the mix - again that is my gut reaction.  

Let us know how you get on.



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

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Reply with quote  #13 
To add;

In terms of your d wanting to go off and work in a Buddhist centre, it sounds as if she is really trying to find herself and where she fits in and what life is about.  This is not a bad thing in itself because she can return to her studies at a later date.  It is a bit like what  people did in the hippy movement in the sixties.

I can understand your disappointment in her choices - but I would be more concerned of her going off somewhere far away from home before she can actually manage her own health and I would be stating that you will put every obstacle in her way to let her go away if she cannot manage her health and weight.   She may well change her mind a few months down the line in any case.

It may be worth having a discussion about her hopes and dreams and what she wants to achieve and what she wants to do in the future beyond this gap year she is thinking about.

Use every opportunity to get her thinking about the future because that is the last part of the brain to develop and it goes on developing right into the mid twenties.  At the moment she is probably living in the here and now and near future.  But thinking about her long term plans is also a way of expressing confidence that a lot of this depression can be linked to going through adolescence.  Even without an ed on the scene, many young people struggle as they move into adulthood on all levels so she is not on her own.  Keep telling her that she will get through this period and life will be better down the line.

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

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Quote:
The Wellbutrin evidently (according to my quick online research done just now) does not actually have that much of an action on the dopamine system but if your d is doing well on it apart from eating as much as she needs, maybe the Effexor would be worth a try as an alternative?


Wellbutrin is a norepinephrine and dopamine reuptake inhibitor.  In the states it is used not only alone as an antidepressant but often times as an adjunct often added to SSRI's when the person doesn't have a complete remission from depression on the SSRI alone.  It is also prescribed to help a person stop smoking (works on nicotine receptors) and seasonal affective disorder.  In the UK and Australia it is only approved to stop smoking but can be used in off label as an antidepressant.

Mel is right though in that the effects on dopamine receptors is minimal at best.  Wellbutrin is contraindicated in eating disorders, particularly bulimia and purging subtype anorexia because it lowers the seizure threshhold and can lead to seizures when taken by someone who is actively purging.  It is marketed as having less sexual side effects and very little weight gain when compared to meds like SSRI's or atypical antipsychotics.

My best friend is a psychiatrist who practiced both in England and now here in the US.  She will not prescribe Wellbutrin to anyone who has a history of purging because of the seizure risk.  She uses Wellbutrin both in people who need to gain weight and people who don't specifically because it does not have the weight gain side effect.  She finds compliance is a huge issue (which makes sense) with meds that cause weight gain.  She said she uses Wellbutrin much more here in the US than she ever did in the UK.  It is actually according to her one of the most prescribed antidepressant over here.

I find it so interesting how different countries use drugs differently.
HateEDwithApassion

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Reply with quote  #15 
Yeah, I have to say, Wellbutrin has made a difference for my D, which is why we've been hesitant to take it away or change to something else. Zoloft made her feel like a zombie as did Lexapro. SSRI's on their own seem to do that to her, so she hates them and stops taking.  Doctor recommended Seroquel for sleep which has a pretty big weight gain side effect, which, on its face, would seem good. But I too worried that the weight gain would cause my D to restrict in order to try and lose any gained weight, which would set that behavior in motion again. Not sure what's worse... weight gain that potentially makes a patient restrict again to lose it or meds that diminish appetite that they have to learn to eat through and ignore the low hunger cues. I think the second might be more conducive to learning to live in recovery, but neither are great.

My husband often wonders if she would be better off without any meds at all because it seems every one of them has issues and then the doc tries to medicate that issue, which leads to a third issue that they medicate, and then medicate that drug's side effects, etc. etc. It's maddening.



__________________
17 yo D. Diagnosed in July 2013. W/R in Sept. 2013 and has remained so. Roller coaster on and off since, mainly with ED under control but co-morbid depression and other negative coping mechanisms making our life hell. Trusting in God for daily strength and wisdom.
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