F.E.A.S.T's Around The Dinner Table forum

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claretre
Hi, my D was diagnosed with RAN last year - 10 yrs old. Her weight is now in the healthy range (although at her age it's a moving target). After a tough Christmas her anxiety has become acute and although she is eating, she won't sit down. Our physician had suggested fluroxetine (starting dose 4mg). The anxiety is debilitating as she won't sit at school.

I've posted on this before but may not have been clear that she is now a healthy weight. I would be grateful to hear any experiences from the community. Thanks .
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PuddleduckNZ
Hi Claretre

My Son was dx with Anxiety Disorder-NOS.

As he became weight restored and in a better place (this took 18mths and 2 hospital stays) his anxiety dropped significantly.

He was started on fluoxetine at the end of his last hospital stay (June 2015). It was a bit trial and error, he had missed 15mths of school and was going back, we wanted it to be successful, so covered all bases.

He is on a low dose of 10mg. I am ho-hum whether or not it has helped much as he was on his way through the worst of the ED anyway I feel. And I still feel the anxiety is tied up in the ED. Its hard to extrapolate which is what.

But we will never know I guess, until we take him off it.

In regards to the standing up, to me that sounds like classic ED, and not anxiety.

I would also add, (I think it was mentioned on the other thread, sorry to repeat if so) check your weight targets, as it is one of the biggest things ED professionals get wrong. My Son needed to be quite a lot higher than his WR target to see some healing and then catch up on the growth he had missed through the starvation.

Take care x



Son 9yrs when he became unwell 2013, ED slide from April 2014, dx at 10yrs July 2014, 2 hospitalisations - dx so many times Behavioural Anorexia, EDNOS, ARFID. FBT from August 2014. Anxiety, Emetophobia. 13.5yrs old now! In recovery, gets better every day with constant vigilance, life returns.
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claretre
Hi PuddleduckNZ, thank you for your reply. I really hope that things are turning around for your family & your son is making a strong recovery.

Did he suffer any side effects from the Fluroxetine? I've heard it can cause tummy upsets & headaches or worse, stunt growth. My D is very small for her age and the ED had curtailed growth. In our last appt with the Clinical Psychiatrist I challenged if it was the right time to use the drug so we left it to think it through. My D doesn't have a weight 'target' I am just told that she is within the normal range, although she is being referred to a Peadiatrician as her height had not kept up with her weight.

We are tempted to hold off on the Fluroxetine until that meeting. But managing the anxiety in the meantime is tough.....
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PuddleduckNZ
I was absolutely hesitant too. I totally get it. Our kids are so young and before this many of us have had nothing to do with anti-depressant, anti-anxiety and ant-ipsychotic medications. Terrifying.

My S was likely growth stunted but has grown in leaps and bound the last 6mths, like a lot. His bone age was 2yrs behind 6mths ago, but no osteoporosis type stuff, we will check this has caught up in a year if everything goes ok. All this growth coincides with him taking this med, so for us, no, it hasn't stopped his growth potential, he is actually taller than his brother at this age, which we would never have imagined, we always said  -oh he is just small, he is scrawny, but he is no longer that kid. So don't be fooled by what has always been (said in the nicest possible way).

Also what I found is he needs to gain a decent amount first, like he even looks a little chunky, then he grows and we start upping the calories. again.

He started the fluoxetine in hospital last admission, he was a mess, so was also on olanzapine, which wiped him out a bit initially. We didn't notice any side effects, apart from a dry mouth, and he is super sensitive, so I was very relieved.
Son 9yrs when he became unwell 2013, ED slide from April 2014, dx at 10yrs July 2014, 2 hospitalisations - dx so many times Behavioural Anorexia, EDNOS, ARFID. FBT from August 2014. Anxiety, Emetophobia. 13.5yrs old now! In recovery, gets better every day with constant vigilance, life returns.
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Iaminspired
My D was also on fluoxetine.  She has severe anxiety, which preceded ED and also missed a year of school.  She started on olanzapine IP but still had severe anxiety.  The fluoxetine was a a game changer for us since depression had also become a significant problem and the anxiety was debilitating.  I debated for a long time because of putting a young teen on this type of med but it was worth it as her mood really improved and the anxiety had a bit of a buffer.  However, after about 6 months insomnia because a serious problem and we eventually changed to remeron.  The transition was a 2 nightmarish months but we are back to where we were with mood and anxiety.  We have an excellent child psych who started her on very low doses and watched her carefully and was willing to change dosages, even over the phone, when I noticed sleep issue or other significant problems.

I agree, the not sitting sounds more like ED than anxiety.  I took my D significantly higher than the medical weight goal, to the point where the doctor was always cautioning me about gaining too much but it was truly the answer for her, she needs to be well above the hospital goal and a BMI of 19. 

Colleen
Colleen in Ontario

Single Mom to DD#1 (20), Autism Spectrum Disorder (diagnosed at 16 1/2), Generalized Anxiety Disorder, Social Anxiety, Panic Disorder
and DD#2 (17), In solid recovery from Restrictive AN, Managing Social Anxiety, Generalized Anxiety Disorder, Panic Disorder, ASD, finished with IP and FBT, successfully managing school and life

If, at the end of my days, I can say I saved the life of not only my child, but helped to save the life of someone else's child as well, then I have lived a good life.
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claretre
Hi Colleen, thanks for your reply, I hope things are better for you all now?

On reflection, do you think the Fluroxetine made a positive difference long term? It sounds as if it made a difference initially but I'm interested ito know if you would make the decision to medicate with the benefit of hindsight?

Clare
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Bottle
Hiya -D's been on Sertraline for a while with no apparent problems. I'm hoping she'll be ready to drop dosage and tail it off soon. You can't have a magic insight into what would have happened without it unfortunately but my view is that we do the best we can with what we've got at the time and for us that's definitely included meds!
Bottle
D2 RAN as part of Pervasive Refusal Syndrome with a history of not walking for a year and being non verbal for a short while too. Considered to be Aspergers by everyone that has worked with her and by us but still awaiting a diagnosis that'll help us access support services she needs.
D1 recovered RAN and D3 doing pretty well considering the mayhem around here!
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claretre
Thank you for posting. It's really hard to know what's best; maybe it's us in denial? We could be making her life harder by not giving fluroxetine.

I really appreciate your comments, Clare
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OneToughMomma
Claretre,

Our d was on fluoxatine during refeeding, and we found it had a significant impact on her general, non-food related anxiety. As a YA she has trailed not taking it, but has decided to get back on it again. It does work wonders for her.

XoOTM
D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
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hopeful_mum
My d had the same where she would stand her whole waking day. This was at the very early days of refeeding. This was definitely her AN. It was IP that broke that habit for us and is now no longer a problem.
We also deliberated over whether to give our d meds for a year and a half. Pre-IP we was told if depression pre-existed her AN then meds was thought to be a good idea. We concluded that our d wasn't depressed pre-AN so decided not to medicate other than melatonin to help her sleep...which it did.
Now we are WR and 3 years into our AN journey (2 years since diagnosis and treatment began) we have decided to put our 14yo d on fluoxetine to treat her social anxiety. This definitely pre - dated her AN and I heard one psychiatrist say that anxiety is the underlying problem for most people who have depression, ED, OCD etc. So we have decided to try and treat her anxiety in the hope that we can turn things around for our d. She has been an anxious child from birth and we had got to the stage where we couldn't see anything else working. She was resistant to seeing a psychologist but we have explained to her that there is no such thing as a magic pill so we have told her if she is on meds she must also start to see a psychologist. We are hoping the meds will quieten her mind enough to be more receptive to this.
Your d is very young but only you know how she was Pre-AN and where she is in her recovery ie WR or not. As you already know food and a true WR is the best medicine for our kids in the first instance. But there are many occasions when our children need more help than this. I don't think waiting has harmed our d in anyway. It has just given us more certainty in our course of action. It also gave us the insight to barter a deal with our d that she sees a psychologist too.
So far for us, no side effects but she is only on 5mg for this first 10 days.
Hope you get the advice and insight you need to make the right decision for you and your d. Hang in there. Whatever you decide will be you making the best decision possible for her so try not to agonise over your final decision once it's made.
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claretre
Thank you so much for your note. Our d has always been an anxious child but so many are! How are we know know as parents what is 'normal'? I'm sitting tight at the moment to see if the standing up thing changes although the posts I've received from other parents has helped to reassure me that meds can have a role & she won't become junkie overnight. She's missing out on so much - yes AN is a total killjoy - and I don't want to prolong the agony for her.
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hopeful_mum
I just reread over my post. Just want to correct my last statement...no decision is final. Whatever is decided can always be changed later should the need arise or you see it differently. My d anxiety is so severe she rushes her speech even at home and she deflects real interaction. All her life we tried to encourage her to try new things and open up but she is frozen by her anxiety. We worry that if its not dealt with while she is young she will never progress in life. She sees all doors are shut to her at the moment. We are desperately trying to help her see that doors are open for her if she can learn to control her anxiety, low self esteem etc. Keep listening to everyone's advice n see how you feel. Thinking of you.
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claretre
That's desperately sad. And I bet she is talented, beautiful and kind. Thank heavens she has you to look after her. Do let me know how you get on with the meds - I totally see how this is a relevant intervention for you right now. Take good care x
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ed_newbie
I believe my d, age 13, also had social anxiety pre-ED diagnosis.  She has always been shy, the "quiet one" in large groups, slow to participate/open up at the start of each school year.  Teachers have always commented about her quietness and how they would like to see her grow more comfortable in speaking up in class if she has a question or knows an answer.  I never really attributed this to anxiety, but in hindsight it probably is.  I'm not thinking about meds at this point as I am hoping that working with a therapist who has experience in treating anxiety in children will help.  Time will tell.

"Lineage, personality and environment may shape you, but they do not define your full potential."    Mollie Marti  

ed_newbie

15 yr old d diagnosed with AN late December 2015 at the age of 12 after a 23 lb weight loss during prior 3 months. Started FBT/Maudsley at home on Christmas Eve with support from amazing local nutritionist specializing in ED and trained in FBT. WR Feb 2016 and pushing our way through puberty and rapid growth.
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BattyMatty_UK
It took a while to persuade my teenage son to take (initially) fluoxetine (later he moved to another SSRI which suited him better: citalopram) because he said that it made him feel weak rather than trying to fix things himself. But in the end he decided to go ahead and five years later he still on it.

Anxiety was a massive problem for my son – social anxiety, sleeplessness and depression. But the SSRIs helped a tremendous amount, giving him the crutch he needed to get well, kind of like putting a plaster of Paris cast on a broken limb. What didn't help was when our treatment team sent along to an "anxiety group" for a series of group sessions about how to cope with anxiety. It made no difference whatsoever!
Bev Mattocks, mother of 24-year old male DX with RAN 2009, now recovered. Joined this forum in 2010 - it was a lifesaver.
 
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lisaNJ_US
My D was 10 at diagnosis.  I remember asking the doc about meds and she was hesitant to prescribe due to her young age. She said if I wanted to discuss the meds further, I could speak with a neurologist (I believe that's who she said). We never pursued the drugs.

Anyway, D is 12 now.  She is an active girl and plays soccer.  She is at a stage where she thinks she needs to be perfect -- in school and on the soccer field.  I'm hoping that's just a stage and she'll get over it.

Good luck with your decision. I just wanted to add my two cents.
Lisa NJ Mom to daughter dx AN (Nov. 2013) at age 10. WR April 2014. ~There is light at the end of the tunnel.~
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hopefulmama
Claretre - 

I know how hard the decision about medication can be.  My d was 17 when diagnosed with RAN and simultaneously diagnosed with general anxiety disorder and major depressive disorder. They were daunting diagnoses to say the least. In retrospect, I could see that my d had dealt with anxiety her whole life.  My h and I tried to protect her from situations that would cause her anxiety her whole life.  Of course, we thought we were doing the right thing, but the more helpful approach for her would have been to teach her skills to manage her anxiety. We fought medication at first and so did my d. A couple of things learned along the way. 

 - When ED is involved, I think the first thing to do is to get past the ED before coming up with a lot of other diagnoses. At this stage meds can be helpful to manage anxiety to help them eat.  For my d zyprexa (olanzapene) was incredibly helpful in this regard;

 - Once they are weight restored (properly to their historic growth curve - and your d's target is going to be moving because she has a lot of growth to go) then it may make sense to look at meds to help with the remaining anxiety.  For us, we were lucky enough to work with a psychiatrist who assured my d that he didn't want to be her doc forever. (My experience is that most psychiatrists are crazy and likely to over prescribe meds.  A lot also don't understand EDs.) We used a low dose of Abilify along with skills based therapy (DBT) to help her brain learn new patterns to deal with anxiety.  The idea is that the anxiety is in large part genetic and it makes sense to teach skills to manage it differently.  Some of this is exposure therapy (exactly the opposite of what we had done with my d her whole life.) It is an investment of time, but it has paid dividends.  My d has now been off meds for 18 months+.  She still gets anxious in situations, but she has skills learned from DBT to handle it.

 - Lastly, we had to try several different meds before finding good fit.  Many report good experience with fluxotine, while my d had a terrible reaction to it.  The process is SO personal and there's where a really good psych can be so helpful

 - You may find posts from forum member yogurtparfait helpful.  She has a little one with anxiety/OCD/ED and she has had good success with a skills based therapy helping her d (CBT.)  She also often recommends the author Tamar Chansky who has authored many books on using skills and exposure therapy to help anxious children.

BTW - My d leaves tomorrow to spend a semester abroad in South America.  She will be living with a family and speaking only Spanish.  She is understandably anxious, but she is dealing with it using her DBT skills and her level of anxiety is totally normal in the circumstances.  I never would ahve thought this would be possible for her three years ago.



Enjoying my 23 year-old daughter's achievement of active recovery that was made possible by the resources and education I found on this forum.

Don't give up hope!
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NELLY_UK
Fluoxetine was a game changer for us but the dosage had to be high - 60mgs.
Just saying.
NELLY D 20 bulimic since age 12, diagnosed in 2011. 20 months useless CAMHs,7 months great IP, home March 14..... more useless CAMHs.now an adult & no MH services are involved. I reached the end of my tether, tied a knot in it and am hanging on. ED/Bulimia treatmentis in the dark ages in West Sussex.
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hopefulmama
I would definitely meet with a psych or any provider before bringing in my child.  It is SO unhelpful and hard to recover from a professional saying untrue things about ED.  We had a dietitian tell me d that she should have a say in her weight range!  Really???? It was hard to recover from.

We got our psych through a referral from an evidence based treatment program.  Absent that option, I would ask around.  I would look for someone that truly understands EDs and is conservative with meds.  Early on we had a psych who kept prescribing a new ADDITIONAL med for my d to counteract the effects of the first med.  i was so desperate for help for my child, before I know it my d was on 5 meds, including a very high does of Xanax.  
Enjoying my 23 year-old daughter's achievement of active recovery that was made possible by the resources and education I found on this forum.

Don't give up hope!
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skechers
My d (16) has been WR over two years and last year we switched from Lexapro to Fluoxetine-40 mg. She has co-morbid anxiety. Her mood and anxiety are good and have been since we switched. Only side effect are hand tremors.
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