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

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Allyson_1
My 14 YO D was diagnosed with AN in November.  She has always been super thin and tall.  She is now WR (tho she never was this weight - she is 24 pounds over where she was at diagnosis and 21 over her heaviest weight prior to that.    When diagnosed,  she was also diagnosed with reactive anxiety/depression & put on an SSRI.  We've weaned her off of the SSRI since WR.  She's had a few days of being really down - unable to go to school, crying, saying her thoughts are jumbled.  I am finding this worse than the ED in the sense that food was medicine & she was good about the refeeding for the most part and I could control the calories and knew blow ups were the ED talking.  She took a 3 week leave of absence from 9th grade to eat & rest.  Her exhaustion has been, and still is, terrible - difficulty walking around the block.  With the anxiety/depression I am out of my depth. She didn't like the SSRI nor did I or her ED therapists.  It was an ED medical doctor who put her on it.    Is anyone else dealing with anxiety/depression post WR?
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tina72
I cannot say if that is kind of side effect due to weaning out SSRI. We did not have that meds. We had anxiety and depression for a year before AN moved in and on its highest level around WR. After adding a few more pounds it slowly got better around 4 months after WR. We then found out that her cortisol level (a stress hormon) was very high. We got it down to a normal level by adding B12 (which she had a huge deficiency). This was the turning point here. Her anxiety and depression decreased from month to month and is now on lowest level we have seen for years (1,5 years after WR). Not only anxiety, also perfectionism is on lowest level ever.
Brain recovery needs a lot of time. Keep feeding and I am quite sure it will get better soon.
Keep feeding. There is light at the end of the tunnel.
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scaredmom

I have seen some that have a lot of anxiety and depression with and without WR. Hard to know for sure, I guess. It takes months of WR and more weight  sometimes to see the brain healing. 
And if it is a "withdrawal", maybe she did benefit from the meds? Just a thought. 
Many have had a lot of fatigue too it too, may get better over time. It takes muscles awhile to get back into shape after being inactive for along time too. So take the exercise slow.

I am sure others with more experience will be here soon too.
Just throwing out some ideas.

XXX 

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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Mamaroo
Like the others have said, it takes a long time for the body to repair all the muscles and the brain needs even more time. We experienced the most anxiety just before WR, also known as extinction burst. It might be that your d might benefit from another couple of lbs and it is quite common for those in recovery to overshoot, the weight settles to a lower point after several months. Here are some links:
https://www.aroundthedinnertable.org/post/some-rather-long-musings-on-extinction-burst-relapse-and-recovery-6462360?highlight=extinction+burst&trail=25#gsc.tab=0
https://www.aroundthedinnertable.org/post/overshoot-and-ed-recovery-10062691?pid=1307865906
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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Anne_D
Having taken different SSRIs myself for a number of years, in my experience there is definitely a withdrawal period where symptoms of depression or anxiety worsen.  I wonder however whether your daughter was on the medication long enough to fully benefit from it. You say she was diagnosed in November.  With most SSRIs, it takes at least three months to really see a solid improvement.  They are also most effective when combined with some form of talk therapy.  I know that many people would prefer to not have to take these medications, especially children/youth, but there is some solid research about their effectiveness.  Did you ween her off the meds with the ED doctor’s input?  Both going on and off these meds can be a lengthy process.  Fatigue and flu-like symptoms are also common.
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Allyson_1
Thank you for the responses.  My d has been on Lexapro since late November.  She started the journey at 5 feet & 3/4, 102 lbs & is now 5 feet 6 inch &127 lbs (over the target weight of 124lbs).  So, not on meds very long once WR.   She is on a very low dose 10mg/day & we were advised by the MD on how to taper correctly.  Tremendous fatigue since starting refeeding & fatigue not better even now that she is WR. She was allowed to continue horse back riding but is finding it very painful with her ankles & knees hurting every time she rides.  Tendon issues with WR?    Riding is her passion & she rode even though painful.  She's just been demoted from her original peer riding class down to an easier class with younger kids and is devastated.  She wants to give up riding completely because the others girls will be getting better & better & she will never catch up.  Has now missed 2 days of school bc she is so depressed over this set back & the stresses of school as the trimester is coming to a close.  So, overwhelming on all counts.   I can't figure out if this is the depression,  or a kickback of going off the meds last week or simply a teenager poorly handling a set back.  She is still eating tho!

Another question I have is when folks have said ANs should gain 10% over the ED doctor's ideal weight gain, is that 10% of the amount gained (25 lbs - so an additional 2.5 pounds over target weight) or an additional 10% over overall body weight (127, so another 12+ pounds?)  The later seems extreme as my d already has a double chin.
Thanks for any insight.
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HopeNZ
Hi Allyson_1

Firstly, congratulations on the speedy weight gain!  

I have a couple of observations.  I know that while you're in the thick of it, the refeeding and healing process seems interminable.  However, the timescales you mention are really very short.  Diagnosis in November, and wr a couple of months later, and in that time going onto, and off, an SSRI... this really does not allow much time at all for brain healing, and adjusting to either the administering of, or withdrawing of medication.  There will be so much going on in your d's body and brain in terms of nutrition alone (the aching joints, fatigue, jumbled thoughts) and all these things take months and months of healing before they come right.  Likewise, a few days of feeling really down and incapacitated does not necessarily add up to depression.  As for anxiety, as you know, that's all part and parcel of the whole wretched disease and in most cases will return to pre-diagnosis levels in time (acknowledging that many of our kids experienced anxiety before they became ill).

I would also encourage you not to focus too much on the numbers on the scales.  As you've probably read around here, target weights are problematic, especially for teenagers who should be growing and gaining continually into their 20s.  On top of that, you mention that your d is 3lbs over her target weight.  For many of us, weight could fluctuate by this much from day to day.  What matters is your d's state.  Her state of mind, her ability to eat, being more herself once more.  Please search the forum and FEAST for 'state not weight'.  And please don't worry about the double chin.  There have been some excellent posts recently explaining 'overshooting' and how this is normal and necessary.  In the early days of wr, as their bodies are trying desperately to recover from starvation, our ed kids get chubby cheeks and tummies.  This weight becomes more normally distributed after a couple of months of good nutrition and healing.

Keep going, mum.  You're doing a hero's work!
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HopeNZ
Mimi321, we must have been penning our posts at the same time, and thinking along the same lines!  Thank you for including those excellent links... they were some of the ones I had in mind 😊
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bluerain
Our daughter had terrible fatigue/anxiety/depression after and during wt restoration- I asked for a fatigue panel of labs and they found her hemoglobin, ferritin, vitamin D and Zinc were all pretty much in the toilet (after 6 months of good re-feeding). We added supplements and she slowly improved, (tried 4 different SSRIs along the way, none of which were helpful and all resulted in suicidal ideation). 
Anyway, I’d suggest getting some blood work. Our daughter was more malnourished than we realized. 
We can do hard things well...
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tina72
Same here. Here it was also zinc and especially Vitamin B12, D and ferritin also. Nearly not measurable any more even after eating everything in a normal amount for 10 months then and she was never vegan or vegetarian before (just a short episode due to restriction with AN before we stopped it). Vitamin B12 correlates with cortisol which is a stress hormon. Low B12 makes high cortisol level. We added all and now her cortisol level is fine and anxiety on its best=lowest level ever.
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
Just doing a quick calculation from the figures you have given - she started out when sick at a BMI of 19.5 and is now a BMI of 20.5  She has grown a lot over that time and she needs fuel both for further growth at 14 and to help keep her brain healing. BMI naturally increases as we age into our early 20's so despite her gain in weight she is truly likely to be not weight restored just yet. It may be that what you are seeing is the stress and anxiety associated when close to weight restoration, combined with withdrawing the medication. 
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.
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Foodsupport_AUS
If I was looking for B12 and other B vitamins vegemite (low salt version) and similar can be great too, equally as concentrated in vitamins and can be used to flavour all sorts of things too. Or just on toast. 
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.
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Suzanne
And... a mother word about stopping the SSRI:
the step down approved and recommended by psychiatrist is often times too too fast for most people, and as a result there may be some physical and emotional side effects. Please report all charges to her prescribing doc!!!
Xo
suzanne 
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Suzanne
( my typo is too perfect!!! 😘😬)
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