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

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

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Yael826_
Just wondering if anyone has given their kids a benzo to help calm an ED massive anxiety/psycho episode. A few times I slipped one secretly into my D's tea during a range where she cut herself and was threatening/gesturing suicide.(she is not suicidal outside of these episodes.) But it is so frieghening to see her in such torment.    I was scarred out of my mind and really was not able to control her. Again therapist  recommended against it, suggesting she needs to ride these rages out. We see psychiatrist next week and I will run it buy her. Therapist also doesn't feel medication is particularly helpful before weight gain. She's concerned that kids with eating disorders may get misdiagnosed if psychiatris is not particularly familiar with the classic ED episodes. I would like my d to have something to take the edge off. Good news is she's getting closer to her pre anorexia weight and rages seem to be less frequent and less intense, and last few days she actually seemed happy. 
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Ellesmum
These episodes you describe were without doubt the most frightening thing I’ve ever seen,  I rode them out, I’d sit on the floor with her to keep her safe and she’d flail and scream and babble until she was exhausted then collapse on me and I’d give her warm milk and ‘baby’ her.   The first time I was terrified, didn’t know if to call an ambulance, scared if I did they’d take her from me and make things worse.   I noticed quickly that the milk would calm her and I think that’s when I really learned what starvation does to the mind, at A&E one time I asked a senior doctor to ‘prescribe’ porridge at bedtime and that 130 calorie bowl of oats quickly became 700 calories with cream, nuts etc.  

Now we have the odd weepy day but nothing like those episodes.   
Ellesmum
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Foodsupport_AUS
Yes, we did use them but very rarely. My D's psychiatrist prescribed them for her very intense crises which happened on a few occasions. These were more than just her ordinary severe distress and suicidal ideations, or self harming. At the time these were daily events. There were times when nothing could stop her from slamming her head into walls, floors etc., or she would try to grab things and strangle herself with anything she could grab including clothing. She also attempted to leap from moving vehicles etc.. On those occasions we did use alprazolam - only half a tablet. She would sleep for several hours after the dose, but it did work relatively quickly 15 minutes or so. It was a way of gaining control of a situation where things were rapidly going out of control. In total I think we used this around 8 times, most other things we just learnt how to deal with it. After the first time she used it, she knew how it affected her. She never asked for it herself but would willingly take  it on those occasions when I felt I could not physically keep her safe. 
The therapist is right in that medication for depression / anxiety does not help a lot with eating disorder thoughts, behaviours. The don't help on these underlying symptoms whilst underweight either. The benzodiazepines and atypical antipsychotics can work as sedatives but I would agree that very careful and judicious use is essential. We used the alprazolam only as part of our mental health crisis plan which was drawn up with the psychiatrist. There was a step by step approach for when she was in immediate danger of suicide/major self injury. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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Enn
I agree that short acting benzos can be helpful during extreme bouts of anxiety. Foodsupport brings up a very good point that I wish to highlight, use them very sparingly.
That class of drug is highly addictive, so please ask the doctor about it. And with all meds that a child could take in moments of severe distress and suicidal ideation, please keep them all locked away as well as sharps and cleaning materials, ropes etc. 
I understand how awful it is to see them so upset.
It is nice to hear that these episodes are decreasing!
good job!
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

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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ACL
Another possibility would be olanzapine. This is an atypical antipsychotic which is sometimes used in kids with severe anorexia to help with intense anxiety, sleep and also weight gain. Unlike benzodiazepines it isn't addictive. And unlike ssri' s it can work in underweight malnourished kids. If you are feeling like it's beyond " She is really distressed, it's awful to see" to " I am not sure we can keep her safe" and\ or her distress is making refeeding her effectively not possible it's worth discussing this medication with a knowledgeable psychiatrist or ED specialist.
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Yogi13
My d. Has been taking olanzapine as prescribed by her psychiatrist.  In the early weeks of re feeding it was challenging to control her for every meal (most meals took hours), so I opted for a low dose to take the edge off of her anxiety, and it helped tremendously. She still has outbursts, and is almost back on her growth curve, but nowhere near the explosive behavior in the beginning.   
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Yael826_
Thanks for your response. Our therapist doesn’t want her to take olanzapine due to the issue of rapid weight gain that can freak a kid out and my daughter’s eating disorder is very mixed restrictive/binging and olanzapine with it increasing appetite might also make things difficult. We have appointment with very good psychiatrist with a lot of ED experience. It will be interesting to see what she recommends.
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ValentinaGermania
I do not understand why all therapists seem to be afraid of rapid weight gain.
1) This does not happen in most cases or ALL anorexia patients would be prescribed that.
2) It is evidence based knowledge that rapid weight gain is best for fast recovery.
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
Interesting concern about rapid weight gain. There is little evidence that slow weight gain is easier to handle than rapid weight gain, and in fact those with the more rapid weight gain in studies tend to have the best prognosis. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1486-9
Furthermore there is little evidence of excess weight gain being an issue with anorexia and olanzapine has been suggested in some studies as showing an improvement in outcomes with AN including binge purge subtypes. https://www.jwatch.org/na48346/2019/02/01/olanzapine-anorexia-nervosa

My D did use olanzapine for several years as part of her treatment for anxiety and sleep disturbance. It made no visible changes in her weight gain.  
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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