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

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joanne34
Hi, after a visit to the ED clinic today it has been suggested again that our daughter may benefit from medication.  Olanzapine or Sertraline have been suggested.   Reading the side effects for both really worries me and ideally I wouldn't put her on either.   I just wanted to get an idea if anyone has tried both or one and whether it has helped, duration before it took effect and also if any side effects were experienced.   Her weight is now 42.4 kg and she is 168cm tall so I'm concerned she may be too underweight for the medication.

I know I have previously asked about sertraline and received some good feedback about that so I probably need more info about Olanzapine.   I really feel quite lost over this and still my gut feeling is to feed her and hope that it helps improve her mood.  However, I do also have to recognise that her mood is getting worse each week.

Thanks
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Enn
Hi there,
Many have had good results with Olanzapine. But meds effects are so individual. Please use the search function to look at old posts.
There is a new guideline  https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-020-0277-8
from Canada that does address meds and what the literature says about them. 
I hope this helps.
Remember if you try meds, and they do not "fit" then you can stop them with medical supervision, of course.
When you embark on any therapeutic regimen, always be sure to understand side effects and regular effects and when to get emergency care or when to wait it out. 
Also many of these meds take at least one month to start to work. Olanzapine can help calm the thoughts and help with physical agitation and make them sleepy. Olazanpine (an atypical antipsychotic) can work on the first dose to cause sedation for some. My d tried it and it did not work, I wish it had. She did use sertraline for over two years and just stopped about 2 months ago. She was still underweight when she tried it but it did help a bit even then. But yet low weight may not be helpful when starting meds.

All the best
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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Torie
We did not use either, but I would have been happy if someone had prescribed olanzapine for D after hearing how many people here had had good results with that.  As Enn says, it takes effect right away (I think) unlike SSRIs so you quickly have a good idea what the effect will be.

In general, I am not a big fan of meds, but this is one I would have liked for her to have had .

I don't know much about sertraline.  xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Enn
Here is a thread
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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Seashell
Olanzipine I feel was what turned it around for my daughter and got her to start to eat because it made her calmer and made her sleep so the distress was less.
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sandie
My understanding is that some psychiatrists start with olanzapine when young people are low weight as it can support weight gain. A friend who is a a psychiatrist in Australia told me that is common practice there. 
Courage is not the absence of despair; it is rather the capacity to move ahead in spite of despair
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lovingmyrose
What makes it support weight gain?
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MKR
I think she has a long way to go weight-wise first! At slightly less than her height, my D weighs 20kg more and there are still traces of ED.

I would follow your gut feeling. Personally, I am too scared of drugs, ie of any side effects or long term effects of drugs as opposed to food, which we can control, we know the ingredients, right?
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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joanne34
Thank you for the feedback, Enn I had a good read of the link you provided.   My gut feeling is still to work on feeding, maybe because I think that her body mass is so underweight at the moment that she may not be synthesising enough serotonin for the SSRI for it to work well.   The anti psychotic med concerns me however, it could help with sleep which she is finding more and more difficult on a daily basis.  She has an in depth blood test on Tues and I've said I don't want to start any meds if there are any irregularities in her blood test results which the Dr agrees with.   I just want her better!!!!  Everyday is just so hard to see her deteriorating mentally.
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melstevUK
Hi joanne34,

Your d is still at a low weight and if anxiety is making refeeding difficult then I would use Olanzapine for a short period as it is the recommended med in the UK for low weight anorexic patients.  The best ed psychiatrist in Scotland uses this as the first 'go to' med for an and I would trust her above anyone else (she has since retired but is the most compassionate psychiatrist in the field that I know of, and also suffered from an herself when she was a teenager).  Your d may still be at too low a weight for an ssri to be effective.  Olanzapaine if taken at night should help with sleeping and anxiety, you don't have to stick with it long term.

The Kartini clinic has a great post historically about the use of meds in treatment - they are there to alleviate suffering.  If your d is struggling so much with eating right now, and you have weight gain as the aim - why would you not give her something to help with that suffering?
Believe you can and you're halfway there.
Theodore Roosevelt.
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Torie
What Melstev said. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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deenl
Dear joanne34,

Here is the article on the FEAST website by Julie O'Toole about medication. 

You are totally correct that food is the most important medication. What I have observed about Olanzipine is that it slightly lessens the determination of ED making it a little easier to eat and it seems to reduce the rumination about eating which helps with sleeping. It can also make the person sleepy in and of itself which helps with getting a full nights sleep. A good nights sleep helps us all with our mental and emotional health so a medication that helps with both sleep and eating does seem worth considering.

Unfortunately, any of these medications require an individualised approach - different medications at different doses have different pros and cons for each person, some do not seem to have much effect and a very tiny few can have an unpleasant reaction to them. The convenient thing about Olanzipine is that it can be started and stopped quite easily so you don't have to make a big decision - it is possible to, say, try it for a few weeks and re-assess. SSRIs only reach optimal effect after about 6 weeks and take more patience to try.

Warm wishes,

D
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, no progress. Medical hosp to kick start recovery Feb 2016. Slowly gaining at home, seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. 2018 growing so fast hard to keep pace with weight. 2020 Off to university, healthy and happy.
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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joanne34
Hi, thank you everyone.  Based on lots of reading, your feedback and feedback from elsewhere we are probably leaning towards Olanzapine.   Nights are getting worse and worse.  Having a bath/shower/getting changed really distresses her as she sees her body and her perception is that is has changed a lot. We know she is basically lying to us pretty much all of the time (obviously part of the condition).  Her nervous tics are getting worse too, to the extent they are now appearing when we are out of the house.   If we start this and aren't happy we can stop and I still think that she is far too underweight for SSRI as she possibly may not be producing enough of the neurotransmitter in the first place.   Just one other thing, we have noticed sometimes a lot of toilet paper in the toilet.......is that usually linked to anything?   We haven't heard her being sick and do have sight of her most of the time.    Anyway thank you everyone, your advice is massively appreciated as things are just so tough at the moment.   Each week seems worse compared to the last.   Thanks xxx
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ValentinaGermania
In my eyes a lot of toilet paper can mean
a) she vomits very silent and you do not hear that but she needs to cover something
b) she uses laxatives and needs to cover that she has some kind of diarhoe from that?
Keep feeding. There is light at the end of the tunnel.
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joanne34
That's our concern.  We'll keep a closer eye on her although really not sure where she would get laxatives from as I don't think she has the opportunity to do so.  She has an in depth blood test on Tues so any abnormalities in electrolytes may show that up.  Also at the dentists this week and I am going to ask the dentist (before we go so it isn't obvious) to look for any enamel erosion due to vomiting.   Thanks.
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deenl
Hi joanne34,

Before our recent dental appointment, I sent the following resources to our dentist.

I asked for no comments about juice or sugary foods. I sent this article about negative energy balance, explained that my son still needed almost twice the calories of an adult and that the risks of malnutrition were more serious than the risks of a filling or two.

Here is a booklet and here is a video, both specifically for educating and refreshing dentists knowledge about EDs.

Many families have a no-flush policy where the parents check the toilet. Our kid would slip food into his clothes houdini style and throw it down the loo. (we ended up frisking him after every meal for a couple of months) Another option is to insist on them going to the loo before the meal and restricting use of the toilet or shower for two hours or so after a meal. Even now, 4 years in my son automatically goes to the loo before meals ðŸ˜† If necessary within that time, a parent can accompany them. All unpleasant but necessary. Ah, the things we do for love of our kids.

Warm wishes,

D
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, no progress. Medical hosp to kick start recovery Feb 2016. Slowly gaining at home, seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. 2018 growing so fast hard to keep pace with weight. 2020 Off to university, healthy and happy.
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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ValentinaGermania
joanne34 wrote:
That's our concern.  We'll keep a closer eye on her although really not sure where she would get laxatives from as I don't think she has the opportunity to do so.  She has an in depth blood test on Tues so any abnormalities in electrolytes may show that up.  Also at the dentists this week and I am going to ask the dentist (before we go so it isn't obvious) to look for any enamel erosion due to vomiting.   Thanks.


The big problem with those blood tests is that they are only good for seeing that there is definitivly vomiting going on if some results are bad, but it can also happen that there is vomitting going on and her blood results are totally fine. My friends d was severly purging for more than a year and had good blood results. This can happen. So best is no flushing policy as Deenl requests or even open door policy and 1:1 (it would happen that way in hospital too).
You can also give limited amout of toilet paper as this will lead to some toilet constipation (I really hope that is the right word 😂).

Check her room as well for hidden boxes and bottles and be creative about windows and garden...
Keep feeding. There is light at the end of the tunnel.
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joanne34
We have started on Olanzapine and did three days on 2.5mg and she has done two days now on 5mg.   We have seen no difference at all, in fact she is more anxious.   This will be in part to the doctor directing us to add another fortisip to her meal plan so she now has two - one with breakfast (i.e. porridge and fruit or weetabix followed by yogurt) and one with her afternoon snack.   Anxiety now feels like it has hit an all time high.   I know this type of antipsychotic is supposed to act straightaway - i.e. not need 6 weeks to build up.    I'm just worried everyday that I've done the wrong thing agreeing to the medication.  If there is no change by the next appointment on Thursday, and the anxiety is continuing to increase, I'm going to ask for her to come off it as it may not be helping and I'd rather she just isn't on medication if that is the case.
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ValentinaGermania
It is possible that the meds do not work in her state. But do not beat yourself up for giving it a try. It could have helped also.
With ED all is try and error. You can go to plan B. And C. And D.
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
For us Olanzapine did not make a lot of difference for day time anxiety. We used up to 10mg per day. It did help with her ruminations. It is very hard to work out how much things are working - as things seem to change so much from day to day. It would be worth waiting for a few weeks and preferably until you are seeing regular weight gain before you decided not to continue. 
D diagnosed restrictive AN June 2010 age 13. Mostly recovered 10 years later.  Treatment: multiple hospitalisations and individual and family therapy.
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Seashell
Of course everyone is different and I’m sure it doesn’t work for everyone and not everyone wants to try it. It’s a difficult decision and only you can really judge if you think it’s having an affect but I thought it might be worth telling you what I saw happen. 

The olanzipine effect was subtle (2.5g was her maximum dose). The most noticeable affect was it made her sleepy at night. Not a complete knock out but rather than being up till 3am agitated she was yawning and getting sleepy between 10-12. Prior to medication after she had been forced her evening meal we could have up to 6 hours of distress, wailing, head banging, pacing etc. for having eaten. After medication this lessened.

On looking back, when she started to eat for me at home coincided pretty much with when she started the medication. Could be coincidence or could be many other factors of course too. But in my gut I feel it made a difference although I grant it was subtle. I even requested she go back on it with recent troubles. Again I could be reading too much into it but some days she refuses to have it and I feel she is much more agitated at night and does more binging/purging in the evenings when she hasn’t had it. I should really keep a diary as I could be wanting it to be true and seeing things that not there...

One other point is the second time we went on I said it’s not having as much an affect but I was giving it to her quite late and they advised me to give it no later than 6pm as it takes a few hours to kick in.

All the best for whatever way you go. The forum is such a good help for me and actually gave me the strength to try the olanzipine which I’m really glad we tried. Love to you all. 



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MKR
I wonder if a magnesium tablet would help with sleep like it does for us parents? 
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Torie
Thanks for the update.  Sorry to hear you are not seeing the results you had hoped for.  Also sorry that there is no way (so far) to tease out what is the effect of the meds (if any) and what is the effect of other things like the additional fortisip. 

I'm sure you will make the right decision about stopping or keeping going.  Please keep us posted. xx

-Torie 
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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joanne34
We are trying giving it earlier so it should be working at the max by the time she goes to bed.  She is already getting very anxious and she had it a couple of hours ago.  We'll have to see if there is a difference in an hour or two.   Every night she is anxious and we also have head banging, scratching/slapping herself, nervous tics, thrashing around in bed which has got progressively worse.  Whether this is due in part to her treatment and really struggling to deal with any weight gain, even though it has been very minimal so far.  Once diagnosed/referred she carried on losing from 44 down to 41 kg and now she has crept up and maintained for the last two weeks at 42.4kg.  However, the real anxiety did start after the first gain and has stayed high since then.   We try to be calm and reassure her but as she doesn't want to change whatsoever at the moment it is fairly impossible to calm her.  Bless her........ it is horrific seeing my  daughter going through this.
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MKR
Would your daughter be able to have a head and shoulder massage early in the evening, before going to her room? Or is she hyper-sensitive?

Just brainstorming. If I have suggested this before, I apologise.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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