Dear Hate ED -
I could have written your post 3 years ago. My d was in the exact same place. The depression, despair and hopelessness were overwhelming - for all of us. My d was a senior in HS, couldn't make it there most days, had isolated from ALL of her friends, refused to consider meds after some bad experiences, etc. I can relate so deeply to where you are right now. So grateful you can. It's helpful to have another who's walked this road share what you did or discovered or tried. Thanks.
Here are some thoughts. I'm sorry I don't know all of your details.
1 - Are you absolutely sure your d is weight restored? I know she has her period (which is great), but is she back at or above HER historic weight percentile? How I used to hate when people on this forum asked me that question when my d was where yours is.
It was infuriating and I thought the only thing they only had to say. The truth is that although my d was at a more than healthy weight (per bogus weight charts), she was a good 10-15 lbs below HER historic weight percentile. She tracked about 75th percentile her whole life and didn't really start to recover until we got back to that range or above it. I thought she was already suicidal so how was gaining MORE weight going to help, but it did. Her mood actually improved! I didn't know the answer and called her pediatrician today. Yes - she is actually at her historic percentile. Now that they are digital files, they didn't immediately have the cute graph on hand, but they went and found the paper chart. Always 50% percentile and now at age 17, that is what she currently is too. This was a profound question. I've been reading about adding weight even though WR and was wondering. Probably still can't hurt, but yes - she's in the historic curve right now.
2 - You are wise to look at other classes of drugs. My d had a horrific reaction to Prozac. We finally found a great psych (so hard to find - Who knew so many psychs were crazy?) who said he would never try her on another SSRI without metabolic testing. He suggested the anti psychotic class and the improvement for my d was almost immediate. She only took a dose in the morning. The pill bottle sat on the breakfast table every morning and I made sure she took it. She HATED it because she was 18 and I was making her feel like a child, but she did it. We are having a very tough time connecting with the doctor this week. I think our psych is very good, but boy - psychiatrists are tough to reach and work with. No answering machines, phone tag, etc. I hope he calls tonight because he doesn't work on Fridays. I asked if he doesn't reach my D - call me. I left a message that she's doing badly on the 10 mg. I'm thinking he'll just up it to 20. Everything is done in stages, which kinda makes me crazy when I'm desperate for a quick fix.
3 - Good for you for finding and implementing DBT. It was a game changer for my d. (Although she had to be WR for it to really matter.) Since you don't yet have a DBT t yet, can you help her to use some of her DBT skills to manage this current hopelessness streak? The distress tolerance skills are usually best in this case and the easiest to learn and use. She is just finishing her first module - the distress tolerance model. She told me today she likes the group but isn't sure the skills help, and I don't think she's using them. I understand that's a common refrain, but that they do indeed help in the long-run. I still believe this is our best hope regarding therapy. She will be doing it for a year and is good with that.
4 - As for PHP, I think it would depend on the program. if it is truly evidence based then it might be helpful. My d ended up going residential again (at this stage), gained some of the extra weight and then came home and went to an evidence based PHP program for basically forever. She needed meal support for a LONG time. She ate every meal at the PHP or with me for months. The risk of being around other sick girls is a risk, but our experience was that the benefits far outweighed (no pun intended) the risks. We have no evidence based PHP here in my town. We have to drive 2 hours. I'm trying to avoid right now because no insurance and my H is in a demanding new job - of course, - so it's really on me to manage what this will all look like. But not ruling it out - not by a long shot.
5 - As for school, we had the same thing. As impossible as it was for my d to go to school, when I said we would keep her home and home school, she said that would only make it worse and make her more depressed. If she is not eating at school that's a game changer to me. When my d went residential, she did finish school to graduate although she never participated in the ceremonies. However, there were lots of girls in the residential and later PHP programs who were just taking a break from school to concentrate on getting healthy first. It is not a bad message to send that nothing happens until they're healthy. We later kept my d home for a semester before college because she wasn't ready. Again, she hated us with a passion, but now says it was the best thing we did for her. Believe me, I know how hard it is to do. We think that if we just let them move forward with life, they will get better. That never worked for us. Once healthy. they all catch up eventually, because they are young and resilient. We talked about this again today. She's still adament that school is better than home all day. If we have to do more intensive therapy, though, we'll do online school and probably not go back unless she's really stable. Again, wait and see.
I am an all or nothing type of person by nature. Dealing with this illness has changed me though. I see so much progress you and your d have made. An analogy we used to use with my d all of the time (and she hated it) was that she was climbing Mt Everest. Your d has made it up maybe 75% of the mountain. She may just need a push and/or some tweaking to make it to the summit. Maybe it helps to look at it that way. Thank you. Hard to see it, but I know that's true.
My d first started treatment 4 years ago tomorrow. I have been very reflective this week. She is studying abroad in South America this semester and embracing every opportunity. ED is not part of our lives. She effectively uses DBT for anxiety she was born with. The DBT is just part of her now. I am very proud of what she has accomplished. This study abroad opportunity is all the sweeter for her (and her us) because of how hard she worked to get there. Your d can get there too!