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Carrie's article that was posted on another thread mentions the problem high serotonin levels can cause for AN patients (excerpt below). So wouldn't SSRI's be exactly the wrong thing for our AN kids? I know my d felt more suicidal when taking Prozac during re-feeding.

Is there medication that does the opposite of SSRIs? Maybe that's what my d needs.

"Kaye’s work with women who have recovered from anorexia nervosa found unusually high levels of the neurotransmitter serotonin in the cerebrospinal fluid that bathes the brain, and he believes these levels were likely also present before the onset of anorexia. Although low serotonin levels are linked to depression, high serotonin levels aren’t good either, as they create a state of chronic anxiety and irritability. As many as three-quarters of those with anorexia had suffered from an anxiety disorder before their eating disorder began, most commonly social anxiety and OCD. It is this anxiety that Kaye believes makes some people much more vulnerable to anorexia.

"The body synthesises serotonin from the amino acid tryptophan, which we get from our diet. Eat less food and you get less tryptophan and hence less serotonin. For people predisposed to anorexia, therefore, starvation reduces the anxiety and irritability associated with their high serotonin levels. Mission accomplished, or so it seems. The problem is that the brain fights back, increasing the number of receptors for serotonin to wring every last drop out of the neurotransmitter that is there. This increased sensitivity means that the old negative feelings return, which drives the person to cut back even more on what they’re eating. Any attempts to return to normal eating patterns wind up flooding the hypersensitive brain with a surge of serotonin, creating panic, rage and emotional instability. Anorexia has, in effect, locked itself into place."

"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
Wow, and wow again. I just couldn't agree more with this piece - thank you for posting. Rightly or wrongly I can certainly relate to it.
Not sure how credible this source is, but along these same lines:

"Previous scientific studies proved people with social phobia have higher nerve activity in the amygdala — for anxious people, the fear center of the brain is overly sensitive. This new research fleshes out the prior work with its suggestion that a surplus of serotonin may be (
at least part of) the underlying reason for this.

"Serotonin, then, does not decrease anxiety as previously assumed, it increases it. Further research into the underlying chemical processes of anxiety should help scientists investigate familiar treatments and possibly develop new ones for what amounts to a debilitating condition for some people."


"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
I've been stuck on this point too. Studies show that SSRIs are effective for social anxiety, which is the same seratonin overload apparently. I'm not clear on why it would work?
17yo daughter diagnosed RAN 8/15 after about 5 months of restriction. WR 11/15. Focusing now on intuitive eating and managing anxiety. Hanging onto the roller coaster for dear life!
Torie, I had exactly the same thought as you when I read Carrie's article. D is on a fairly high dose of fluoxetine (and has been since the early days of AN) but as you know, has had high levels of anxiety throughout. Definitely worth exploring further, and raising at next appointment with psychiatrist.

Mum to 17 year old daughter with AN,1 year IP from Feb 2015, discharged Feb 2016, WR but mentally nowhere near where she needs to be. Remained stable but rapid weight loss again leading to admission to specialist ED unit Sept 2016. Back round the circle...
OK - I am pretty confused on the science of this topic. But the impression I had picked up was that SSRIs have the opposite effect on depression vs anxiety, and that is partly why it is very hard to get the right dose etc. Too much and it is bad for the anxiety, too little and it doesn't help the depression. But I could be completely wrong!
Hopefully Irishup, Colleen, or Carrie will see your post and comment. 
Interesting how the brain is predisposed to anorexia AND starvation changes the brain.
Also, how neurotransmitters are metabolized could be at play. Not sure what happens to the receptors when SSRIs are taken.
14-year-old daughter with restrictive ED including symptoms of exercise compulsion and orthorexia; dx at age 11. Weight loss/illness onset due to underfueling for sports.  Still recovering!
Maybe anxiety + self-loathing + suicidal ideation doesn't add up to depression even though our kids get diagnosed with depression, if that makes sense. I just know my d's "depression" is not typical depression. Maybe I've been barking up the wrong tree trying to understand her pre- and post-morbids as depression. 

Such confusing kids.

"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
Or maybe, for some, but only some kids, SSRIs, beyond minimum dose, are dreadful - perhaps those who had a preexisting anxiety /social anxiety disorder anyway. admittedly it was fluoxetine that was very bad, for us , and a switch to a different drug class (is it called Maoi inhibitors or something?) was completely different and considerably better (though not perfect). For others I am quite certain they are life savers or presumably they wouldn't prescribe. I sometimes wonder though why they leave very sick young people on exactly the same medication (usually an SSRI ) for so long - I mean shouldn't they switch to a different class of drug after 6 months or so if there is no improvement?
You asked whether anyone has explained the link between high seraltonin levels and anxiety and anorexia to heir kids. I have, in fact I sent my d the link to Carries article and highlighted the parts that really stood out for me. My d is a science student so she understands the science and responds more to scientific explanations rather than logical ones! I think also that d understanding that there is a scientific explanation for how her brain works helps her to feel less guilty about "putting us through this again".
However frustrating this illness is, understanding the science really helps me too to accept and deal with it.
HillBilly (formerly registered June 2012 under another name)
I've asked Dr. Kaye about this directly, and he said honestly he has no idea why SSRIs are effective for some people with anorexia.

My guess is that SSRIs do more than just raise serotonin in the brain. There have been some studies that they promote neurogenesis (the development of new brain cells), which is why they take several weeks to start showing efficacy. It could also be that the drugs generally help 'level out' serotonin levels.

The fact is that people don't actually know precisely how SSRIs work. 
Carrie Arnold Blogger and author at http://www.edbites.com
Thanks for that Carrie. 

Sometimes I am amazed by how much we understand about the human body and how much there still is to figure out!

Warm wishes,
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.
This is interesting. I feel that for my D, Prozac has reduced anxiety, but isn't as effective on the low mood/depression. It lifts it from it's very bottom, but never really gets to a stable level. However, I definitely see a decrease in anxiety when she's taking it. She's only on 20 mg dose - anything higher puts her to sleep and doesn't do much more for her anyway. Hmmm... I honestly don't know. 

19 yo D. AN - since about 15 years old. WR quickly - but the last four years have been tough. Since Sept. 2017, two residential stays, now in IOP, fighting a relapse. ED is hanging on, mental state not great, can't get her to remain at a weight long enough or high enough to see mental healing. She's on a gap year that will likely now turn into two.
I'm confused, I thought there is not data supporting use of Ssri for treatment of AN...
Interesting.  Could it be like a placebo effect?
You're right- SSRIs are not effective against AN. When people are underweight and/or not eating, the body doesn't have the necessary building blocks from which to make serotonin, so the medication has nothing to even work with.

However, they are effective against co-occurring conditions like depression and anxiety.
Carrie Arnold Blogger and author at http://www.edbites.com
My D has struggled with anxiety for a few years (of course, we were blissfully unaware until recently) and after her recent "RAN" relapse, she was able to tell us that she feels that she has always had anxiety and uses the food restriction to control the anxiety. 

This time around, she is being treated for the anxiety primarily, and she feels that this is helping her.  She is on Sertraline, after a previous failed attempt with Fluoxetine (Prozac).  She is at WR, so there is much less emphasis on calories and weight (which also helps!).  She says the Sertraline is helping a little - we have a review with T tomorrow, so may have an increased dose, if T thinks is is necessary. 

Early days yet.....
UK - South East

19 yo D

Dx AN Feb 2015 (Aged 15). Pre-existing low self-esteen and high anxiety. 

2015: 3 x medical hospital admissions. 1 month in IP which she self discharged from [eek].
2016: 3 x hospital admissions. 
2017: CAMHS CBT. WR, dropped out of 2 different colleges and started an apprenticeship.  Started having grand mal seizures and was diagnosed with epilepsy in Nov 2017. Sacked from job because of this.  Tribunal ensued.
2018 - doing a Psychology degree through Open University and working in retail to pay her way in life. Relapses with eating disorder in June 18 and Nov 18 😢. 

On particularly rough days when I am sure I can't possibly endure, I like to remind myself that my track record for getting through bad days so far is 100% and that's pretty good. [Author Unknown]