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

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deenl
Read on for good laugh but also question re olanzipine.

Hi all,

In the depths of this sucky illness the carers need to have a good laugh. I assume that was the intention of our psychiatrist and it is in that spirit that I share it with you all. 

The psychiatrist wanted to prescribe an SSRI to our severely ill son. After I explained to HER why that COULDN'T have any effect (for those interested I explained it in Things to think about 6 http://www.aroundthedinnertable.org/post/things-to-think-about-7906825?pid=1290831558#gsc.tab=0) she said 'Oh, I do have an appointment in a few days with the pharmacist to see if it would work' [frown] Not exactly inspiring my trust there.

I bring up the possibility of prescribing Olanzipine.
Psy: 'hmm, we used it in my previous workplace but we don't use it here'
Me: 'So you can't prescribe it?'
Psy: 'Well, yes, I can but, well, it does have the side effect of causing weight gain'

[confused] I was so stunned that I couldn't think of anything to say! Did it escape her notice that my son looks like a skeleton? BMI 11! WTF?

So here's you chance folks. Let rip with the black humour. What should I have said?

A week later she gets back to me to say it can only be prescribed in 1mg doses and she finds that too much for S. He was then 27.3kgs and is now 29.3kgs, BMI 11/12. I understand that the starting dose is 2.5mg, few days later 5mg and then 7.5mg if needed.

So my question is what weight and rough BMI were your kids when prescribed Olanzipine?

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

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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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Sotired
Congrats on not strangling that pysch deenl.olanzipine only comes at the doses you mentioned I thought.our d is on 2.5mg and that's as low as it gets.if only it caused weight gain!my d is older so the parameters are different.she was 15 and 48kg when first prescribed olanzipine.she has been on 2.5,5 and 7.5 doses.primarily what it makes her is tired.she is now on the low dose of 2.5.
Is this psych all that is available to you?dear oh dear.feel free to take one of my imaginary neon pink cards that say 'no sh#t Sherlock' to every meeting with her...
Sotired42
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Psycho_Mom
Yep, that's a stunner alright.

I've been on here a couple years and read a lot of stupidities, but that one is up there at the top.

WE should have an award. A yearly contest for the stupidest thing said or done by a clinician. WE could have a thread for nominations, and then at the end of the year one of those survey things to vote and determine the winner. And then a printable certificate that the person unfortunate enough to have encountered the winner could print out and deliver. That would be fairly delicious, eh?

And then of course, another award to recognize outstanding contribution to ed treatment for the year. Could be a great nurse in a hospital or a researcher or someone who delivered a great presentation....



As for your question about dosages, I don't know much but I'm confused. A starting dose is 2.5 mg, but your psych says that 1 mg is too much?

best wishes,
D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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deenl
Toothfairy, it was certainly one of those 'if I don't laugh, I'll cry' moments! Thanks to ATDT forum I know more than her so I choose to laugh!

Hi sotired, definitely need the neon pink card. 

PM, love the certificates idea. It gave me a laugh. She confuses me too! Basically she talks B*llsh**. I am not pushed about changing her as she has no decision making power and I just ignore most of what she says. I only really need her to write out prescriptions for olanzipine and melatonin (higher dose than over the counter). If she won't do that then I will change again.

But I would really love to keep hearing your experiences with olanzipine folks. Is the dosage related to weight or is it the same for everyone. The more info I have the better I can slap her about the head with it.

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

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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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alorica
I know from my daughter that a 5 mg dose is typical and she was taking 6.25 at one time. Yes, it does help during refeeding because they actually get hungry.
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Torie
Would it help to ask your pharmacist what dosages are available? I'm pretty sure 2.5 mg is the lowest.

Excerpt: "We are fortunate in the use of Olanzapine in several ways: younger children seem to metabolize it rapidly, and we are able to get good results with very low doses (2.5 mg- 7.5 mg/day) and a short treatment period (weeks to months, rather than years to lifetime)."
http://letsfeast.feast-ed.org/2014/05/guest-post-by-dr-julie-otoole.html
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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deenl
Hi Torie,

I checked already and 2.5mg is the lowest dose here too. I am actually gathering my facts and information in preparation for a meeting with her. I wonder if she was just telling me any ol' thing because she was affronted that a mother knew about SSRIs, tryptophen and low body weight and she didn't/forgot. 

If anyone has links to research papers about olanzipine they too would be most welcome.

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

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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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Tali97
Hopefully some one can find you a more recent study that has a more conclusive data.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111870/

This study might help you , but they basically found problems with their sample group and they are a very small unit to begin with.

The possibility of weight gain was mention when my son was proscribed olanzapine, but it was in the discussion of other possible side effects. The only reply he got to the weight gain possibility was good. To which he agreed it would be good. 
18 year old boy (Gluten Free/Dairy Free 2005)
 IP - March/April 2014.  ARFID.
 2015 - Gastroparisis
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Trytrytry
I think she may have been a bit stumped at the question.

I think old school is to go for the ssri, I have had a number they that with malnutrition they are't producing serotonin so will always be depressed so we are just replacing it and can stop when WR. I don't know if that was just a hypothesis that they taught be I have been told that same thing by lots of psychs.

Another one that lots have told me is that studies show that olanzapine doesn't cause weight gain the same as it does in the non ED patients.


They are very common psych comments I have heard over the years. Admittedly, some studies may not have been widely available until recently
I want a realistic dr and team, not someone who says what I want to hear and not a 'touchy feely nice' dr that doesn't have success.
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Psycho_Mom
Hi,

Does olanzapine come in tablet form? If so, and if the psych wants to start at a lower dose, can't they just cut a tablet in half? Sorry if you've thought of that, but when we wanted a slightly lower dose of SSRI I had to go ask the pharmacy to special order tablets instead of capsules and they did it. Many medications also come in liquid form. 

Also, I think olanzapine causes weight gain for non-ed patients because it causes increased feeling of HUNGER, which then translates to eating more. Ed patients however, don't respond to hunger in the usual way (kinda the definition of the illness)and in fact are often calmed by the feeling of hunger, so wouldn't gain simply because of the drug itself. So if you want to engage your irrational psych in an irrational conversation, you could explain that, and that there's little fear your s will gain weight because of a med she prescribes. (You can feed him, and take all the blame....)

best wishes,
D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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PuddleduckNZ
OMG.

Olanzapine was given to my son at 25kg and in 1.25 to start.

It did help with weight gain here, bonus!
Son 9yrs when he became unwell 2013, ED slide from April 2014, dx at 10yrs July 2014, 2 hospitalisations - dx so many times Behavioural Anorexia, EDNOS, ARFID. FBT from August 2014. Anxiety, Emetophobia. 13.5yrs old now! In recovery, gets better every day with constant vigilance, life returns.
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Torie
PuddleduckNZ wrote:
Olanzapine was given to my son at 25kg and in 1.25 to start.


Was that 1/2 of a 2.5 mg tablet, or what? 
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Foodsupport_AUS
We used Olanzapine wafers. My D was very against their use as she knew of the side effects of weight gain. There was 0 weight gain for her on this, and no loss on withdrawal. That being said my main concerns about use of olanzapine are the implications for insulin resistance and raising blood glucose. It is assumed this is a temporary effect but I guess it would take a while to work that out. 

It did help my D a lot with anxiety but had a lesser benefit with respect to eating. Like others the side effect of sleepiness was the thing that stopped use in the end. I have attached the product information here from Australia but I think the info is relevant everywhere. http://secure.healthlinks.net.au/content/lilly/pi.cfm?product=lypzyprx11212
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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NELLY_UK
My d was on 7mg at a BMI of 17 in IP she reduced to 5mg then 3.5mg (we cut the 7mg in half ) then back up to 5mg. It solved the voices and the self harm. She dis not gain weight, that has now been proved that it is extremely uncommon but I know it used to be a belief. If only! It is taken in the evening because it does make d drowsy. That was why she was dropped from 7mg.
Your psych deserves that award.
NELLY D 20 bulimic since age 12, diagnosed in 2011. 20 months useless CAMHs,7 months great IP, home March 14..... more useless CAMHs.now an adult & no MH services are involved. I reached the end of my tether, tied a knot in it and am hanging on. ED/Bulimia treatmentis in the dark ages in West Sussex.
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deenl
So much great information folks. I don't know what I would do without you guys.

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

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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.
Quote
PuddleduckNZ
Yes cut tabs Torie
Son 9yrs when he became unwell 2013, ED slide from April 2014, dx at 10yrs July 2014, 2 hospitalisations - dx so many times Behavioural Anorexia, EDNOS, ARFID. FBT from August 2014. Anxiety, Emetophobia. 13.5yrs old now! In recovery, gets better every day with constant vigilance, life returns.
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Winnipuh
well.....actually: No.

I did research in the link you posted but there is no evidence, that SSRI "couldn`t have any effect".

To the contrary, there is a study which compares the effects of Paroxetine versus Clomipramine in Female Adolescents Suffering from Anorexia Nervosa and Depressive Episode - and the result is:

"The discontinuation of the antidepressive treatment due to adverse side effects or a lack of efficacy was significantly more frequent with clomipramine than paroxetine (33,3 vs. 15,4%). The increase of body weight (2,8 vs. 2,6 kg/m2) was similar in both groups, but the duration of treatment was significantly shorter under paroxetine (71,9 vs. 96,5 days). Conclusions: A shorter duration of treatment, faster increase of body weight, lower percentage of dicontinuating the antidepressive medication and last but not least economic reasons lead to the conclusion, that paroxetine should be preferred in female adolescents with anorexia nervosa and depressive episode. However, prospective studies are needed to confirm our findings."

http://econtent.hogrefe.com/doi/abs/10.1024/1422-4917.32.4.279



Another study about the positive effect from sertraline:
http://online.liebertpub.com/doi/abs/10.1089/104454601750284045



I understand that every parent wishes that the suffering child gains fast and if any medication has this side effect - why not grab it?

Because: To me its very simple and clear: i want my d to gain with food, to reestablish her body functions, metabolism, making her brain working properly. I clearly dont want her to gain as a side effect from an antipsychotic agent, while she is clearly not psychotic!




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deenl
Hi Winnipuh,

I admit that I am a pure amateur when it comes to medical issues but what I understand is:

Quote:
SSRIs need release of something called 5-HT. 5-HT is derived from tryptophan which is used in the biosynthesis of proteins and is precurssor of the neurotransmitters serotonin (contributes to feelings of well-being and happiness) and melatonin (used to regulate sleep and the circadian rythm).It is an essential amino acid which is only obtained from the diet; it is a component of most protein based foods. Tryptophan is very much reduced in severely underweight restricting anorexics. Fluoxetine does seem to have a role to play nearer weight restoration.


If I have misunderstood, I would very much welcome discussion about the points I have misinterpreted.

Kind regards,

D

Edit: Like all parents here, I am desperate to see progress in my son ASAP but with medication I do believe in first doing no harm so I need to be pretty sure of the benefits vs the risks (this is only my very personal opinion, I totally appreciate that there are many different viewpoints)
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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.
Quote
deenl
This 2011 assessment of using olanzapine for restricting AN and EDNOS for anyone who wants to read the pros and cons of the medication. http://online.liebertpub.com/doi/pdfplus/10.1089/cap.2010.0131?src=recsys

And one that shows no effect of SSRI fluoxetine in treatment http://online.liebertpub.com/doi/abs/10.1089/cap.1999.9.195?journalCode=cap

One on the SSRI Sertraline http://online.liebertpub.com/doi/abs/10.1089/104454601750284045

And a case study of two identical twins, one treated with SSRI fluoxetine and one with anti-psychotic olanzapine http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3579522/

A study about olanzapine https://www.ncbi.nlm.nih.gov/pubmed/18558642?dopt=Abstract

Another for olanzapine https://www.ncbi.nlm.nih.gov/pubmed/21663423?dopt=Abstract


A case study for anti-psychotic Risperidone in an out patient setting http://springerplus.springeropen.com/articles/10.1186/2193-1801-3-706

Another study for Risperidone https://clinicaltrials.gov/ct2/show/results/NCT00140426?sect=X9ij0156&term=anorexia+nervosa&rank=5#outcome3

2011 review of atypical antipsychotics by American Academy of Child and Adolescent Psychiatry https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/Atypical_Antipsychotic_Medications_Web.pdf

NHS in UK http://www.nhs.uk/Conditions/Anorexia-nervosa/Pages/Treatment.aspx


Basically, nothing is straight forward and some of the studies contradict each other. If anyone has any others I'd love to read them.

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

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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.
Quote
Winnipuh
Me, too, i am an amateur to this. All i can do is asking for help and making me understand about how medication may or may not work.

And i see that there is room and maybe need for further research when it comes to treat ppl with AN/ED with olanzapine as there are few and limited studies. But i have to say that using medication that leads itself to weight gain in the treatment of ED reminds me very much at the beginnings of the treatment back in the 1960s/70s. I was hoping state of the art would be different.

Over here i have ever heard of AN treated with olanzapine Giving SSRI is quite common, with different results. What i see, not only by my own child but also by other patients at the facility she was for over nine months - when it comes to psychoparmacology there is ALOT about trie and error. What for some works, does not for others. So, if olanzapine helps anyones d/s here at the forum, i am happy about it. Everything that helps - really helps - will be great.

I think in general the treatment guideluines and the understanding of AN is very different from USA/UK to other european countries. This forum is a mirror of it, quite logically.

But i read a bit further and afais onlanzapine might be helpfull in severe cases on AN when it comes to pure life saving and making the brain working propperly. In theses cases it may be the best esp for the sufferer to reduce anxiety and pain. So my opnion know is a bit different from wghere i came from :-) thanks for letting me learn!


Did u see my first linked study? Its an english version beneath

Here are some others:

http://cckan.ruhosting.nl/olanzapineanorexia.pdf

https://www.researchgate.net/profile/Palmiero_Monteleone2/publication/6312421_Olanzapine_therapy_in_anorexia_nervosa_psychobiological_effects/links/02e7e52d3e27d5fffd000000.pdf


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deenl
Hi again Winnpuh,

I agree, we are all looking for something to help our kids and there are no definitive answers when it comes to medication, it is indeed trial and error. Although there is a genetic test (cheek swab) available called the Genecept assay that can test in advance which psychiatric drugs will work or not. it's $700 in Europe.

I think with SSRIs  one of the main issues is whether the depression pre-dates the ED or not. I also understand that SSRIs are not helpful when the patient is very severely underweight but can be a tool in the kit once closer to weight restoration.

But the thing about all EDs is that there is no one-size-fits-all treatment and all treatment plans (including medication or not) must be personalised. If an SSRI helped in your case then it goes without saying that I am really happy for you.

I did see the studies and they have also lead me to further information, so thanks.

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

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • 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.
Quote

        

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