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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by milly on May 27, 2006, at 9:18:49
A close friend has a 13yr old daughter who has been anorexic for the past 3 yrs and also has OCD (exercising) she has been in a residentail therapy unit for the last 2 years, she is out now but to be honest life is still VERY difficult mainly caused by the OCD. I was just wondering if there were any meds which might help in this situation, she had something way back for the psycosis but i just wondered if there was anything someone so young could be offered.
thanks
milly
Posted by Racer on May 27, 2006, at 11:21:31
In reply to Information please, anorexic OCD 13yr old, posted by milly on May 27, 2006, at 9:18:49
I'm of two minds here -- there are a lot of drugs that can help with OCD, but at 13...
SSRIs are pretty classic for OCD, and Zyprexa is being used a lot in anorexics to reduce obsessionality. BUT at 13, her brain is still developing, and no one really knows what these drugs will do to the development process.
That said? I think it's pretty important to get this kid to a GOOD child psychopharmacologist/psychiatrist. Looking back at my life, I'm pretty sure I would trade the natural development of my unmedicated brain for a less painful adolescence. Truly. I wish to heaven someone had stepped in to help me. No one ever did.
Also, while I wouldn't necessarily pass this thought on your your friend, if you are looking for a good child pdoc for her -- and I hope you do help her find a good one -- I'd check for someone with a lot of solid experience with autism, and autism spectrum disorders. If this girl has been AN and OCD since 10, get her checked stem to stern for autism before deciding it's "only" psychiatric.
Good luck
Posted by Phillipa on May 27, 2006, at 15:16:17
In reply to Re: Information please, anorexic OCD 13yr old, posted by Racer on May 27, 2006, at 11:21:31
Racer Autism? How do they relate to each other. Love Phillipa
Posted by linkadge on May 27, 2006, at 15:54:20
In reply to Re: Information please, anorexic OCD 13yr old » Racer, posted by Phillipa on May 27, 2006, at 15:16:17
A lot of the meds they use for anorexia work poorly. SSRI's can occasional help the OCD type of thinking, but not always. In addition, some of them are appetite supressants.
A low dose of say amitryptaline might be usefull
Linkadge
Posted by Racer on May 27, 2006, at 17:04:46
In reply to Re: Information please, anorexic OCD 13yr old » Phillipa, posted by linkadge on May 27, 2006, at 15:54:20
> A lot of the meds they use for anorexia work poorly. SSRI's can occasional help the OCD type of thinking, but not always. In addition, some of them are appetite supressants.
Link, while it's true that SSRIs can cause GI problems, and might even reduce appetite, they're often helpful after other treatments have restored weight. After two years of residential treatment, one would hope that this girl's weight is at least partially restored.
In AN, using SSRIs before nutritional rehabilitation is pretty well useless. They do have a use in helping control the OCD issues involved. And they work pretty well for that purpose in most cases.
>
> A low dose of say amitryptaline might be usefull
>
> LinkadgeNope, TCAs are contraindicated in AN. Their cardiotoxicity is too dangerous. AN often weakens the heart, sometimes leading to sudden death. Adding a TCA to that isn't a great idea.
Hope that helps.
Posted by linkadge on May 27, 2006, at 17:56:03
In reply to Re: Information please, anorexic OCD 13yr old » linkadge, posted by Racer on May 27, 2006, at 17:04:46
>Link, while it's true that SSRIs can cause GI >problems, and might even reduce appetite, >they're often helpful after other treatments >have restored weight. After two years of >residential treatment, one would hope that this >girl's weight is at least partially restored.
Anorexia is a documented side effect of some of the newer antidepressants. While anorexia may fall in the OCD spectrum, and while SSRI's may help some emotional symtpoms, they have not proven consistently effective in changing the anorexic mindset.
The problem with SSRI's is that an increase of serotonin in the hypothalamus leads to a decrease in food consumption, while a decrease in serotonin is related to an increase in food intake. Cyproheptadine (periactin) a serotonin antagonist, has been used sucessfully in some cases of anorexia.
>Nope, TCAs are contraindicated in AN. Their >cardiotoxicity is too dangerous. AN often >weakens the heart, sometimes leading to sudden >death. Adding a TCA to that isn't a great idea.
I have heard of cases of anorexia which responded to amitryptaline or remeron, but not SSRIs. Amitryptaline has serotonin antagonist properties which is not shared by the SSRI's.
If after rehabilitation, the heart is in a more healthy state, you may need to ask yourself which medication would be more effective for the OCD. While TCA's are often more effective for bulimia, certain such as elavil or anafranil can sometime be more effective than SSRI's when comorbid depression / OCD is present.
Linkadge
Posted by blueberry on May 27, 2006, at 19:38:23
In reply to Information please, anorexic OCD 13yr old, posted by milly on May 27, 2006, at 9:18:49
The SSRIs are probably first line choices for OCD. If the OCD is primarily just on specific activities though, that might respond well to counseling, psychotherapy, and behavioral control changes.
My doctor has talked to me about how they treat anorexia in hospital residency. Some of the more common meds they use are the antidepressant remeron, the antipsychotic zyprexa, and the mood stabilizer depakote, often two of them in combination. They could also help with the OCD. It would be nice to get it all treated with talk therapy though before going to medications. But if meds are needed, these are some ideas.
Posted by jealibeanz on May 27, 2006, at 23:29:36
In reply to Re: Information please, anorexic OCD 13yr old, posted by blueberry on May 27, 2006, at 19:38:23
Isn't Paxil a good choice for OCD, especially anorexia, since it's an SSRI known to cause more weight gain than others. I don't think it's very stimulating either and never decreased my appetite like other medications have.
Posted by Meri-Tuuli on May 28, 2006, at 9:01:58
In reply to Re: Information please, anorexic OCD 13yr old, posted by jealibeanz on May 27, 2006, at 23:29:36
Posted by Racer on May 28, 2006, at 10:31:40
In reply to I thought SSRIs cause weight gain?? Not loss? (nm), posted by Meri-Tuuli on May 28, 2006, at 9:01:58
Posted by ed_uk on May 28, 2006, at 12:45:41
In reply to I thought SSRIs cause weight gain?? Not loss? (nm), posted by Meri-Tuuli on May 28, 2006, at 9:01:58
Hi Meri
Initial weight loss is common with the SSRIs. People often loose a few pounds during the first few weeks of treatment - which is why the SSRIs were initially claimed not to result in weight gain.......the first clinical trials were only a few weeks long. Some pdocs still believe that the SSRIs are weight neutral, especially in the UK.
Unfortunately, after the first few weeks of treatment have passed, many people start to put on weight. In the long term, some people put a lot of weight on while taking SSRIs.
A while ago, SSRIs were being used as a treatment for obesity. Hopefully this doesn't happen anymore!
Ed x
Posted by milly on May 28, 2006, at 13:30:47
In reply to Re: Information please, anorexic OCD 13yr old, posted by Racer on May 27, 2006, at 11:21:31
> I'm of two minds here -- there are a lot of drugs that can help with OCD, but at 13...
> SSRIs are pretty classic for OCD, and Zyprexa is being used a lot in anorexics to reduce obsessionality. BUT at 13, her brain is still developing, and no one really knows what these drugs will do to the development process.****She has got pretty sick at times and we don't know what organ damage she might be left with permanently yet
> That said? I think it's pretty important to get this kid to a GOOD child psychopharmacologist/psychiatrist.***We are in the Uk so you get what you are given I'm afraid and the whole treatment i have felt was a bit hit and miss. I think they trust their psychiatrist now but have had some pretty cr*ppy experiences (eg if she won't stop exercising then just wrap her in a quilt and pin her to the floor!!!!)
>Looking back at my life, I'm pretty sure I would trade the natural development of my unmedicated brain for a less painful adolescence. Truly. I wish to heaven someone had stepped in to help me. No one ever did.
***She has had lots of 'help' and continues to but I just can't help wondering if medication could take the edge off the obsessional thoughts to give the therapy process more chance. She herself doesn't want to because she says it will hold up her recovery.
> Also, while I wouldn't necessarily pass this thought on your your friend, if you are looking for a good child pdoc for her -- and I hope you do help her find a good one -- I'd check for someone with a lot of solid experience with autism, and autism spectrum disorders. If this girl has been AN and OCD since 10, get her checked stem to stern for autism before deciding it's "only" psychiatric.
***what would be the clues to that? how does it tie in to AN & OCD?
>
> Good luck****Thanks Racer your input has been really helpful, i am at such a loss as to how to help anymore.
milly
Posted by milly on May 28, 2006, at 13:34:04
In reply to Re: Information please, anorexic OCD 13yr old » linkadge, posted by Racer on May 27, 2006, at 17:04:46
> > A lot of the meds they use for anorexia work poorly. SSRI's can occasional help the OCD type of thinking, but not always. In addition, some of them are appetite supressants.
>
> Link, while it's true that SSRIs can cause GI problems, and might even reduce appetite, they're often helpful after other treatments have restored weight. After two years of residential treatment, one would hope that this girl's weight is at least partially restored.****Yep her weight is within acceptable limits although she is the size of a 9/10yr old
> In AN, using SSRIs before nutritional rehabilitation is pretty well useless. They do have a use in helping control the OCD issues involved. And they work pretty well for that purpose in most cases.
>
> >
> > A low dose of say amitryptaline might be usefull
> >
> > Linkadge
>
> Nope, TCAs are contraindicated in AN. Their cardiotoxicity is too dangerous. AN often weakens the heart, sometimes leading to sudden death. Adding a TCA to that isn't a great idea.**** I don't think that would be great as they are still monitoring the long term damage that may have resulted from AN
Posted by milly on May 28, 2006, at 13:37:57
In reply to Re: Information please, anorexic OCD 13yr old, posted by blueberry on May 27, 2006, at 19:38:23
> The SSRIs are probably first line choices for OCD. If the OCD is primarily just on specific activities though, that might respond well to counseling, psychotherapy, and behavioral control changes.
**** But how long before meds should be considered? It's 3 yrs since she started to have 'talk' therapy. Then 2 yrs ago she was in residential therapy for6 months, out for 3 then back into a different unit for 13 months. When would meds be considered do you think?
>
> My doctor has talked to me about how they treat anorexia in hospital residency. Some of the more common meds they use are the antidepressant remeron, the antipsychotic zyprexa, and the mood stabilizer depakote, often two of them in combination. They could also help with the OCD. It would be nice to get it all treated with talk therapy though before going to medications. But if meds are needed, these are some ideas.
Posted by ed_uk on May 28, 2006, at 14:28:44
In reply to Re: Information please, anorexic OCD 13yr old » linkadge, posted by Racer on May 27, 2006, at 17:04:46
Hi Racie :)
>In AN, using SSRIs before nutritional rehabilitation is pretty well useless. They do have a use in helping control the OCD issues involved. And they work pretty well for that purpose in most cases.
What do you think about starting an SSRI before nutritional rehabilitation and continuing it during and after rehab?
Love
Ed x
Posted by linkadge on May 28, 2006, at 15:35:31
In reply to Re: Information please, anorexic OCD 13yr old » Racer, posted by ed_uk on May 28, 2006, at 14:28:44
I know that the alternitive supplements inositol and zinc have been used in combination with some sucess in anorexia.
Linkadge
Posted by Racer on May 28, 2006, at 15:59:12
In reply to Re: Information please, anorexic OCD 13yr old » Racer, posted by ed_uk on May 28, 2006, at 14:28:44
> Hi Racie :)
>
> >In AN, using SSRIs before nutritional rehabilitation is pretty well useless. They do have a use in helping control the OCD issues involved. And they work pretty well for that purpose in most cases.
>
> What do you think about starting an SSRI before nutritional rehabilitation and continuing it during and after rehab?
>
> Love
>
> Ed xHonestly? Not much... Maxime mentioned one of the big problems here not too long ago: not enough dietary tryptophan to make it worthwhile. But in general, they haven't been shown to help at all in any of the studies I've seen, until weight restoration is pretty well complete. At that point, they help prevent relapse in a lot of people.
On the other hand, I have known a lot of people from my ED group and so on who take Zoloft for the OCD components of their disorders, despite not having restored their weight. So, go figure...
OH! On the other hand, while it didn't do anything like "curing" or even "treating" my AN, Paxil did pack enough pounds on me that I stopped restricting. I was down to one salad per day, working out at the gym for more than two hours daily -- and gained about 25 pounds! By then, I figured my life was over, nothing mattered, may as well shovel food into my fat face, since I was a completely worthless failure anyway.
So, SSRIs can be helpful, or harmful, or just useless, depending on the person. But if I were making a decision about anything, I'd say -- nutritional counseling, psychotherapy, and then SSRIs
Posted by Ocracoker16 on May 28, 2006, at 20:33:08
In reply to Information please, anorexic OCD 13yr old, posted by milly on May 27, 2006, at 9:18:49
I think that medication should be considered to augment therapy. She has received therapy for 3 years and has been in residential treatment. If despite these treatments she needs more, then trying medication makes sense. Did the residential program have a position on medicating her?
I would caution that some meds mentioned especially Zyprexa cause considerable weight gain. This could be a positive, but if she gains weight she may refuse to take it. My doc who has managed anorexia inpatient and outpatient has told me that some patients who have been tried on such a drug refuse to take other medicines and revert to old behaviors.
Katie
Posted by milly on May 30, 2006, at 9:28:58
In reply to Re: Information please, anorexic OCD 13yr old, posted by Ocracoker16 on May 28, 2006, at 20:33:08
> I think that medication should be considered to augment therapy. She has received therapy for 3 years and has been in residential treatment. If despite these treatments she needs more, then trying medication makes sense. Did the residential program have a position on medicating her?
****That how I feel, I know life for me got easier with psychotherapy AND medication (admittedly for a different mental health problem)The residential programme seems to have a position of not medicating.
>
> I would caution that some meds mentioned especially Zyprexa cause considerable weight gain. This could be a positive, but if she gains weight she may refuse to take it. My doc who has managed anorexia inpatient and outpatient has told me that some patients who have been tried on such a drug refuse to take other medicines and revert to old behaviors.****Oh I could see why that would be a problem, thanks for your help
milly
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