Serious drugs

When I first read the following: "Anorexia nervosa is a serious, multifactorial disease, characterized by psychiatric and neurological disturbances, which would appear to be similar to the manifestations of dementia."

...I felt immediately protective of those with anorexia, not wanting them to feel somehow insulted to be compared to those with dementia. Which is odd, because I spend a lot of my time trying to shake people into a realization of just how serious anorexia is.

Most people talk of anorexia as serious only in a medical way - the risk of death and the leaching of bones and shrunken hearts. I think that is a distraction, to tell the truth, because no one should EVER be suffering from that level of malnutrition, period. I am far more interested in us stopping anorexia at the levels that it is mangling the mind, and that happens at even trivial levels of malnutrition. THAT brain damage is both the time to intervene and the opportunity to halt the cascade of long-term mental illness.

Can we compare dementia to anorexia? Well, yes. Dementia blunts affect, distorts memory, blocks understanding, renders its victims unable to take care of basic functions and does not allow the patient to understand why those around them are concerned. I have no idea whether this or other drugs used in dementia would be helpful in anorexia recovery but there are currently no drugs known to be helpful in anorexia recovery and that is, quite seriously, frightening.


  1. I have always been disheartened by the multiple physical qualifications for a diagnosis of anorexia nervosa. I remember feeling as if I had to prove I was really mentally sick by being even more thin, by making myself physically more ill. But I didn't need to be severely underweight for my thoughts to be irrational, obsessive, and torturous. I don't think a person NEEDS to be underweight at all to have anorexia nervosa, just malnourished. But that's just my silly, uneducated opinion.

  2. This is like the medical director at a smaller Midwestern hospital program who believed every patient with anorexia was psychotic, due to the nature of disorted thoughts, obsessionality, magical thinking, and body dysmorphia. He also believed all ED patients had a mood disorder.

    Consequently, every patient on the floor was prescribed antipsychotics and mood stabilizers ... and if you refused meds, you were discharged for noncompliance.

    All I ever experienced on those cocktails were extreme side effects, more medical complications, and increased psychological symptoms/strange thinking.

    Most other doctors I have worked with follow a standard that believes medication is largely ineffective in low-weight patients ... that you don't get the desired improvement but get all of the side effects. Psychiatric drugs mess with peoples' brains, hormones, emotions, organ function, and so many areas ... I don't think even benign medication is much of an answer for the treatment of anything in anorexia, at least not until a patient is weight-restored or has a marked, diagnosed co-morbid illness.

    I also think likening features of disparate illnesses is faulty, dangerous and grasping at straws. Since patients with eating disorders, especially anorexia, are notoriously medication-resistant (control issues, fear of weight and metabolic effects, fear of lethargy, etc.), researchers also would be hard-pressed, I think, to test whether dementia medications have any use for this mental illness.

    I think this is more about drug companies havng released a new medication for the treatment of dementia and the desire to expand its use beyond the defined population. There are ads on TV right now for two dementia drugs, and the rattling list of side effects and warnings is daunting, even for those there is a strong probable effective outcome.

  3. AM,

    I don't doubt that the drug companies are doing just that. But you seem to be rejecting all drugs, period. I do believe we need to explore and seek drugs to allieviate the suffering of illness and especially the short-term and relapse-provoking suffering of the recovery process.

    The fact that ED patients (and most patients with mental illness) reject the idea of drugs and the need for them is often a symptom of the illness itself - not a reason to believe the medicines won't be helpful.

    There is, by the way, an antipsychotic that is getting attention in anorexia and may turn out to be very helpful.

    My point in the post was how I reacted to the comparison with dementia - protectively. But eating disorders ARE extreme, the ARE disabling - though unlike dementia EDs can be temporary and treatable.

  4. Zyprexa has been used in trials on units where I have been a patient, and I have been on it. But, it caused extreme low blood pressure (60/40), and I couldn't stand up, sit up, remain conscious. Some people take it without side effect, however, and I had a roommate who said that it *did* relieve some obsessionality ... but she was on an IP unit and restoring weight at the same time, so it might be hard to say. Because it is notorious for weight gain (though not usually at the tiny doses given to AN patients), many won't take it. However, there must be a lot of docs who are telling their patients it's "for sleep," because I have run into many who call it their "sleeping pill" (and it *does* make one very sleepy). Zyprexa has a significant side-effect profile, however, and all anti-psychotics carry the risk of motor/repetitive motion/tic-like issues.

    Many patients are trying Abilify, as well, though I haven't heard any personal feedback among AN patients who thought it helped them (but I have heard some positives from BN patients ... and I *know* that it works great for kids with autistic-spectrum issues, b/c we have a child on the spectrum who takes it ... and it magically relieves him of obsessive fears, rumination, etc. ((and since eating disorders and autism have been loosely linked in some literature, there's that going for it)) ).

    I've also heard about docs going back to an old drug, Haldol, in tiny doses for "psychotic-like features" of AN but without some of the troubling side effects being reported among the atypicals.

    In the '90s, many docs prescribed Paxil, because of its assocation with relieving OCD symptoms and because it was linked to weight gain/appetite (afore-mentioned Midwestern hospital doc put all AN patients on it; all BN patients on Effexor). Lexapro seems it may be the new "it" SSRI among some providers the past few years.

    I'm not against all meds, and I believe anti-anxiety agents can help tolerate treatment. Sometimes, it isn't even a Benzo, though ... I have been given both Benadryl and a similar drug used for "allergy symptoms and to treat nausea and vomiting." I also think medications that relieve gastric motility and gastric distress issues are helpful. I also think for patients who actually *do* report depressive symptoms, meds might help ... b/c it's going to take 2-6 weeks to reach a therapeutic level, so it'd be wise to start titrating while refeeding. I think it has been noted some providers automatically link eating disorders with depression, but for me that wasn't true. Pure anxiety is my greatest challenge.

    Largely, however, I *do* believe a minimum of medication is better. I have had so many terrible side effects from so many different drugs, and doctors have explained that my experience isn't unusual b/c AN patients are often like the elderly in response to drugs (more sensitive or slightly different responses/reactions).

    For those in outpatient treatment, issues of absorption and therapeutic level are important, too. I don't purge, but I have been in lots of groups with people who are all messed up on their meds b/c purging, hydration and excretion status can be so chaotic.

    No doubt about it, however, EDs are extreme and disabling ... and medications are serious business.

  5. To Anon Moms comments:
    Benadryl has a very interesting place in the histoy of modern Psychopharmacology. It may surprise you what drugs spured the development of others and why Dr's are willing to use them so freely.
    Benedryl ranks up there with Asprin as a wonder drug.
    When body chemistry is out of order, chemical assistance has a place in restoring it.


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