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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Cairo on December 25, 2004, at 19:50:56
My 15 y/o's appetite decreased noticeably about two months ago. She has been on Lexapro 10mg for about a year, but her appetite was fine until then. She was started on Librium 5mg BID four weeks ago without any any change in appetite, and adding Provigil 100mg qAM hasn't changed it either.
I've asked her whether she doesn't feel hungry, or if her stomach is upset, or whatever else might be bothering her, but I can't get an answer from her. She's going through this teenage "don't bother me" stage as well as having an expressive language disorder, dysthymia, anxiety and ADHD, so she often won't answer when it might be difficult for her to formulate a response.
There are days when she barely eats anything. She might take only a bite or two of egg or a couple of bites of cereal, drink only chocolate milk for lunch (and leave her sandwich and cookie), and a bite or two for dinner. Other days she might eat a little more. She ate almost a whole pizza the other day and she might drink a chocolate Scandi-Shake, but she can't live on those. On whole, her caloric intake is decreased dramatically.
As this occured before starting the Librium and Provigil (which have helped her anticipatory anxiety and made her more pro-social), but long after being on Lexapro, it doesn't appear to be tied to the med. But, is it possible that appetite is affected after being on SSRIs a long time?
I wonder what else might be affecting her appetite. Should we have her tested for parasites or some other health issue? Anorexia? Am I right to be worried? I don't think this is a symptom of depression as her mood actually seems better on this combo of meds.
I would appreciate advice. Thank you.
Cairo
Posted by Racer on December 26, 2004, at 11:23:09
In reply to Should I be worried about her decreased appetite?, posted by Cairo on December 25, 2004, at 19:50:56
I can only speak for myself, but I know that when I'm slipping into an episode of AN, I feel stronger and happier and generally better all the way around. That makes me come off as doing a whole lot better. Then the weight loss becomes more apparent, of course, and sometimes people notice that and sometimes they don't. But when I'm first starting to starve myself, that's when I start looking as though I'm feeling a lot better.
If your daughter has trouble expressing herself, that's tied into my AN, so there's a reasonable chance that this is the starting phase of an ED. If so, this is the time to treat it -- but only if you can be absolutely, positively sure that you have good help and that she can be shown that this is concern and caring and love for her, rather than punishment. I don't mean saying it to her, either. I mean she needs to see it that way for real, otherwise she'll learn the sneaky side of AN.
I hope that I'm wrong in your daughter's case, and I hope that everything works out well. Good for you for noticing, and best luck for your daughter's improvement.
Posted by Maxime on December 30, 2004, at 2:41:36
In reply to Should I be worried about her decreased appetite?, posted by Cairo on December 25, 2004, at 19:50:56
Hi Cairo
I have had anorexia for 23 years now. Sometimes it's severe restricting and other times it's moderate restricting.
To be blunt people with eating disorder are liars. We lie all the time. I used to make up imaginary dinners I could tell my mom I had eaten at a friend's house. It's a hard position to be in because if we are confronted about how much we ate we end up lying. Anything to keep control.
I'm not saying your daughter has anorexia, but don't trust what she says to be the truth. If she is eating large amounts at time she could be binging and purging.
You might want to check out the Something Fishy web site where it lists signs to look for. I hope she doesn't have an eating disorder. But you need to be aware of the "signs"
Take care,
Maxime> My 15 y/o's appetite decreased noticeably about two months ago. She has been on Lexapro 10mg for about a year, but her appetite was fine until then. She was started on Librium 5mg BID four weeks ago without any any change in appetite, and adding Provigil 100mg qAM hasn't changed it either.
>
> I've asked her whether she doesn't feel hungry, or if her stomach is upset, or whatever else might be bothering her, but I can't get an answer from her. She's going through this teenage "don't bother me" stage as well as having an expressive language disorder, dysthymia, anxiety and ADHD, so she often won't answer when it might be difficult for her to formulate a response.
>
> There are days when she barely eats anything. She might take only a bite or two of egg or a couple of bites of cereal, drink only chocolate milk for lunch (and leave her sandwich and cookie), and a bite or two for dinner. Other days she might eat a little more. She ate almost a whole pizza the other day and she might drink a chocolate Scandi-Shake, but she can't live on those. On whole, her caloric intake is decreased dramatically.
>
> As this occured before starting the Librium and Provigil (which have helped her anticipatory anxiety and made her more pro-social), but long after being on Lexapro, it doesn't appear to be tied to the med. But, is it possible that appetite is affected after being on SSRIs a long time?
>
> I wonder what else might be affecting her appetite. Should we have her tested for parasites or some other health issue? Anorexia? Am I right to be worried? I don't think this is a symptom of depression as her mood actually seems better on this combo of meds.
>
> I would appreciate advice. Thank you.
>
> Cairo
>
>
>
>
Posted by CareBear04 on January 10, 2005, at 23:35:48
In reply to Should I be worried about her decreased appetite?, posted by Cairo on December 25, 2004, at 19:50:56
dear cairo,
i can speak from the other side-- the daughter side-- from my recent and current experiences.
there are a lot of things that can affect appetite-- stress and meds are big ones. when i started adderall, i had a decrease in appetite, but i made myself eat in between doses. when i switched to adderall xr, my appetite was obliterated because the dose lasts through mealtimes. i was busy with long days of classes and activities, so i had an increased need for energy and decreased intake. my body hung on to weight for a long time before my weight started falling, fast. i had an upper endoscopy done-- could be something to think about with your daughter. maybe she has a GI problem that is affecting her appetite or causing discomfort when she eats. the problem was that the scope punctured my throat, making it too painful to eat or drink. that's when i lost weight.
i was put on narcotics for the pain, and they messed with my mood so bad that i was suicidal within a week of starting them. i went into the hospital voluntarily, actually was in medicine first for lithium toxicity. i've seen dozens of doctors since first seeing a psychiatrist two years ago, some are the big-name experts, and others are the day to day drs i see that know me well. anorexia was never considered by any of the drs, but they fixated on it in the hospital. to make it worse, they never mentioned the word 'anorexia,' even though they were convinced i had it, so i couldn't talk it out with them, but they watched and recorded everything i put in my mouth. i didn't realize it, but that kind of monitoring turned me off from food even more. when i left the hospital and got away from that, i gained about four pounds in the first week. since then, i haven't been able to gain much weight. if i were living by myself, i think i could motivate myself to eat healthily and work towards weight gain. instead, i live with my parents right now, and the more my mom tries to force me to eat or nags and scolds, the less appetite i have. i would prefer her to be silent or to be silently encouraging by fixing foods that i like and not looking at me in accusing ways. she defended me while i was in the hospital and told the drs that i've never had eating-disordered behavior, but somehwere along the line, i think she started to believe in the anorexia. i would please be careful not to reinforce anorexic behavior by forcing your daughter into a corner where she won't eat just so she can feel in control and not pushed around or, for whatever reason, where eating becomes even harder. there are also things to think about like GI motility-- when you stop eating or eat only a little for an extended period, your GI tract slows down and food just sits in your stomach, and you can get constipated and really uncomfortable. foods that you used to be able to eat can make you nauseated or cause stomach cramps and pain. i used to live off of ice cream, but when i tried to eat it in the hospital and for weeks after, it was too rich and gave me the worst cramps. a soft diet can help, but protein and sodium are also important. if nausea is a problem, a good antiemetic can really help.i don't know if this has helped at all, but i think if i were you, i would keep an eye on your daughter's eating, but give her some space, maybe put her in touch with a professional or a friend who can talk to her about her eating whom she will listen to, and most of all, don't be overbearing and don't force food on her. if you're worried about medical problems, i'm sure her primary care doctor can help and if there are GI problems involved, he or she can refer her to a specialist.
good luck!
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