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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on August 2, 2010, at 16:07:25
In reply to Re: Weight loss meds » emmanuel98, posted by Maxime on August 2, 2010, at 15:18:54
Dear Maxie,
I know you won't want to hear this but I honestly believe that no medication will significantly relieve your depression until you start eating an adequate diet. However high your antidepressant dosages are increased, and however potent your combination, no medication can reverse the effects of starvation on the brain. Your brain needs calories to function normally. It needs fatty acids, it needs carbohydrates, it needs proteins and amino acids. It needs vitamins, it needs minerals - it needs to be nourished. Even if an antidepressant can elevate your mood to some degree, there is no possibility that you will achieve remission or even near remission on 300 calories a day. It simply cannot happen - 300 calories is so far below what you body needs. Anorexia is like a vicious cycle; the more you starve youself, the worse you feel.......and the more you want to starve yourself. The only way to escape this cycle is to begin eating a healthy, balanced diet with adequate calories to permit normal bodily processes to occur. It won't happen overnight, but a healthy diet will eventually restore your metabolism to normal. High protein foods such as eggs could help to increase your caloric intake without the issues associated with hi-carb foods. Why not have a couple of scrambled eggs? I always find scrambled eggs comforting, especially when I'm feeling unwell.
Weight neutral meds are best in anorexia. Meds which cause weight gain invariably cause distress. Meds which cause weight loss tend to end up being misused, leading to a downward spiral in mood and behavour. Nortriptyline is a decent antidepressant but it frequently leads to weight gain. Switching to Surmontil probably wouldn't help in the weight department.
If only you could learn to like yourself more Maxie. I like you. Does that help even a little bit? Any kind of therapy which could help you to love and accept yourself would be fantastic. Well, you don't need to absolutely love yourself. So long as you can recognise all the things which are good about yourself, that's enough. Let me start.....you're thoughtful, you're intelligent. There are so many good things about you Maxie, but when you're depressed, you just can't see them anymore.
Take care of yourself,
Love Ed
Posted by 10derHeart on August 2, 2010, at 17:53:44
In reply to Re: Weight loss meds » Maxime, posted by ed_uk2010 on August 2, 2010, at 16:07:25
what a wonderful post, ed. You are thoughtful , intelligent, and caring yourself - clearly.
Maxime, I agree with all ed said. You know I have long appreciated you here. I have prayed for you numerous times when things were so dark for you. I worry about you when you disappear. You always take interest in others even while feeling like absolute crap yourself. That takes some inner grit. You have survived so much for so long. Strangely, though no one would wish anorexia, depression, etc., on themselves on anyone, the very suffering the soldiering on has probably made you tougher and tougher. Don't know how to make a point here, but I know I am trying awkwardly to say I admire you.
But, of course, we'd rather see you thrive, not just survive. I hope there is some alternative, some support gropup, a buddy suystem, something safe, medically sound and healthy you could do while waiting for space in the program you mentioned, to have daily - even hourly - support for your eating. I would never be so wrongheaded as to say, "I know what it's like," or ,"I understand what you are going through." No - not unless I either had been anorexic myself, or at least had someone very close to me go through it. But I will say, being very overweight and pretty much a slave to food, and coping with the frustration of all the da*n meanings behind overeating (comfort, stress, emotional eating, control issues...you know the drill) I think I do 'get it' slightly. And it's hell and it's hard and it seems impossible to change, but it is NOT. It can't be. People have. You (we) are people, too. Who says we can't triumph? Maybe we're just the slower learners...
You will find some answers.
Posted by Maxime on August 2, 2010, at 19:37:41
In reply to Re: Weight loss meds » Maxime, posted by ed_uk2010 on August 2, 2010, at 16:07:25
I cried when I read your post, Ed. You are so right about everything. But I can't fix the eating disorder on my own. I feel like I need to be in an inpatient treatment. I am on a wait list, but it could take up to a year.
I really hate myself. I think of myself as a fat and ugly monster. I can't even look at myself in the mirror. The reflection is too ugly and scary to look at.
I feel so desperate that I even wrote to Dr.Phil. But he wouldn't want a fat person on a show about eating disorders. But I didn't know what else to do.
Thanks again for what you wrote. I believe everything that you wrote, but I don't know why you care about me.
Posted by Maxime on August 2, 2010, at 19:44:33
In reply to Re: Weight loss meds » ed_uk2010, posted by 10derHeart on August 2, 2010, at 17:53:44
Thank you. You are very caring. I have no money because I am Welfare. I need to find a therapist who has a sliding fee scale. I really need a therapist. I know that I do. I need help. I can't keep on going on like this. I every thing I need to kill myself in a drawer. Sometimes I take it out and start to count out pills. But then I put it away and tell myself that I have try some other things before I do that to myself.
I think I will be staying at the Crisis Centre some time this week. If things don't go well there, they will take me to the ER of a hospital. I recognise that I really need help right now to keep me alive. I will call them tomorrow. I call them every night for support, but I can call them during the day and they will come to my house to evaluate me.
I am so tired of living like this. I know that I have been strong, but I am starting to lose grip and I don't really care. I never thought I would this long to begin with.
Thanks again for your kind post.
Posted by ed_uk2010 on August 2, 2010, at 20:44:33
In reply to Re: Weight loss meds » ed_uk2010, posted by 10derHeart on August 2, 2010, at 17:53:44
Thanks 10derheart, I appreciate your post.
Posted by emmanuel98 on August 2, 2010, at 20:50:01
In reply to Re: Weight loss meds » emmanuel98, posted by Maxime on August 2, 2010, at 15:18:54
Maybe this is the wrong way to think about it though. I was a normal weight when I started taking AAPs, maybe 10 pounds overweight. But if you are underweight to begin with, the weight-gaining drugs can be beneficial. My sister-in-law gained 25 pounds on abilify after years of being frighteningly thin and, for the first time in years, she looks healthy and normal.
>
> These types of meds, though helpful, should NOT be given to someone with an eating disorder. I don't and can't purge my food. I restrict my food and use laxataives to make me feel empty. I am not losing laxatives this week since I am doing this little experiment for my my pdoc.
>
> I have gained 3 pounds since Friday night on Lithium with an average amout of calories between 250 - 500 a day. We will see how it goes. I know that weight can vary even in the day but I have been weighing myself first thing when I get up in the morning and pee. :) I have been drinking as much water as possible since I am on the Lithium.
>
> Thanks for your support.
>
> Maxime
Posted by ed_uk2010 on August 2, 2010, at 20:54:35
In reply to Re: Weight loss meds » ed_uk2010, posted by Maxime on August 2, 2010, at 19:37:41
Hi again Maxie,
>But I can't fix the eating disorder on my own.
I know, you need help here. Is there any chance your current doctor can do therapy as well as meds?
>I really hate myself. I think of myself as a fat and ugly monster. I can't even look at myself in the mirror. The reflection is too ugly and scary to look at.
But you know this is only your perception, which is severely distorted both by your depression and by your anorexia? A while ago, you sent me a photo. You looked nice - certainly not ugly at all! And no, I'm not just saying that to make you feel better.
>But he wouldn't want a fat person on a show about eating disorders.
How do you know what he would want?
>I believe everything that you wrote.
In the absence of eating an adequate diet, do you take any supplements to try to ensure sufficient vitamins/minerals? I'm thinking of a good multivitamin, omega-3 fish oil, extra B vitamins including folic acid, calcium and magnesium etc.
>...but I don't know why you care about me
That's your depression talking. It's natural for people to care about others when they are in need. It's part of the human condition.
Love Ed
Posted by Maxime on August 2, 2010, at 20:56:16
In reply to Re: Weight loss meds, posted by emmanuel98 on August 2, 2010, at 20:50:01
I am obese (BMI wise) thanks to numerous meds I have tried. My behaviours are anorexic, but the weight doesn't come off. I hate it. I HATE IT! I HATE ME!
Sigh.
Posted by emmanuel98 on August 2, 2010, at 20:56:17
In reply to Re: Weight loss meds » 10derHeart, posted by Maxime on August 2, 2010, at 19:44:33
Maxine - You say you're fat, but how much do you weigh and what is your height? Maybe your body image is distorted.
Have you considered overeaters anonymous? The group combines people with all sorts of eating disorders -- binge eaters, bulimics, anorexics. Some are fat, some are emaciated. It's free and meetings occur with some frequency in most areas.
Posted by Maxime on August 2, 2010, at 21:26:53
In reply to Re: Weight loss meds, posted by emmanuel98 on August 2, 2010, at 20:56:17
I don't want to give my weight, but my BMI is in the low 30s. I am so fat that my GP told me to lose weight. I am so fat that none of my clothes fit me. I really am fat. Before I tried all these meds my BMI was in the underweight range which is where I like it to be.
I do go to an ED support group once a week. I am not sure if it is helping me, or making me feel even worse about my body image. There are some very emmaciated women in the group and it's triggering.
I'm fat and ugly. There is no way around that fact.
Posted by Maxime on August 2, 2010, at 21:34:54
In reply to Re: Weight loss meds » Maxime, posted by ed_uk2010 on August 2, 2010, at 20:54:35
My doc could do therapy with me, but I don't think he is the to do it. Afterall, he ask me to starve myself (his words) this week whilst on the Lithium. I don't think he has much experience with eating disoders.
I do take multi-vitamins and fish oil and B complex vitamins. I hope there aren't too many calories in these pills. *worried* I was taking iron pills because my iron level was 3! Now it is back to where it should be. I also have the occasional Ensure drink ( version of your Fortisip)when I KNOW that have to eat something or I will pass out and that I can't eat normal food.
Posted by morgan miller on August 2, 2010, at 23:08:39
In reply to Re: Weight loss meds » morgan miller, posted by Maxime on August 1, 2010, at 22:14:27
I was just thinking of psychodynamic therapy with a really good empathetic and compassionate therapist because it may help with getting to the root of why you have an eating disorder. I'm sure a therapist that specializes in eating disorders will addresses this.
Hope you get through the list fairly fast!
Posted by morgan miller on August 2, 2010, at 23:15:51
In reply to Re: Weight loss meds, posted by emmanuel98 on August 2, 2010, at 4:01:35
> Well just because you haven't seen it, doesn't mean it hasn't happened. I ate a perfectly normal diet (1500-2000 calories a day). Exercised more than is usual (3 one-mile swims, 4 5-mile walks), went on AAPs and gained 2-3 pounds per week. Not water. Fat. One week on zyprexa, I gained 5 pounds. These medications are notorious for messing up basic metabolism, so that the calories in-calories out equations don't work anymore. Lithium and Nardil have similar reputations. So save the lectures about exercise and blueberries. People get fat on these drugs through absolutely no fault of their own.
This is true to some extent and I understand your frustration. Still, taking all the right measures is better than doing nothing. Maybe you would have gained more weight had you not been doing all of those things. Also, moderate to intense pulsatile bursts of exercise(interval training is one example) will have a much greater impact on metabolism than slow to moderate paced cardiovascular exercise. Plus, if you are not weight training and doing moderate to intense cardiovascular exercise, you won't get the same results as you would if you were just doing cardiovascular exercise.
Posted by morgan miller on August 2, 2010, at 23:21:19
In reply to Re: Weight loss meds » emmanuel98, posted by Maxime on August 2, 2010, at 15:18:54
>I have gained 3 pounds since Friday night on Lithium with an average amout of calories between 250 - 500 a day.
Restricting your calories like this will just make things worse. Lithium will do more damage to your metabolism if you are not eating properly. I understand this may be very difficult for you to grasp given your eating disorder. Not only is it bad to restrict calories to this extent, but you are likely missing out on the types of foods that are beneficial for weight management. I'm sorry your having such a difficult time right now. Hopefully you will get through that list sooner than later and a therapist will be able to help you.
Posted by overtheedge on August 2, 2010, at 23:42:42
In reply to Re: Weight loss meds, posted by morgan miller on August 2, 2010, at 23:21:19
Hi, Just wanted to give my opinion.
i also suffer from anorexia. but what i find is that i will not take a med if it will put weight on, just not worth it, there always is a better alternative.
right now i am on pristiq and abilify and have lost weight.
been on zoloft, lithium, none of them put weight on or not much that i could not control.
i do find the pristiq does give me energy, which i so despretely needed.
and i hear what you are saying about a messed up metobalism..
good luck
Posted by emmanuel98 on August 3, 2010, at 1:39:15
In reply to Re: Weight loss meds, posted by overtheedge on August 2, 2010, at 23:42:42
I will not take a med if it puts weight on. I gained enough from my various trials of AAPs. I completely undertand this. I also undereat -- about 800 cals per day -- and have ramped up my exercise, but I still strggle to get the weight off. The body resists weight loss. It is a known fact that trips up dieters all the time. I am so tired of people saying, try this diet or try interval training. The basic metabolic equation is that if you expend more calories than you eat, you shold lose weight. That has not been my experience at all and i am quite discilpined.
Posted by morgan miller on August 3, 2010, at 3:14:53
In reply to Re: Weight loss meds, posted by emmanuel98 on August 3, 2010, at 1:39:15
> I will not take a med if it puts weight on. I gained enough from my various trials of AAPs. I completely undertand this. I also undereat -- about 800 cals per day -- and have ramped up my exercise, but I still strggle to get the weight off. The body resists weight loss. It is a known fact that trips up dieters all the time. I am so tired of people saying, try this diet or try interval training. The basic metabolic equation is that if you expend more calories than you eat, you shold lose weight. That has not been my experience at all and i am quite discilpined.
Unfortunately, it's not always that simple. You can still up your caloric intake and easily burn enough calories to possibly manage your weight. What I am saying is that you CAN and SHOULD and WILL expend more calories than you take in even if you double the amount of calories you are currently taking in. People practicing healthy calorie restriction diets are taking in more calories than you are daily, probably around 1200 calories. 1200 calories is considered a calorie restriction diet, what you are doing is just plain unhealthy and is screwing up your metabolism, making it harder for you to lose the weight. With that low of a daily caloric intake, it is highly unlikely that you are getting all the nutrients you need for your brain and body to have a chance at working properly. I'm sorry for sounding harsh but you are thinking about this too simply. I also think your eating disorder and the psychological components behind it are negatively impacting the way you want to believe in what is good and what is bad.
Have you tried eating 1200 to 1800 hundred calories a day, splitting them up into 4 or 5 meals, and including the right foods with the right balance of protein and complex carbs? Have you tried combining weight training with intense cardiovascular exercise? Do you eat a meal withing 30 minutes after exercise so you quickly metabolize the meal and keep your metabolism going at a faster rate? If you haven't tried all of these things, I don't think you have the right to say you are sick of all of the suggestions.
Finding a very good therapist, some group therapy, and a nutritionist(if you can afford one, if not just do some research) should be a priority. Really the therapy and some support you can hopefully get from friends and family are the two things that are really going to help get you where you need to be in the long run. Right now try your best to dig deep for some will power and energy. I realize this is incredibly difficult if you are suffering from depression.
Posted by emmanuel98 on August 3, 2010, at 3:57:31
In reply to Re: Weight loss meds, posted by morgan miller on August 3, 2010, at 3:14:53
I wonder though. Are you overweight? Have you ever gained 40 pounds from psych meds then tried to lose them? I tried a diet where I varied my calories from 1000 to 1200 to 1500 a day, so as not to go into fasting metabolism. Didn't lose a pound. I lifted weights for years, though now I am so fat I'm embarassed to lift weights with all the mirrors in the rooms. I swim 3-4 times a week and interval train. No go. Are you a middle-aged woman? Weight loss gets more and more difficult when you are.
This si a problem for me because I have arthritis in one knee that is made much worse by the weight. Also, parnate is not holding me, but I refust to accept this since the alternative, nardil, almost always causes weight gain and I will never take a med again that cause weight gain. I tried all the AAPs and they all worked for me (except geodon) and they all made me gain weight at frighening rates -- risperdal, 15 pounds in one month. Zyprexa -- 15 pounds in three weeks. Abilify -- 10-12 pounds a month and this was so affective that i tried it for months, with cytomel, metformin, alli.
Posted by emmanuel98 on August 3, 2010, at 4:03:42
In reply to Re: Weight loss meds, posted by morgan miller on August 3, 2010, at 3:14:53
One more thing that I have hated about gaining weight Everone's an expert. First, there's the assumption that I have bad eating habits, which I don't. Then theres the well-meaning but ignorant suggestions. One woman told me I shouldn't swim because swimming didn't cause you to burn calories, but running did. (I think she was thiking about bone loss. Not that it matterw. I can't tn on my arthritic knee unless I lose more weight). One person told me I shouldn't eat bananas, since they were high in fat (I think she was thinking about the atkins diet). And so on. It gets tiring
Posted by morgan miller on August 3, 2010, at 4:58:28
In reply to Re: Weight loss meds, posted by emmanuel98 on August 3, 2010, at 4:03:42
I hear ya, you definitely have some things going on that are making managing your weight very difficult. Sorry, I think I got a little frustrated with your earlier post, as I'm sure you did with mine.
I guess all you can do is keep trying and hope that some treatment/treatments will help you feel better without effecting weight gain and metabolism too much. I know, it seems like it's impossible until newer better medications are available.
So I guess metformin didn't help huh. Were you taking metformin, cytomel, and alli at the same time. If you were, then wow, that sucks that they didn't help.
I know it must be frustrating having people that don't know what they are talking about tell you what you should and should not do. I'm sure it's still frustrating when someone does know what they are talking about gives you advice.
You say you do eat well right now but didn't you say you only eat 800 calories a day, right? I really do think asking your doctor or a good nutritionist what they think would be helpful. I don't see how your brain and body could be getting everything they need on such a low daily caloric intake.
What are all the meds you are on now? Parnate and what else? Sorry I'm just curious.
Well all I can say is try hard to not give up, there is hope, for you, and Maxime.
I have gained up to 35 pounds at one point a few years ago after being on Zyprexa and Depakote. So I can empathize and relate to what you two are experiencing to a degree.
Like I said, hang in there and try not to give up hope!
Morgan
Posted by Maxime on August 3, 2010, at 5:24:37
In reply to Re: Weight loss meds, posted by emmanuel98 on August 3, 2010, at 3:57:31
Weighed myself this morning and I have gained 2 more pounds. That is 5 total and I still have to make it until Friday. :( I don't know I manage to gain weight when I eat less than 500 pounds a day. :( This is not helping my suicidal thoughts.
Posted by Maxime on August 3, 2010, at 5:28:26
In reply to Re: Weight loss meds, posted by Maxime on August 3, 2010, at 5:24:37
Forgot to say that if my pdoc insists I stay on Lithium I will start taking some Ephedra. It has worked in the past, so it should work again. Actually even if I don't have to stay on the Lithium I will hunt down some Ephedra. I know that I shouldn't take it with the Parnate, but I have in the past and I suffered no ill effects.
I really wish that I could purge. It would solve my problems. But I am unable to purge. Lord knows I have tried.
Posted by Maxime on August 3, 2010, at 10:12:57
In reply to Re: Weight loss meds, posted by emmanuel98 on August 3, 2010, at 3:57:31
I know your message was for Morgan, but I just wanted to say that I have gained so much weight from meds. I gained 40 pounds from Seroquel. They were slowly coming off me and then I had the Lithium which added a good 20-30 pounds. And it seems like every time I gain weight, I go about 15 pounds over my highest weight ever. So I kept on having a different highest weight number. :(
It bad enough to have BP type 2, but adding weight gain on it is just insult to injury.
Posted by Maxime on August 3, 2010, at 10:15:19
In reply to Re: Weight loss meds, posted by emmanuel98 on August 3, 2010, at 3:57:31
Emmanuel, how did the Metformin work? Did it help at all?
Posted by morgan miller on August 3, 2010, at 12:07:22
In reply to Re: Weight loss meds, posted by Maxime on August 3, 2010, at 5:28:26
> Forgot to say that if my pdoc insists I stay on Lithium I will start taking some Ephedra. It has worked in the past, so it should work again. Actually even if I don't have to stay on the Lithium I will hunt down some Ephedra. I know that I shouldn't take it with the Parnate, but I have in the past and I suffered no ill effects.
>
> I really wish that I could purge. It would solve my problems. But I am unable to purge. Lord knows I have tried.If you take ephedra, take a good all natural ma huang.
I guess you still don't believe that eating more, getting more calories, eating several meals a day, and eating the right foods could help not just medications work better but with weight loss as well.
I'm really sorry you are feeling so bad. I do hope you find some help very soon.
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