The medications are meant to give her some help with getting through the refeeding because the eating disorder thrives when the brain is malnourished. It thrives because a malnourished brain produces less serotonin, a brain chemical which we all have, that, gives us self-confidence, a feeling of safety and security, causes us to feel sleepy, and gives us our appetites.
The antidepressant can't increase the serotonin but it can change the way the brain uses it which can over time cause the brain to produce more serotonin. Unfortunately in anorexics, their brains produce even less serotonin as they are gaining weight which continues until they are close to their ideal body weight which is when the brain chemistry normalizes again.
So until the brain's serotonin levels are normal, Emily will continue to have high anxiety and obsessive thinking over all Ed related issues which include, food, eating, weight gain, body image, clothes, relationships, self esteem, exercise, restricting and purging.
The energy Emily has to expend to deal with the anxiety and obessive thinking have taken their toll. She is emotionally and mentally exhausted and suffers from insomnia, which together are a recipe for the constant headaches she is experiencing. Under these conditions, anything beyond eating six times a days and activities that provide a distraction from the Ed thinking are all she can manage. But hopefully she can squeeze in a few hours of school this week and a guitar lesson. They will also provide some welcomed distraction which we hope will outweigh the angst she feels when she thinks about doing them.
Today at lunch she took the anti-anxiety pill for the first time. It really zoned her out, and it's always freaky to see your kid a little high. I will be interested to see what she thinks about the experience once she sobers up, which should be anytime now. This drug is addictive so she will only use it for the next two weeks until the antidepressant kicks in.
The antidepressant has some side effects including drowsiness which in her case is a good thing because she takes it at night and it should start helping her to sleep through the night very soon. It also causes some stomach and bowel upset but so far she hasn't complained very much about that. The most frightening possible, but rare, side effect is an increase in suicidal thoughts. She was given the drug with the condition that she will tell us if she starts to have kind of self harming thoughts and we have a 24 hour emergency response phone number to use if that happens or we can take her to emergency right away. The shrink, Dr. C. has never seen this happen in eating disorder patients so she is very confident that it won't happen with Emily, but we will have to be vigilant over the next few months.
The other interesting thing that happened this week was that we found out Emily has been lacking confidence in us using the Maudsley Approach to treat her disorder. She had been doing her own research on treatment options and she was afraid that we weren't using the best one for her, partly because she knows they aren't treating the illness yet, but also partly because Ed knows this approach is working, as evidenced by her weight gain, and he doesn't like it.
The Team spent some time talking about the need for her to refeed before she will have the mental and emotional energy to devote to the therapy which will focus on changing her thinking and behaviours. And we assured her that we felt the Maudsley was the best approach for our family but that if it didn't work we would try every other approach out there. But it wasn't until she found the Maudsley Parent website and devoured everything on it, that she became more confident in this approach. She really turned a corner on those fears on Thursday morning which in turn resulted in a really good day for her.
Unfortunately, she got sucked under by Ed thoughts yesterday when she was dressing because she spent too much time looking in the mirror which generates a host of distorted images and thinking. And today she was deeply disappointed over not being able to volunteer at the Run for The Cure, which we have done as a family for five years. Because she needs to shift her thinking from Ed as a friend to Ed as a foe, I took advantage of the opportunity to remind her that Ed was the reason for her disappointment.
On the upside, she has found enormous comfort from a couple of books she's been reading on eating disorders. And she discovered that laying her clothes on her bed can give her an idea of whether or not they match without having to look in the mirror. She's a smart girl. She'll get there.