Posted by Elizabeth on April 20, 2002, at 13:12:30
In reply to Most treatment resistant person, ever..., posted by tb on April 19, 2002, at 15:03:55
> I am really discouraged. I must be THE most treatment resistant person EVER.
Lots of people feel this way when they've tried a bunch of things and nothing seems to be helping. It's the depression talking! Don't give in to the despair & demoralization. I tried a lot more medications than you have before I found something that worked -- but I *did* find something (a combination of somethings).
Some things that are not on your list -- ask your pdoc if any of these might have a chance:
* You've tried two of the SSRIs, so that's _probably_ not the way to go, yet there's still a small possibility that one of the others (Paxil, Luvox, Celexa) may work for you.
* You've only tried one of the tricyclics (clomipramine). Imipramine and desipramine have been found effective in treating bulimia nervosa. Of the two, desipramine usually has milder side effects.
* MAO inhibitors are always something to consider if the usual stuff doesn't work; also, they've been studied specifically for bulimia. Don't get scared off by food interactions -- they've been overhyped, and there are really only a few foods that actually interact with them. Reversible MAOIs (moclobemide, brofaromine, toloxatone) might be worth trying if you can get it, but if they don't work or are too hard to get, the older (irreversible) MAOIs are still worth trying, since they work for a lot of people who don't get any benefit from the reversible ones. The MAO-B inhibitor selegiline (which becomes nonselective at higher doses) may also help.
* Trazodone is an antidepressant that has been established as effective for bulimia and is dissimilar to the other antidepressants. It tends to be sedating for most people, but my experience has been that the sedation goes away after a little while.
* Benzodiazepines: you didn't mention any of these, yet they help people with a wide range of psych problems. There may be some specific reason why your pdoc has chosen not to prescribe them, though; that's something you need to talk about. If you do decide to try one, Klonopin would be my first choice.
* Atypical antipsychotic drugs, taken in low doses, can sometimes help people with nonpsychotic depression and some related problems. They might be worth trying, particularly in combination with an antidepressant, if you find one that works partially.
* There are several anticonvulsants other than Topamax that can help with mood disorders and might be of use to you: Lamictal, Trileptal, Tegretol, Depakote, Neurontin, Gabitril. (I may be missing some, but those are the ones I can think of.)
* Lithium helps a lot of people with mood disorders, although it might not be so great for the bulimia.
* What dose of Buspar did you try taking? Buspar can work better at high doses, up to 90 mg/day (or even more). (It's perfectly safe: it was originally tested as an antipsychotic in doses in the thousands!)I might be able to say something more specific if I knew more about what's going on for you. For example: Do you have any diagnosis besides bulimia nervosa, and if so, which one is primary? (e.g., is the bulimia caused by depression? depression caused by bulimia? both independent, no cause-effect relationship?) What kinds of symptoms do you have? What's your body mass index? Did all the drugs you tried do absolutely nothing for you, or did some of them help a bit? etc. I'm not pressuring you to talk about anything you'd rather not talk about, but these are things that could lead to more precise ideas.
What sorts of therapies do they use at the eating disorders clinic? There should be at least some cognitive-behavioral therapy; that's something that helps a lot of people with bulimia and other types of impulsive behavior problems.
Do you keep a diary and note when you have a binge episode, how long it lasts, whether you purge, etc.? That sort of thing can be useful if you're trying to tell if/how much a treatment is helping.
I like Kate's idea of making a list of all the things you've tried, deciding if you gave them all adequate trials, if any of them helped in some ways, etc. If something helps partially, it might be worth sticking with it and perhaps combining it with other things.
Something else to consider that might be helpful: treating bulimia nervosa is not simply a matter of stopping the binge eating. Don't think of it as something for which you have to take appetite suppressants. Although drugs that decrease your appetite may help with the bulimia, they won't continue suppressing your appetite in the long term.
BTW, in case you're interested, here's the list of drugs I've tried (at least, that I can remember):
Prozac, Zoloft, Paxil, Effexor, Serzone, Wellbutrin, Remeron, trazodone, Buspar, nortriptyline, desipramine, amoxapine, Nardil, Parnate, Marplan, selegiline, Klonopin, Valium, Xanax, Ativan, Librium, Tranxene, Ambien, Sonata, Depakote, lithium, Lamictal, Neurontin, Trileptal, Cylert, Ritalin, Dexedrine, Adderall, Provigil, Zyprexa, Risperdal, Seroquel, Mellaril, Moban, propranolol, pindolol, clonidine, buprenorphine, MS Contin, Ultram
and there are even more where those came from! :-)
Some worked partially, some worked but caused problems, a lot didn't work at all. Today I'm taking Effexor, buprenorphine, and Ambien, plus Xanax as-needed and Trileptal for seizures.
So like I said, don't despair! There's hope.
-elizabeth
poster:Elizabeth
thread:103563
URL: http://www.dr-bob.org/babble/20020416/msgs/103650.html