I’ve had an eventful few days in terms of my treatment progression, which has led to a few of my planned out attack strategies being harder to follow through on. Some of it is my fault, others are out of my control. My appointment with the psychiatrist was moved to Thursday morning, but only being told on Wednesday afternoon sent me spiralling into freak out mode I guess. She weighs me, so the whole “Tuesday is weigh day” thing went out the window. And I’d lost weight even though I’ve been hitting my minimum target for over a week, which led to phone calls to the dietician and an officially upped minimum calorie intake. I’m not confident in my ability to hit that target consistently, but hopefully if I take every day as it comes, I’ll be able to get there. Sometimes when I plan ahead I freak myself out, so hopefully if I can keep in the present I can stop my head from spinning prematurely at the prospect of eating enough in the future. I cannot wait for the day when food becomes less of a focus in my life and I can move on to have more interesting things to think about. That’ll be nice – and a whole load less boring. Once my body is more healthy and happy, this should start occurring of its own accord, I just have to get there first.
The big change in my treatment plan this week is that I’m officially medicated now. Antipsychotic drugs sedating parts of my brain. I’m somewhat against this for a lot of reasons. Olanzapine has a lot of side effects and I’m never really lucky on the side effect front. The immediate side effects for most people is increased appetite with subsequent weight gain, drowsiness and lethargy and increased prolactin in the blood. In fact, in those whose primary symptoms are of a psychotic nature, clinically significant weight gain is seen in 50-90% of all patients on the drug (depending on where you find the statistics). I have researched till I cannot possibly research anymore and found that olanzapine treatment in patients with anorexia may lead to greater rates of weight gain and increased likelihood of reaching a target weight rate, though these results are not entirely reliable and in double-blind, randomized controlled trials, rate of gain shows no statistically significant difference between placebo groups and olanzapine groups rate of gain. Obviously, as I only have access to abstracts, I can’t really tell how these results were measured, but it seems as if it doesn’t change rate of gain in and of itself, but rather increases the likelihood of sufficient calorie intake for clinically significant gain. Olanzapine has been shown to modestly improve some of the psychological symptoms of anorexia (such as obsessionality, anxiety and delusional thoughts regarding body weight and size) which could lead to greater compliance to treatment and thus lead to greater adherence to weight restoration plans. However, within inpatient units (where calorie intake is tightly controlled), no difference has been shown between rates of gain in both groups, and in outpatient settings, drug treatment alongside CBT has had little effect on relieving symptoms or increasing rate of gain (see here and this and these results and this trial and this review for some of the findings if you’re that way inclined). A lot of the research on olanzapine treatment in anorexia is fairly unreliable due to low participation levels, the fact that olanzapine is often used in more severe cases and in patients with greater levels of reluctance to adhere to treatment, so the benefits of such a drug maybe more obvious in these cases than in those who are more able to comply to treatment without medication.
So anyway, with such unreliable data available, I’ve decided to trial the drug. The psychiatrist suggested that I stick with it for a week or two and if the side effects become alarming to me, I can just stop taking it at any point as it has a relatively pain-free withdrawal period, and she’ll try me on something new. It’s often a first line of pharmacological treatment in people with anorexia (which is notoriously resistant to medications) as antidepressants have been consistently shown to have little psychological benefit in underweight patients and olanzapine is seen to have less adverse side effects than many other atypical antipsychotics and has not been linked to nausea or weight loss seen in many mood stabilizing medications. Plus increased appetite and weight gain is hardly viewed as a medical problem in those suffering from anorexia. We’ll see what happens. Right now I can only tell you that it knocks me out for a good 8-10 hours at night, meaning that I’m now waking up at midday – with the added bonus of feeling entirely groggy and with a bangin’ headache for a few hours. Maybe I should start taking it earlier rather than when I’m actually in bed though as waking up this late is really ruining my chances of sticking to some sort of meal plan routine. Hopefully it’ll make me less anxious and depressed and panicked. Those emotions are proving themselves to be blocks to my recovery and pretty debilitating on the day-to-day. Hopefully everything will go well and I’ll feel better, but it’ll take a few weeks to see the full effect. Right now I’m just insanely monitoring myself for any changes. I have to keep remembering that actually, the increased appetite and runaway weight gain often seen in those with schizophrenia or bipolar disorder who take this medication is hardly ever-present in those with anorexia. At least that’s what the psychiatrist and my trusty recovery book Anorexia Nerovsa: Hope for Recovery (Dr A. Ayton 2011) says. Plus I should really listen to my psychiatrist – there will be a good reason for prescribing these pills and so it’s highly likely that they could help, and if they don’t, at least I’ve tried them and have evidence to support me if I decide to discontinue their use. It makes me kinda sad though as I was just beginning to enjoy getting incredibly drunk or off my face again, but now they’re both off the cards for the forseeable future – my alcohol tolerance will be lowered and alcohol increases the sleepy effect of the pill, and it nullifies the effects of uppers plus increases the chances of them causing seizures and passing out more generally.
In other news, as far as my aims go, so far so good in terms of food choices. I’ve been mixing up my bread choices a little with crusty rolls and crumpets and baguettes, I’ve had two meals out which meant two desserts (caramel gateau and raspberry and white chocolate parfait) and one terrifying meal of fear foods (chicken breast and a huge potato cake). I hit my revised calorie target (the top of my previous range) for the first time in over a month yesterday which was incredibly difficult as I saved a lot of calories till the end of the day and ended up having a mini feast. Still, I got there. Regular times and not pushing back calories is still excruciatingly difficult – especially if you wake up at midday, so I’ll keep working on that. The volunteering thing is moving along and hopefully I’ll be in a year one classroom soon enough. Realistically it doesn’t feel like good progress as I’m still majorly obsessive over calorie counting and often find myself cutting back in various places to feel more comfortable, but hopefully if I keep pushing myself it’ll get easier. Hopefully. My treatment team are all singing to the same tune now – “We cannot support you for ever so do the hard stuff now when you still have people to help guide and support you if it is difficult for you. If you don’t do these things now, you won’t have this help when you finally do start to tackle them.” Everything feels so pressured. I hope I can get a move on in all of this now.