DD16 - is it time to ask for anti-depressants?

[Tramway23]

Hi all - I will try and be as concise as possible. We've had a few very difficult years with DD16 and I just don't know what to do anymore...

2020-21: Became very anxious during lockdown and subsequent return to school, stopped eating, panic attacks

2022: Urgent referral to CAMHS for anorexia, 1 week off being hospitalised for low weight but she co-operated (and basically lied on all their psychological tests and said she didn't think she was fat etc and she wanted to put weight). CAMHS discharged her after 6 months with a referral to see a NHS Dietician (DD saw them once oand refused to go again)

2023: Since weight restoration (she is still only a size 6), she has suffered from severe stomach pains, constipation (resulting in a week's stay in hospital to be deimapcted) and daily bloating which makes her look 6 months pregnant. She has seen a gastro consultant after a year's wait and they just keep prescribing her shed-loads of laxatives which is rather problematic for someone with an eating disorder. They refuse to consider a mind-stomach connection is causing the constipation / bloating eg IBS etc (btw she bloats even when she doesn't take the laxatives and we have tried cutting out dairy and gluten).

2024: Currently, she barely leaves house, cries every day, has stopped all hobbies and doesn't see her friends, She wears enormous baggy clothes to hide her stomach. She is maintaining her weight but cycles through binge-restriction with her eating and cannot bear anyone to watch her eat. She looks exhausted and there is no joy left in her. She is extremely anxious about her upcoming GCSE results as I am sure most of her peers are, but this seems to be on another level.

Most current update - I have put her on Ashwaghanda this week out of desperation even thought I know it's not technically allowed for under 18s. Ihave shelled out £100 on the Nerva app which she has been doing for 3 weeks so far to try and calm her stomach pain (nothing so far). She refuses to go back to CAMHS for counselling (and it would be a two year wait anyway so pointless) but after years of me pleading, she has finally consented to go to see a private therapist (first appointment is in 2 weeks)

I suppose my main question is should I take her to GP now and talk about anti-depressants or will they just say go away and try the talk therapy first? I get the impression from the NHS website that they are very reluctant to put under 18s on this sort of medication.

Does anyone have any advice or a similar experience? Thanks so much!

they will not give any depressants

they will want therapy

Balance of risks and benefits at this age rarely favour antidepressants. Go and speak to GP with no fixed ideas and listen to what they say

she has not recovered from anorexia despite weight restoration

would you consider private in patient if you can afford?

what’s her school attendance?

She needs adolescent pyschiatrist for anti depressants.

She sounds ND to me.

what makes you say that?

how often seeing the therapist?

and does the therapist have a special interest and experience in eating disorders?

@kimchi81 Thanks for your replies. Yes, I thought they would want therapy first.

We cannot afford private in-patient care, even the therapist is going to be a bit push at £50 a session. She is not an eating disorder specialist, no, but has lots of experience in working with young people with stress and anxiety. We live in a remote area and options are very thin on the ground...she would like to see someone in person and not online.

For school attendance she missed a lot of time in Year 10 and the beginning of Year 11 for hospital / GP / CAMHS appointments. But went in apart from that.

my feeling is that anorexia lies at the root of everything and unless that is addressed… there will be no change

Your DD is still deep in her ED. Her Gastro problems and her poor mental health can all be attributed to that. You say that she is still binging and restricting so she is still stuck in the cycle? Her body and brain still need to repair. Did you do FBT while under CAMH’s and the ED team? YOU need to take complete control of her food intake until she is at a healthy weight and the ED behaviours have abated. Gastric/digestion issues are common during the refeeding period. As is depression/anxiety. The brain needs to recover after being starved of nutrients.

The GP won’t prescribe antidepressants for your DD given that she’s under 18. They have to be prescribed by a psychiatrist. You could look in to getting this privately. However I think you need to tackle the ED first. Your DD is most definitely not recovered.

Post on the teen eating disorder thread. There is lots of support and guidance there!

https://www.mumsnet.com/talk/eating_disorders/5033256-support-thread-12-for-parents-of-young-people-with-an-eating-disorder?page=14&reply=134948066

Anxiety
Eating disorder
refusal to leave the house.

All ND traits. My Dd is ND. She has had lots of issue with school after Covid and refusal to leave house. She was in ND burnout for 18 months when she was refusing to go to school or leave the house.

Shes getting better now. ADHD meds were the turning point. Anti depressants didn’t do anything.

I'm not sure I can help much, but I have had some similar issues with my dd. She did get anti depressants under 18 through NHS but she had a history of attending regular sessions with a CAMHS psychotherapist as a younger teen who referred her to a child psychiatrist thinking they probably wouldn't give dd the ADs (dd had asked for them) but they did. She has been on them since (now 19) but now has a new diagnosis through the adult service, and is reducing with a view to changing to a different type of medication (not related to depression). TBH none of us think the ADs helped much, and her bigger issue is anxiety.

Her history is similar in some ways to your dd's OP though not as extreme. She works, has friends, a boyfriend etc. She has toyed with eating issues but they have never escalated thankfully. She also has self harmed (cutting) in the past.

My dd is adopted though and that has made it easier to access services for her. I'm sorry things are so hard for you and ypur dd, and understand how helpless you must feel.

Also ND girls often present with anxiety or EDas first symptom of ND.

Then they are diagnosed as anxious or with an ED and another one slips under the radar.

There was that thing once where they screened ED inpatients for ASD. I think 80.% met the criteria.

@Rollergirl11 We never did any FBT with CAMHS. To try and be more concise, I over-simplified the details in my first post. Because of the answers she gave on their forms (including a 2 hour home visit where she dutifully ticked all the right boxes), they declared that she wasn't anorexic and that she had lost weight unintentionally through stress and anxiety.

I had seem her rolling on the kitchen floor screaming at us for putting butter on her pasta but played along as I was so grateful that she was seen so quickly and she seemed to respond well to the 'You're not like those other girls with tubes down their noses, you're not anorexic, just stressed' approach. Hindsight is a wonderful thing and I would have fought for a different diagnosis if I went through it again. So every week we would troop in, they weighed and measured her, took her blood pressure, gave us the usual CAMHS meal plan (which she refused to even look at) and told her that when her weight was up, she would be offered counselling for stress/anxiety but it was entirely up to her if she accepted it. You can guess what she did.

It is only very very recently, in the last month, that she has admitted to me that she did have an eating disorder and that she had lied when answering their questions. I feel that at least that this admission is some progress, as is the acceptance to see a private therapist.

I have tried contacting CAMHS but was told that as long as her weight is in a healthy range (which it is - she was 4 stone 10 at one point but now around 7 stone, she is also very short), she won't be given an urgent referral. She could be referred via GP but wait list over 2 years.

Anxiety and not wanting g to leave house will likely be down to anorexia

she weight restored independent of treatment?

Another one for ruling out ND as the underlying cause. There’s a number of studies, that have established a link between ED and ND. I can’t remember if they were US or U.K. based, but it’s worth exploring. If it is, the approach should be ND affirming rather than from a purely MH standpoint.

@kimchi81 Yes, apart from the weekly weigh ins at CAMHS and fortnightly appointments with a lovely GP who went above and beyond (she has now sadly left the practice). It took about a year of us trying to get her to eat more as a family, it was a very rocky and miserable time and she hated it but she did do it. She refused to follow meal plan though and insisted on choosing her own food. Her weight gain was tiny for ages and then suddenly shot up and she put on lots of weight in a short time (despite eating the same things)

Are you confident on her weight? Have you seen her on the scales without clothes on? It sounds to me like the anorexia is still very much in control.

I don’t disagree that there may well be some ND as the underlying cause. But ED’s, anxiety, depression, OCD all feed in to each other. You’d be hard pushed to determine where one ends and another begins.

But at the moment I think you need to tackle the Anorexia as I think this is currently at the fore front.

OP, I cannot stress enough having a read of the thread I linked in my earlier post as there are lots and lots of likeminded parents over there all dealing with a loved one with an ED.

FWIW our family has had its own battles with ED’s. DD was diagnosed with Anorexia in 2021 when she was 15 and she also struggles with long term anxiety. She was put on antidepressants as part of her recovery plan. She is still on them now. We tried to lower her dose with a means to her coming off them but she started struggling with her anxiety becoming unmanageable again. She is generally well with regards to the Anorexia although she has just had a little blip with the stress of sitting her A levels. I had to take control of what she was eating for a good while after her diagnosis and when she feels the behaviours starting to slip in again she asks me to keep an eye on her. She restricts her food as a way of regulating her emotions during times of increased stress. She also has private therapy as and when needed but she had consistently once a week for about 18 months after diagnosis.

@Rollergirl11 I am confident she is not losing weight at the moment. In fact, recently things have changed gear into more of a bingeing eating disorder (jars of nutella /boxes of Lindt balls vanishing in the night etc). This will go on for couple of weeks and then she will plunge into a few weeks of trying to be 'normal' which while more restrictive in that she cuts out sweets / biscuits, is enough in terms of calories and nothing like what she was trying to survive on when she was underweight (taking one raw carrot to school in her lunch box etc)

(I tried contacting CAMHS to ask for help about the direction her eating disorder was taking but have had no reply)

However, any time she eats anything she bloats and is in pain which adds to her daily distress.

She has confided in me and I am trying my utmost to support her - not demonising any foods, regular meals, enough protein, enjoying some treats, regular gentle exercise, recognising your emotional triggers and coming up with ways to self soothe....

We were making progress but around Easter (and GCSEs really kicking in), all the wheels have come off and that I am getting very worried that she is really depressed - she has worn the same tracksuit all through the summer holidays, doesn't even wash her hair, is exhausted but does nothing all day.

As others have said, anti-depressants are not currently an option so all I can hope is that the private therapy will help - I'm aware it could take a year of more to do any good.....

Has she been tested for celiac or crohns?

@Touty celiac yes - negative blood test. They haven't mentionned Crohns. The only other examination they did was a gut transit test (where they track the passage of some special pills through the gut with X ray). That was in in January. They said that she did have very slow gut transit but they thought it would improve on its own and not to worry

Have you tested for allergies?

Try eliminating gluten.

Is the stomach kwashiorkor? Sounds like you need to address the ED.

It’s such a shame they won’t prescribe to under 18s, I went on anti-depressants at 16 for anorexia & they helped massively. Mind you that was nearly 30 years ago and I’m still on them now..
Any update? Do hope things have improved x