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ED Anxiety treatment is not working

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Dorrie2553

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I had eating disorder symptoms as young as age 9 (2015) but my anorexia really did blossom by the age of 14 years (2020) when I was diagnosed with anorexia nervosa. In December 2022 (bear in mind I was very underweight at the time and eating 1200-1500 calories a day) I started getting increasingly prevalent thoughts (or anxiety and paranoia) about calories. It got to the point in which eating anything would induce a massive panic attack and I wouldn't eat anything that had to be prepared (such as toast or microwaveable ready meals) other than pot noodles which I felt comfortable eating for some reason or anything that had to be kept in the refrigerator (such as salad, yoghurt, or almond milk). I wouldn't drink any kind of hot drink because I feared the mug would be laced with thousands of invisible calories. I wouldn't drink diet coke because I feared it would actually contain full-sugar coca cola (caused by incidents in 2021 where I ordered diet coke from McDonald's but received full-sugar coke instead by accident). I discussed this anxiety with the eating disorder team and I was prescribed 2.5mg daily olanzapine. Initially (combined with eating a sufficient amount of calories and gaining to a healthier weight) the olanzapine helped, but as of December 2023 (taking 5mg daily olanzapine. My tolerance has probably increased and I smoke cigarettes regularly, and as far as I'm aware smoking reduces the amount of olanzapine absorbed) I am constantly anxious, but about different things. I am still anxious about my weight, but to a lesser extent. I am a lot more anxious about other things, especially my physical health and what happens after death as well as how others perceive me (I worry that people think I'm stupid, naive, childish and cringeworthy and not thin enough, not smart enough, not physically attractive enough, not cool enough).
In March 2023 I started smoking cannabis. Initially I would feel intense relaxation and euphoria and often appear hyperactive when under the influence. Whenever I smoke pot now I just get really paranoid that I'm dying and I find it harder to breathe.
Yesterday (December 20th) I smoked a joint and began panicking. I found it harder to breathe. I felt fine later that night, but the day after at 1.15pm I smoked a cigarette and found it harder to breathe. I had another cigarette at 5.20pm the same day and my symptoms got even worse. I went hysterical. I got so anxious that it became even harder to breathe, I was experiencing pain in my form, I experienced headaches, and I felt dizzy. In reflection, it sounds so stupid and impulsive of me because it was just cigarettes (I smoked a joint the day before, however) but I was so anxious that I was going to die that I called 111 and went to hospital. Doctors inspected my blood pressure, oxygen levels, etc; took samples of my blood; and performed an ECG; and everything was fine. By the time I got home my anxiety was no longer present and it was easier to breathe despite smoking another cigarette at 9.00pm. I worry that this is going to become more regular, that I get so anxious that I find it harder to breathe.
I feel so self-conscious just by making this post and elaborating on the crap I had done. It's so stupid of me to go to hospital for the stupidest of reasons. I am on the wrong medication. Olanzapine is not helping my anxiety at all. Neither is the talking therapy I have with my psychologists because I am too stupid to understand it. I want to speak to my GP about my anxiety but I have a feeling they will just ask me to discuss that with my psychologist or the eating disorder team, which doesn't work (I vaguely remember something like that happening in the past). How do I cope with anxiety? How can I access adequate treatment?
 
There’s potential for other medications to be of more assistance than the olazapine, so I’d talk to the prescribing doctor about trying something else.

There’s pretty solid evidence that nicotine makes anxiety worse, and that cannabis reliably makes anxiety worse (especially in teens). So that’s an easy way to reduce your anxiety.

There’s good evidence that regular cardio exercise helps.

There’s also good evidence that cbt-based therapies help.
 
the fashion link is the only thing standing between myself and an anorexia dx. my own tendency to starve myself is from childhood neglect and malnutrition. the absence of fashion motives makes the doctors reluctant to lump me in with hollywood bimbos, but the symptoms hit my radar as being near enough for empathy. the only intelligent medical dialogues i have had on the subject were with "third world" doctors in their home countries who are exposed to chronic malnutrition daily.

i tackle my own anxiety management on two separate fronts: physical and psychic. on the physical front, forgetting to eat, hydrate, exercise, etc., can trigger the lymphatic system to dose me with anxiety hormones. my chronically over-developed survival instincts will keep those hormone shots a-coming indefinitely. look up, "anxiety hormones." those are potent, mind-altering drugs that the anti-drug warriors would outlaw if they could. purging those chemicals from my system is top priority. i will have the competence of a meth head until i do. detox diets and vigorous exercise are my tools for this step.

then we get to the psychic half of the puzzle. . . alas, that piece is not so simple as a detox diet and vigorous exercise. . . ouch. . .
 
Unfortunately, we don’t always get to pick and choose between side effects.
I really like the feeling of being stoned, I just don't like the anxiety that comes with it.
Written another way, you’re basically saying: I like what happens when I smoke pot, I don’t like what happens when I smoke pot.

The answer to that not-a-real-problem is reeeeeeeally simple.
 
You might ask your ED team about Strattera.

It’s prescribed off-label for Anorexia (It’s an ADHD med), with the curious side effect of STOMPING on body-related anxiety, hyperfocus/hypervigilance, and the oh-so-useful to ED in that it doesn’t cause weight gain. Any weight loss/gain follows the indivudal’s diet/exercise/physiology.

Being someone with ADHD, PTSD, & an ED… I went ALL the way up to double the max dose, and dooooooown to the introductory dose for children (160 to 5). I, personally, got the same benefit to my ED on 5 as 160, but the effects on my ADHD carried tremendously. So it’s not something to sniff at, being kept at a low dose. You want the OOMPH, without the side effects. Personally, I got the BEST oomph, at the lowest doses available. Which made my docs ROFL, as I test off the charts, they were really expecting to be Rx’ing me at double the standard dose, and were cracked up that such a minimal dose got me everything I wanted. Other people? Find their best doses elsewhere, on the spectrum. Neurochem? Is wacky. More is often worse than better.)
 
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