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Fat pills for the fatty
April 25, 2011 10:06 AM   Subscribe

I suspect I have Body Dysmorphic Disorder and Avoidant Personality Disorder. My current psychiatrist is only treating me for Social Anxiety/selective mutism. During our first session he did not focus on what I consider to be the disorders causing me to remain homebound and avoidant of people.

He abruptly took me off the Zoloft (100 mg) my PCP and another psychiatrist from a psychiatric unit prescribed me, and he put me on two medications known to cause weight gain (Remeron and Paxil) even though I'm 100 lbs overweight and have hypothyroidism. Why? Because I checked that I've been experiencing "unintended weight loss" and "a decrease in appetite" on the form and told him probably very inarticulately on paper about my unconventional sleeping habits (I sleep during the day and feel my most energetic at night).

I took the medication for almost a week, overslept not only in the day but also in the night, felt extremely anxious about gaining back the weight I lost, and eventually flushed the medication down the toilet after I gained 5 lbs. I also read other people's experience on these medications, which did not help. For the first time in months I cried like a baby and thought about giving up.

The question: How do I tell my seemingly anti-Zoloft psychiatrist I refused to take these medications and that I want to give Zoloft another try with his current Klonopin dose?

I'm realizing the benefits of Zoloft since he took me off of it. I regret stupidly telling him I didn't notice much of a benefit taking Zoloft except that I was more abrasive with family members, which, now that I think back on it, was probably a good thing for me. Since I'm no longer on Zoloft I'm also starting to realize I wasn't suicidally depressed about my physical defects, even though I still had intrusive thoughts about them and thought about plastic surgery often. I also didn't experience a decrease* or increase in appetite or any other adverse side effects from taking the medication. However, I was still a selective mute and mildly anxious, but I believe with the proper dose of Klonopin with Zoloft I'd be able to talk.

I'm too ashamed to go back in two weeks. I'm also contemplating not taking the Klonopin as well only because I'm worried he'll think I'm a substance abuser and only went to him for the Klonopin. I was falsely accused of abusing Klonopin and alcohol in January (I wasn't) because an ARNP volunteering at a then not-for-profit organization took an e-mail of mine out of context. I told her I was depressed about the organization losing their funding and that I couldn't afford future counseling sessions, thus leaving me back where I started: homebound and friendless. I agreed to go to "the hospital" anyway because at the time I didn't have insurance and the organization led me to believe my sibling and I would get the medical attention we needed while we were in the psychiatric unit getting our medication properly adjusted. They also told us they'd take our counselors away if we didn't comply, so I felt I had no choice. Let's just say we didn't go to a facility that could give us medical treatment and leave it at that. I hate telling the story. The whole experience was absolutely traumatic for reasons I'd rather nor delve into and it, the false reputation, continues to haunt me every time I see a doctor or psychiatrist. Fortunately, my PCP is finally starting to believe I'm not a substance abuser, which is why I don't want to take the Klonopin when I'm not taking the other medication the psychiatrist prescribed me. I want to keep her trust.

I don't know what to do. I know I'm making a mistake. Should I just go to my PCP, explain the situation, and ask her to re-fill my Zoloft prescription?

*I was already intuitively eating a lot of protein a month prior to taking Zoloft. This would explain the decrease in appetite.
posted by anonymous to Health & Fitness (13 answers total) 6 users marked this as a favorite
 
Surely your psychiatrist is used to people changing medicines all the time. Finding the right drugs and dosages is hard. Perhaps your anxiety is making you feel like this is a bigger deal than it is?

Print out this question and take it to your psychiatrist ASAP. If that psychiatrist won't listen to you, or doesn't want you to return to Zoloft (and can't explain to you why in a convincing manner), go back to your PCP ASAP and get a recommendation for a new psychiatrist.

(I know nothing about these drugs, but it seems to me that if you are going to NOT do what a doctor has prescribed for you, you should go back to that doctor as soon as possible to find a different solution/discuss it with them. Clearly you should not be unmedicated.)

Hang in there!
posted by dpx.mfx at 10:12 AM on April 25, 2011 [1 favorite]


Based on your description, it seems like your psychiatrist is using some "cookie cutter" treatment choices for you. Some of this might be just because he doesn't know you all that well. Or, he might have a reason for it that he hasn't told you. Another possibility is that he's not really very good at what he does.

I think that you need to try your best to tell him what you've told us, and see if you can work something out. In particular, stress the new things you've learned since stopping the Zoloft.

If you feel like the doctor isn't really listening, then you should find another one. But, give this one a shot to explain himself clearly, first.

One last thing: Don't consider yourself "friendless". There are good people here who are happy to lend you a hand in what way we can.

I hope that things feel much better for you soon!
posted by Citrus at 10:23 AM on April 25, 2011 [1 favorite]


You're doing a good job of getting help and you are trying to make the best decisions for you. Your proactive attitude and your persistence in the face of difficulty is something that you can be proud of.

My doctors have always been willing to change my medications if I feel that the side effects are intolerable. They are used to patients who don't take their meds, hate their meds, or want to go on different meds. Especially with SSRIs and weight gain--it's up there with sexual dysfunction as a common reason to flush the SSRIs down the toilet.

You can also communicate that you felt better on the Zoloft but didn't realize it until you got off of it.

I have taken stimulants for ADHD and benzodiazapenes like klonopin, and I've never had a psychiatrist seriously worry that I was "just" getting them to abuse them. There are some red flags that they look for, but just wanting to be on klonopin and not an anti-depressant is not a red flag. It's totally normal to have preferences about medications and to prefer something like klonopin that is so effective at relieving anxiety.

HOWEVER! If you're not comfortable with this psychiatrist, going back to your PCP is a good idea. If they're willing to put you back on the Zoloft and recommend another psychiatrist, that is even better.
posted by the young rope-rider at 10:33 AM on April 25, 2011 [1 favorite]


The tough part here is that it seems you need an advocate you can trust who has a good idea of your "baseline." For some people, that's a PCP, but it seems like you're not quite at that point with your PCP yet. However, it sounds like you've got a good start.

If you're nervous about talking to people/confrontation, etc., writing things down can be a big help. You can get your thoughts in order, and you can also hand your thoughts to someone instead of trying to remember what's more important or psyching yourself up to talk about something tough.

Do this for yourself/your desired outcome. Also do this as a record of what the psychiatrist has said or done so you can point to the parts that don't fly with you right now. I agree with the posters above: give the doctor a chance to explain, but if it doesn't sit right with you, go back to your PCP and make a change.

Yes, you have friends and resources here. More people have been in your situation (or had similar experiences) than you'd imagine, and WAY more people want to help.

Personally, I'm really proud of you that you've taken these steps to make things better for yourself, even though they might not be working out as you'd hoped. And hey -- I don't even know who you are! I just know how hard it's been for me to do that kind of stuff sometimes, and I can imagine the inner resources it took for you to go for it. You can do this: one step at a time.
posted by Madamina at 10:33 AM on April 25, 2011


Personality disorders like avoidant are difficult to diagnose, especially if you have a hard time expressing yourself with strangers. I would suggest looking for a therapist who specializes in body image disorders or personality disorders. A person who is not experienced with these disorders may have a harder time recognizing them and/or treating them. I had body image problems for years, wound up with a great therapist who had tons of experience and got much much better over the course of a few months.

Sometimes the right fit is the most important thing about psychology/psychiatry. If you're not comfortable with your meds and/or your course of treatment, its within your rights as a patient to say something and expect some changes, or a very good reason why they won't change things. You may also wish to find a doctor you are more comfortable with. Best of luck to you, you can memail me if you want with questions. You have no reason to be ashamed about your reaction, its perfectly ok to not feel comfortable with the first practitioner you see. And a good doctor won't take it personally either.
posted by gilsonal at 10:34 AM on April 25, 2011


"it seems to me that if you are going to NOT do what a doctor has prescribed for you, you should go back to that doctor as soon as possible to find a different solution/discuss it with them."

Yes, this is a good point. At times I have seen my psychiatrist once a week for medication adjustments, which I hated, but it's what I needed at the time to get myself adjusted and make sure I got the help I need.

Going for weeks in this state of limbo can't be helping your anxiety, either! I know that anticipating the conversation for weeks (especially with a controlled substance involved) would make me miserable so I used to just suck it up and go in ASAP. That day, if possible.

Of course, I am not you, so use your judgment!
posted by the young rope-rider at 10:38 AM on April 25, 2011


And a final note about your diagnoses--Avoidant Personality Disorder doesn't have a whole lot of science behind it, in terms of having a specific course of treatment that has been tested in an empirical way. It's not really a consistent diagnosis (meaning that whether or not you get diagnosed with it depends highly on who is doing the diagnosis). I know it's in the DSM-IV, but a lot of the personality disorders in there are really unscientific and arbitrary.

Its symptoms overlap significantly with other disorders (like social anxiety) that are much more commonly and consistently diagnosable and treatable on the basis of evidence. Social anxiety also has less permanence to it, and hope is a good thing. So, given that it's a subjective difference anyway it makes sense to diagnose you with the problem that has a better "road map" for treatment.

I can't speak to Body Dysmorphic Disorder because it is not something I have read much about. How would the treatment for that differ from the treatment you're getting right now? If the difference would be significant and you feel like it would help you function, then it is definitely worth asking for the treatment that you need.
posted by the young rope-rider at 10:54 AM on April 25, 2011 [1 favorite]


It's only been one session. The second session will be a lot better because both of you will be able to draw course from the fusion of your energy (especially you).
posted by parmanparman at 11:04 AM on April 25, 2011 [1 favorite]


I hate to do this, OP, but I tried typing out a response to this and too much of it was getting publicly into my medical issues and the psychiatric issues of a close friend whose experiences are relevant... but I'd be happy to share with you personally if you MeMail me. If you get a mod to post an anonymous address, I'll watch here to mail you, too.

I can however give a few rules of thumb:
1. PCPs are not good for anything in this vein beyond garden-variety depression. You definitely should not be seeing a PCP for this.
2. Zoloft is an SSRI, just like Paxil, and can cause weight gain, just like Paxil. Paxil would probably do you just as well. But they all take awhile to kick in.
3. You have nothing to be ashamed about, psychiatrists are totally used to patients who have trouble with medication adjustments and compliance and you will not be the worst thing they've seen by a long shot.
4. A scale is the worst thing you can possibly own when your mental state is tied up with your weight.

Hang in there. Things will get better. I have *seen* people get better who sounded like you do now, so that's not just false hope.
posted by gracedissolved at 12:15 PM on April 25, 2011


Zoloft seems to cause less weight gain than the other SSRIs. If the OP was happy on Zoloft and the psych couldn't give her a decent reason as to why he took her off of it, then I would look for a second opinion.
posted by elsietheeel at 2:33 PM on April 25, 2011


Beware the Klonopin! I have a lot in common with you, and the klonopin made me sleep a lot. It was wonderful sleep, but it HAD TO HAPPEN every afternoon. I got switched to Xanax, which has a much shorter half-life than Klonopin, and I was able to be awake again.

You can memail me if you want.

Also, check out the forums at crazymeds.us -- they are knowledgable and kind.
posted by MeiraV at 4:32 PM on April 25, 2011


Wellbutrin is a different type of antidepressant and for many people causes weight loss.
posted by Jacqueline at 9:37 PM on April 25, 2011


Just to check, are you being treated for the hypothyroidism? Being properly treated for that is the best place to start, and it's a straightforward thing to fix.
posted by Zarkonnen at 11:42 PM on April 25, 2011


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