I can't eat. Please advise.
September 29, 2013 6:16 AM   Subscribe

My depression took a turn for the worse a couple of weeks ago and I've barely been able to eat anything. This is bad for my psychiatric as well as physical health. I could really use some advice on how to take care of myself despite my loss of appetite.

Gory details here.

First, background: I've struggled with serious depression for a long time, and it took a long time to develop a medication regimen that made even the slightest dent in it. I am on a combination of drugs that is the result of some pretty intricate tinkering and the counsel of a lot of Expert Opinions, and I'm probably as well medicated as I can possibly be.

Then, the turn for the worse: Nonetheless, being medicated doesn't make me immune to difficult and painful feelings. I have had a lot of extreme setbacks in the past year and have been feeling pretty bad about life because of it, but about two weeks ago I became dramatically more depressed. Nothing really precipitated it; I think I just am very worn down by my situation (short summary: nearly 40, unemployed, without children or partner, and living with my parents) and am having more and more trouble coping.

The problem: For the past two weeks, I can barely bring myself to eat. I have no appetite. I don't feel hungry. I get no pleasure from food and trying to eat something feels laborious. I have to make a concerted effort to get down a few bites of, say, salmon or something else that's nutritive, and then I can't seem to force myself to eat any more. I have been eating some oatmeal in the morning and try to get down a hard boiled egg or something like that at some point during the day, and then can stomach a slice of bread or so at night. This has been accompanied by more general anhedonia (failure to get pleasure out of things), having a hard time bringing myself to do basic stuff like shower, being overwhelmed by minor tasks, finding interacting with people exhausting, and generally being unable to do much except the very minimum.

This is unprecedented. In the past, during bad periods, I tended to overeat and engage in emotional eating, and I've always had a very active appetite regardless of how much physical activity I'm engaging in. I'm the kind of person who carries a bag of almonds everywhere in case I suddenly need to nosh, which is usually pretty frequently. I am generally on the slimmer side of things but not extremely so.

I know this is a really bad thing. Eating properly is part of basic self-care, and not eating enough of a healthy diet is bad for you mentally and physically. I don't think I've lost weight- historically, my body has stuck pretty stubbornly to the same number on the scale, and my clothes feel the same- but I feel awful. I'm freezing all the time. My body aches. I look awful. Every day I feel like I've pulled an all-nighter even though I'm oversleeping (10-12 hours a night). I'm sure the lack of calories is not helping either my mood or my motivation. Strangely enough I'm not feeling lightheaded or faint, and I don't have an explanation for that.

I have an appointment to see my psychiatrist next Weds. but I'm not sure how much help he can offer other than state the obvious, which is that I'm depressed. I hoped folks here might have some ideas about how to stimulate my appetite and do better at eating.

Some data points: I have recently had my thyroid checked and it's normal. For reference, I take Welbutrin, Trazadone, Trilafon, and Zoloft. I really don't like the sensation of being high so I don't think buying myself a nickel bag to give myself the munchies is a good option (I also am painfully clueless as to how one would go about purchasing drugs).

I really appreciate your thoughts.
posted by anonymous to Health & Fitness (26 answers total) 13 users marked this as a favorite
 
Buy a bunch of pre-made meal replacement shakes. Just swig one down every few hours. For 10 seconds of effort you could get some balanced nutrition.

You haven't mentioned a therapist. If you don't have one, you need one ASAP. Call your psychiatrist for a referral and make an appointment immediately. Medication + therapy works better than medication alone -- studies have shown this.

If you enjoy writing or any kind of art, try putting your experience of depression down in it in as poignant and poetic a way as you can. It's a proven way to experience happiness again.
posted by shivohum at 6:30 AM on September 29, 2013 [10 favorites]


I think you need to see your psychiatrist or another doctor much sooner. Call your psychiatrist, describe what is happening, and perhaps they will see you sooner or refer you to a doctor who can.

Hang in there.
posted by mzwz at 6:32 AM on September 29, 2013 [4 favorites]


I've been there, and I'm usually a comfort eater too, so I know how weird it can be.

If eating is too hard, what about drinking? Do you think you could drink a protein shake or carnation instant breakfast? Even milk/soy milk/etc.? That will get you protein and calories. Take a bit of care to get fiber or take a laxative if you only drink protein (I speak from painful experience).
posted by cabingirl at 6:32 AM on September 29, 2013 [1 favorite]


How are you about drinking? Perhaps you could keep something like bottles of Boost handy, so you can get some nutrition?

I commiserate on the long-term depression. I'm going on 50 years now.
posted by Thorzdad at 6:33 AM on September 29, 2013 [1 favorite]


Should have added, a fiber pill with the shake would be enough.
posted by cabingirl at 6:33 AM on September 29, 2013


I have gotten like that before.

What helped was sticking to fatty, high-calorie foods--forget about nutrition for now, eating junk for a week isn't going to harm your health. Basically if you can only stand to take five or ten bites at a time, make them as calorically dense as possible. Peanut butter, ice cream, rice pudding, five bites of a cheeseburger--whatever. Supplement with a can or two of Ensure.

Also, it helps for me to make a deal with myself to eat X bites every two hours, even if I'm not hungry.

Hang in there.
posted by elizeh at 6:33 AM on September 29, 2013 [11 favorites]


First: so sorry you're dealing with this, and sending good thoughts your way. It sounds like you already know a lot about self-care, and what does and doesn't work for you.

In reading your description, there are a few things that make me wonder if there's an underlying physical cause, notably the lack of appetite (which is not normal for you) and a lack weight loss while feeling cold and having body aches.

You said you've had your thyroid checked, but you may want to go back to a doctor for a full blood panel, or an endocrinologist if you can. Maybe adrenals or mono?

Food-wise, calorie-rich smoothies with honey, fruit and peanut butter can be eaten in small sips or spoonfuls and stored in the freezer for thawing. When I don't feel like eating, I often make little batches of different finger foods - boiled eggs, guacamole, peanut-butter crackers, cut-up fruit - and eat them mid-morning or mid-afternoon. Anything that doesn't feel like a "mealtime" and make me feel that I'm forcing myself to eat.

Best wishes to you.
posted by Occam's Aftershave at 6:41 AM on September 29, 2013 [2 favorites]


as everyone else is saying, when i'm at this point, it's all meal replacement shakes and, as elizeh says, maybe some junk food.
posted by nadawi at 6:41 AM on September 29, 2013 [2 favorites]


Sorry you're going going through this :( smoothies might work - just add fruit, milk, oats and nuts to taste. Also, icypoles can be easy to take when you don't have an appetite
posted by lifethatihavenotlivedyet at 6:46 AM on September 29, 2013


Nthing the meal replacement shakes. Presumably you still have a thirst drive or you'd be dead by now.
posted by Jacqueline at 7:09 AM on September 29, 2013


If it's possible, can you see a general practitioner in addition to your psychiatrist?

There may be some other health issue at play here. In particular, feeling very cold and tired could be a thyroid problem.

Hang tight, I know how hard depression can be.
posted by mai at 7:11 AM on September 29, 2013


Ooh I missed you last sentence about having your thyroid checked. Sorry.
posted by mai at 7:12 AM on September 29, 2013


Something to think about is whether the not eating is causing physical problems, or whether more of the distress is being caused by your depression chiding you about it. Our bodies are pretty resilient when it comes to limiting intake. The little bit you're eating now really is fine, for now.

I mean, I don't want to imply it's not distressing, and don't want to imply that there's no physical issue, etc....this is depression we're talking about, and it comes with a host of complications, obviously. And you want to get it checked out as soon as possible.

But just don't beat yourself up for not having an appetite, you know? If you can manage to fit in some kind of shake or something that is palatable, go for it. Anything that would appeal...if you drink coffee, add a bit more sugar and cream. Add a little fruit to the oatmeal, a little more butter to the bread at night. But, speaking as someone who went a couple months eating nothing but brown sugar and cinnamon pop tarts during a particularly awful bout of depression, I can say that your body can survive a lot of dietary things, even if your mind is telling you the whole time that something is really really really really wrong.
posted by mittens at 7:20 AM on September 29, 2013 [1 favorite]


I believe Wellbutrin can act as an appetite suppressant in some people. That might be something to talk to your doc about.
posted by LobsterMitten at 7:32 AM on September 29, 2013 [2 favorites]


Can you eat a bit of banana or drink some orange juice? The potassium in them might help with your appetite.

Other than that, can you get into some sun and/or go for a walk?

(Try these AFTER you get a call in to your practitioner, as they need to know what you are up against here.)
posted by St. Alia of the Bunnies at 8:05 AM on September 29, 2013


Are you drinking enough fluid? Being mildly dehydrated can cause appetite loss, also add to fuzzy thinking and make you feel tired and irritable none of which I imagine would help depression.
posted by wwax at 8:19 AM on September 29, 2013 [1 favorite]


Hey. I feel really bad for you, and this is hardly an answer to your question, since I don't have an answer - just sympathy. When I think back on my worst depressive time, the thing that to this day makes me tear up, is remembering being in a cozy pub and ordering what was my absolute comfort food, a junky nutritional splurge knowing that gooey fatty food has always been my go-to to feel better - a fancy grilled cheese sandwich on white crusty bread with 3 kinds of cheese in it, with not just fries but a bowl of soup. It arrived, and I took a bite, and it was like cardboard in my mouth, and I just wasn't interested in eating it. I couldn't get up any enthusiasm at all, and this was supposed to be one of my absolute favorite emotional treat meals, the thing that I'd ordered knowing that I just couldn't face a plate of meat or vegetables; all I could do was go back to the restroom and cry. Reading your post makes me realize how lucky I was that this was the experience that made me start on medication, rather than something that was ongoing when the meds were as good as the doctor could make them. I'd like to think that your meds could do better, but of course you and your doc know the situation best; still, be sure you explain at your appointment that things are definitely not working as well as you'd like.

The above suggestions sound good. Drink plenty of water for hydration, or juice or ideally protein shakes if you can manage it. Go to the grocery or pharmacy and get a can each of their nutrient drinks - the carnation instant breakfast, the Ensure, even the slimfast or Pediasure - basically anything that is designed to get nutrients into the body and might not taste just like the other brands. That way, you can work your way through the collection with the sense that you're trying a lot of options; one thing that helped me was to feel like I was taking control of the situation in one way or another, and a methodical march through various nutrient shakes might've been just entertaining enough to be possible.

Good luck; I'm impressed with your fortitude and your will to take care of yourself.
posted by aimedwander at 8:40 AM on September 29, 2013 [12 favorites]


Reiterating what a few other people have said, because I know from experience it can be helpful to hear things multiple times when you're depressed!

* You're doing the best you can. Every time you want to judge yourself harshly, either for not eating or for being more depressed, tell yourself (out loud if possible), "I'm doing the best I can right now, and that's enough." Say it as many times as you need to in order to stop the judgmental thoughts in the moment.

* Forget about nutrition right now. Eat or drink anything that you think you can get down. It's ok -- you're doing the best you can right now, and that's enough.

* If you can get in to see your psychiatrist sooner, I would try to do so. If the only thing he says is, "Welp, you're depressed! Not much else I can do!" then you have my permission to kick him in the shins and find a new psychiatrist.

* If you don't have a therapist, please ask your psychiatrist for referrals or go back to a therapist with whom you've worked in the past. You're being really hard on yourself in the way you wrote this question, and having someone coach you through how to look at the situation more realistically and compassionately would very likely help right now.
posted by jaguar at 10:29 AM on September 29, 2013


Everyone has covered most of what I was going to say, but one thing that has helped me in times of not being able to eat is protein-boosted chicken soup. Drinking a mug of warm broth can feel easier (and more comforting, to me) than drinking a shake-type thing.

Also, I put sriracha in it.
posted by Sidhedevil at 10:37 AM on September 29, 2013


I think this is a bit of a trick question. I think this question is set up to reinforce your depressive spiral.

See, not eating is a way to demonstrate to yourself three times a day that you are a fail at the basic tasks of life. Identifying the not eating as a symptom of worsening depression and setting a doctor's appointment are excellent signs of self-awareness and it's this instinct that will help you get better.

Asking a bunch of internet strangers for help with eating - what happens if you don't follow through on any of this advice? Does it push you further down the "I suck at everything" path? Does it actually make it worse ("why should people even bother trying to help me, I suck at everything even eating!"). Also if eating is making you physically uncomfortable, forcing yourself to eat will also make you feel worse ("I deserve not to live if I can't even eat to keep myself alive!")

My suggestion is to forget eating for now. It's not a problem, it's just a symptom. The only thing you need to do is be as kind to yourself as possible while waiting for your doctor to help treat your depression.

In terms of acts of kindness that may help with the eating thing if you feel you must solve it. Try giving yourself a massage. If you like hippie folk remedies put peppermint essential oils into the massage oil and massage your abdomen. Alternatively, if you are a tea drinker, make yourself a hot cup of tea. Again, if you want to treat yourself like a nausea patient make ginger/honey/lemon tea. Don't go into any of these with the expectation that you'll feel like eating after. It's just a chance for you to do a nice thing for yourself.

But if you don't want to do those things, that's fine. Go do anything that is nice to yourself. Go have a nice hot bath. Curl up under 500 blankets and watch your favourite movie on Netflix. Whatever. You are sick right now. Just be as gentle as possible until you feel a bit better.
posted by crazycanuck at 10:39 AM on September 29, 2013 [10 favorites]


Nth'ing meal replacement shakes. Specifically Ensure Complete. You can live on those and nothing else if you need to (so says my dietitian mother-in-law) and that version has some fiber in it so it won't mess up your bowels.

Although I like cooking up something tasty for dinner, I hate dealing with lunch. I don't like eating it, I hate having to get up and make something for myself, I don't care what it tastes like, I don't like having to decide what to have, I don't want to worry about how much I eat, I just don't want to bother with is. The only reason I eat lunch at all is because I feel hungry and tired all afternoon if I don't. I imagine that some of that resonates with you.

Instead, I know that I'm going to have one of these shakes for lunch every weekday, I know that they have the right amounts of everything my body needs, it won't be to much or to little, it tastes just fine, and I can chug the thing in about 5 seconds and be done with it. I don't get hungry again for 4-5 hours and I don't have worry about what I'm putting in my body.

I've switched to Slimfast shakes because they're a lot cheaper and are the only powdered shake mix I could find that had fiber in it. They're lower calorie per serving but they're otherwise pretty close nutritionally. But, you have to mix them with milk and you'd have to drink a lot more of them to get enough calories.

You're still just treating a symptom but it's a symptom that can cause some negative feedback on the root problem so meal replacement shakes might help you to get well enough that you can eat some real food again.

I also wonder if it might be worth a call to your doctor. You might be able to get a prescription or something to get your health insurance to help pay for the shakes or something.
posted by VTX at 12:08 PM on September 29, 2013


When she first started it, Wellbutrin gave the girlfriend some nausea and appetite problems, much like what you seem to be experiencing. (We lived together, and trying to find food that she could eat was...unpleasant for both of us.) The Nurse Practitioner she saw for meds was able to give her something to increase her appetite. After a few months, she went off it, and has been eating pretty happily since then.

Takeaways:

1) This could absolutely be a medication or meds + depression issue. It isn't necessarily either a sign that you have other health problems or a sign that your depression is worse than ever.

2) Even if it is a meds issue, it doesn't mean that you will have to discontinue otherwise-helpful medication. Modern medicine has been really good at finding meds with appetite-increasing side effects.

Hang in there! Things will get better.
posted by catalytics at 12:37 PM on September 29, 2013


The problem: For the past two weeks, I can barely bring myself to eat. I have no appetite. I don't feel hungry. I get no pleasure from food and trying to eat something feels laborious. I have to make a concerted effort to get down a few bites of, say, salmon or something else that's nutritive, and then I can't seem to force myself to eat any more. I have been eating some oatmeal in the morning and try to get down a hard boiled egg or something like that at some point during the day, and then can stomach a slice of bread or so at night. This has been accompanied by more general anhedonia (failure to get pleasure out of things), having a hard time bringing myself to do basic stuff like shower, being overwhelmed by minor tasks, finding interacting with people exhausting, and generally being unable to do much except the very minimum.

One thing to consider is that eating IS a chore and shouldn't always be pleasurable. Don't expect food to make you happy, because it never will. You are just setting yourself up for disappointment. Figure out what you need to meet your nutritional needs, and eat that. For example: I sometimes have trouble deciding what to eat. In those cases, I have a couple of go-to meals that are more or less nutritious that will keep me going. A hamburger with everything, chicken tenders meal with beans, Subway sandwich, etc. Having those ideas at the ready in case I get indecisive it really helpful.

The other thing to consider is that you might just be sick with the flu or something.

See if your doctor would recommend switching to Prozac from the Zoloft. I think (myself included) people find it to be less sedating.

And cognitive behavioral therapy should be something to look into.
posted by gjc at 12:44 PM on September 29, 2013 [2 favorites]


If what you could use is help motivating yourself to consume some calories, consider this: if you go long enough eating nothing much, you may start waking up half an hour (or longer) after passing out at the onset of a hypoglycemic seizure. If you experience this in the same way as the person I'm thinking of it'll occur without any precursors or warning, you'll just find yourself stretched out on the floor when it's all over.
posted by mr. digits at 3:24 PM on September 29, 2013


I've been through something similar (though less intense), and what I did to force myself to eat was bake cookies and eat them. The act of baking and creating something to take care of myself was helpful, and eating baked goods was the only thing I could stomach at the time. And I got to try a couple of new recipes, when normally I would have felt it was unnecessary to bake and eat sweets.
posted by never.was.and.never.will.be. at 4:18 PM on September 29, 2013 [2 favorites]


Meal replacement shakes are probably the best solution to this (bear in mind that ideally you want higher calorie ones, not weightloss ones) but my go-to simple recommendation for this sort of situation is yoghurt. It may not be pleasant to eat, but it's nutritious, easy to swallow, and sort of sits easily in the stomach (when I am very depressed the feeling of having food in my stomach is strange, I don't know if you're the same). You should try to see a mental health professional as soon as possible, because not eating is one of the points where maybe a higher intensity of care needs to kick in.
posted by Acheman at 3:37 AM on September 30, 2013


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