No prescription for BDD

I’ve been told more than a couple of times that negative body image is one of the last things to go in eating disorder recovery. Doesn’t that seem unfair? You want to think that you’ll feel better and be more accepting of yourself with the start of treatment, and that will motivate you to eat better and take care of yourself and move on past the disorder. And maybe at some point in treatment the nutrition kicks in and decreases the depression and anxiety that starvation heightens… but even then you can still be crawling out of your skin. In a more logical world, positive body image would precede recovery.

Today’s rant was inspired by this article on BDD (Body Dysmorphic Disorder) treatment… or really, lack-thereof. I find the suggestion of Prozac + psychotherapy a little depressing, and for a couple of reasons:

1. Prozac has not been proven to be effective for patients under 85% IBW.
2. Only half the people treated in the trial were even helped by Prozac.
3. I’ve been on Prozac and had psychotherapy!

Unfortunately I don’t have any clever suggestions for treating BDD. I’ve never found a body image group to be particularly helpful. The only thing that has helped me is weight maintenance. Even if you can’t stand your weight, maintaining feels a lot better than gaining. I feel too heavy no matter what my weight is. But… there is some relief in being able to wake up and put on the same pair of jeans that you did last week. Somehow being able to cognitively rationalize that I did not gain 10 lbs over night puts my mind at ease, just a little bit…

I don’t really see BDD being an aggressively-pursued area of research in the near future… but wow do I wish something revolutionary would be unearthed.

Puppies, Prozac and Carl Rogers

I was doing some Christmas shopping online at Amazon this morning (free shipping AND free gift wrapping? I’m sold.) and I ran across this book: “Puppy Chow is Better Than Prozac”

I’ve read plenty of books on the healing power of pets (and I completely believe in pet therapy) but never a book on pets and Bipolar disorder. Now I haven’t purchased this yet (I assure you that it IS in my shopping cart, though), so I can’t review the book… but it did get me thinking about pets and recovery.

I remember two girls who were inpatient with me getting puppies as soon as they were discharged. At the time I was thinking,

1. Was this some kind of reward for completing treatment?
2. Are the puppies supposed to keep the girls happy & therefore less likely to relapse (some kind of logic that family/friends would use)
3. Or, were their families planning on getting dogs, anyway?

Or… maybe I was just jealous and trying to invent a way to convince my parents to get a puppy.

Anyway, after my junior year in college I decided to get a puppy. My roommates were gone for the summer, my boyfriend was a resident and scheduled to work in the ICU for the next three months, and my summer internship only was only in the mornings. So, for all of these reasons (maybe I should also mention that I was supposed to be studying for the MCAT and thought a pet would be a good study buddy — ha!), I decided to get a puppy. While I thought just having the companionship would be helpful, there were a couple of other things that hit me after a couple of weeks with him:

1. He needed to eat & go outside every couple of hours (he’s a yorkie and you have to be careful of hypoglycemia when they are little). This means I had to stop what I was doing every couple of hours and feed/walk him. At the time I was often, “too busy to sit down and eat,” so this was a bit of an unanticipated shock. It was important to stop and take care of him. What does that mean re: making time to take care of myself?
2. I am his mom (well, you know what I mean). No one else in the world is going to take care of him. I am the only one that he has to rely on. If he’s hungry, lonely, tired, whatever–I am the only one who knows that. This little tiny puppy is trusting me to take care of him. He NEEDS me. I am needed!
3. He loves me unconditionally. I don’t have to be afraid of screwing up the relationship — which is good, because I can’t run away from it if I do think I’ve ruined it. He doesn’t care about my weight, my job, my reputation, etc. He loves me because I am me, and just wants me to be there.

I know these are all such basic ideas, but everyday life and relationships with others can be so complicated. I had all of these excuses for each of these points…

“Taking care of myself is not important to the rest of the world — it’s not an excuse for not living up to expectations.”

“I am replaceable — No one really needs ME.”

“I am not enough and I ask for too much… there is always the risk that I could ask for something that I don’t deserve, and then I will wreck the relationship.”

So, in summary: What is it about the relationship with my dog that helps me question my distorted beliefs? Well maybe it’s positive regard. Really, this whole relationship seems a little Carl Rogers to me. The incongruence between the “real self” (who I genuinely am) and “ideal self” (who I think I should be) which is the result of my quest for positive regard. My construction of inadequate defense mechanisms in an attempt to feel less threatened or vulnerable. The ensuing neuroses 🙂

If only I had realized earlier that a PET would give me positive regard and allow me to realize my genuine, authentic self!

Excusing some of the sarcasm in that last statement, I do think that there is something to be said for positive regard and the unconditional love that you get from your pet.

I’ve heard Prozac is in the water, but not Over The Counter

This article came out last week, but just caught my article today: Prozac Over the Counter? – TIME

The article makes some great points, so I definitely recommend reading it… but I of course have to give my two cents.

Why do I think that Prozac should NOT be OTC?  Well, my biggest concern, is that depressed individuals who would take OTC Prozac would not seek the help that they need — and they may very likely need MORE help than just an SSRI.  It’s hard to seek mental health treatment — while depression has become so common these days, there’s still a stigma attached to it.  If you could just go to the drug store and pick up some antidepressants, then you don’t have to take that first asking-for-help step.  Suicide rates are going to rise, because so many cases of depression are going to go unreported.  And this isn’t because they’re going to take the OTC Prozac and feel better — it’s because they’re going to think that a Psychiatrist can’t do any more for them.

Pills don’t make problems with psychological components go away. Take diet pills for example — they clearly have not ended the obesity epidemic or cured people suffering from binge eating.  They have caused a lot of heart attacks, though.

Do I think that it should be hard to get antidepressants?  No.  Do I think they should be basically free?  Yes.  (and Prozac practically is at Walmart!  Still waiting for the day when Wellbutrin is on the $4 med list… the day may never come…)  I do think it should SSRIs should stay prescription, though, because I think that someone should be somehow monitoring you at least a couple of times a year.

I've heard Prozac is in the water, but not Over The Counter

This article came out last week, but just caught my article today: Prozac Over the Counter? – TIME

The article makes some great points, so I definitely recommend reading it… but I of course have to give my two cents.

Why do I think that Prozac should NOT be OTC?  Well, my biggest concern, is that depressed individuals who would take OTC Prozac would not seek the help that they need — and they may very likely need MORE help than just an SSRI.  It’s hard to seek mental health treatment — while depression has become so common these days, there’s still a stigma attached to it.  If you could just go to the drug store and pick up some antidepressants, then you don’t have to take that first asking-for-help step.  Suicide rates are going to rise, because so many cases of depression are going to go unreported.  And this isn’t because they’re going to take the OTC Prozac and feel better — it’s because they’re going to think that a Psychiatrist can’t do any more for them.

Pills don’t make problems with psychological components go away. Take diet pills for example — they clearly have not ended the obesity epidemic or cured people suffering from binge eating.  They have caused a lot of heart attacks, though.

Do I think that it should be hard to get antidepressants?  No.  Do I think they should be basically free?  Yes.  (and Prozac practically is at Walmart!  Still waiting for the day when Wellbutrin is on the $4 med list… the day may never come…)  I do think it should SSRIs should stay prescription, though, because I think that someone should be somehow monitoring you at least a couple of times a year.