BLOG No. THIRTY EIGHT

Welcome back to my blog on anxiety and depression. Today I would like to bring you a case study in anorexia nervosa. “Sara” was not my patient but was brought to me by a dietitian who was trying to help her with her anorexia. Sara was a 38-year-old mother of two children, who at the time, was estranged from her husband. She has severe anorexia and was under the care of a caseworker, who then enlisted the help of the dietitian. The patient’s doctor admitted that he knew nothing about anorexia and had no resources to help her, other than the social worker at his hospital.

Somehow, my name came up as a doctor who did a fair amount of psychiatry, even though I was a family doctor. And even I admitted, at the time I didn’t know much about anorexia. It was 15 years ago and I was just starting to learn about D2 dopamine and the symptoms that it caused.

Sarah had suffered through most of her life with anxiety and depression, however had not use medications to treat them. She had been married to a fighter pilot at the local Air Force Base, until he began having numerous affairs, not bothering much to cover his tracks. When she, in tears, finally confronted him regarding the affairs, his response was, “Because you got fat and I was no longer attracted to you!” Let that digest for a moment. A nice lady with anxiety and depression was then told she was unattractive and fat. It was her fault that her husband had numerous affairs. Suddenly, the chemistry in her brain just got more complicated. Remember, environment magnifies genetics. Maybe it is time for a joke break.

A panda walks into a bar and sits down. He orders some food and a beer and consumes them. When the waiter brings him the bill, he shoots the waiter in the shoulder. Then without paying, he starts to leave. The owner is incensed. “Where are you going? Why did you shoot my waiter?”

The panda shouts back, “I’m a panda, look it up!” So the owner grabs his computer and Google’s “panda”. A panda is a bear native to China that climbs trees, eats shoots, and leaves.

Okay, that joke is corny enough to make bourbon. But let’s get back to our story. Because Prozac was the only drug used to treat anorexia at the time, we began there. She did respond a little. She at least stopped losing weight, but would not gain any weight back. She bartered over or how many green beans she would eat with the dietitian at the next meal.

So after a few weeks, I knew we are missing a chemical. At the time I was speaking for Lilly pharmaceuticals on bipolar disorder, my first exposure to D2 dopamine. Though I knew Sarah was not bipolar, I realize she had some bipolar tendencies—racing thoughts, poor sleep, and lots of anxiety. So I added some samples of Zyprexa, at the time a novel direct D2 lowering agent.

A week later (D2 lowering agents work quickly) she looked at me and then looked at the dietitian and asked, “Why didn’t you tell me I was so skinny?” I exchanged smiles with the dietitian and never saw her again. Now, as I look back, I realize that she had a depersonalization disorder as well as obsessions and compulsions. Together, they made her anorexic.

Well, I am on a tiny plane to Wisconsin to visit a friend. There is nothing to eat or drink on the flight, including Chardonnay. The plane is cramped and very hot—and I am in coach, rubbing shoulders with a sumo wrestler (almost). All that, and they won’t let me use my cell phone to call the suicide hotline! So until next time, when we discuss hoarders (the condition not the show) this is Dr. G saying keep the faith!