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Concerta and unintentional weight loss

Hi,
I'm a 19 year old female in college. My psychiatrist on concerta about a week ago (18 mgs/day in the late morning) as a way to boost my concentration, lethargy, mild depression, motivation and poor cognitive functioning due to what I think are side effects of the mood stabilizer (lamitrogine) and anti-psychotic (ziprazidone, aka geodon) I'm on. I'm not ADD or ADHD (I'm "officially" diagnosed with bipolar type II, GAD, panic disorder, and I have been diagnosed with anorexia nervosa in the past) but since this is a drug primarily used for ADD I figure here is the place to post.

The concerta has actually been working extremely well and I'm really happy with the results, except for one major side effect- I never want to eat for the 12 hours that the drug is in my system. My lack of appetite is so bad that it is actually physically painful to consume anything except for small amounts of fruit punch kool-aid (i have NO idea why that is the only thing that I can eat right now, I don't even like drinking water); even if I put food in my mouth I feel like I am going to vomit. It is hard to even brush my teeth on the drug because toothpaste tastes like food. I'm afraid that I'm going to lose weight- I am currently 109 pounds and 5'6" tall (I have lost 4 pounds from 113 lbs that I weighed a week ago). I'm underweight already (although I naturally am underweight) and have extremely low body fat (about 11%), and any more weight loss would be dangerous. It could also spark my anorexia nervosa because it usually starts when I begin to eat less because of stress, and bad habits form when my love for numbers going down on a scale is sparked by weight loss.

Does anyone have any suggestions for how to keep my weight up? Is there anything I can do to counteract the extreme fullness I'm feeling? Should I just not be using this drug? I would love to keep taking it because I feel so much better than I did before.
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replied January 3rd, 2010
Hi verenaanne,

I understand what you are going through--I've had somewhat serious problems with disordered eating in the past (never diagnosed--my entire family is obese so when my eating is messed up I'm still a "normal" weight so I get congratulated, not accused of anorexia), and I'd totally conquered this and even made peace with the fact that I will probably always be overweight if I'm not starving myself. Then a medical condition popped up that is seriously killing my appetite, and my ADD medication makes it even worse (I'm on Adderall). I've dropped almost 10% of my body weight in the past 2-3 months. The little thrill of weight loss is starting to get to me, I'm finding myself becoming more concerned/obsessed with my food intake and changing body. I'm a little bit concerned that all the work I've done to get through my food and body image issues will be undone by this.

Here's some advice my friend who's gone through something similar gave me (like you, she's naturally underweight so when she has medical issues that cause appetite loss, it's something she needs to deal with right away):

"Remember, ensure plus, pot (we live in CA where medical cannabis is legal), and candy are all your friends. Exercise also might help, especially if it's lighter - it doesn't burn all that many calories but might make you more hungry.

Basically, it helps to develop a mindset of trying to look at everything you're about to eat, and trying to figure out how to add more calories. Look for super energy-dense stuff. But the major downside is that most such things are unhealthy, and it's not really a habit you want to have forever. Eating enough vegetables gets really tricky, but at least in the short term no veggies is the lesser evil than losing energy & immune function."

I've been improving by following some of this advice--on days when I can eat protein I'm trying to make sure I do strength training exercises to keep my metabolism/muscle mass up and exercise usually increases my appetite. I always make sure to eat at least three times a day, even if the only thing I can eat is a third of an apple or a bite of yogurt. When I do feel like eating, I take full advantage--my medication is less strong in the evening, so I plan to have a larger healthy dinner at those times.

I also make sure to take breaks from my ADD medication on the weekends/vacation or on days when I know I won't need to focus as much. That's okay to do with Adderall, I'm not sure if that's fine with Concerta or not--you should ask your doc about that one.

Let us know how it goes. Smile
-C.
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