NW150

Compulsive eating and naltrexone-I have some questions!

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Hello all,

This is my first post on this website. I'm posting because I have a few questions regarding compulsive/binge eating and naltrexone. First off, a little background on me. I have a pretty long history with eating disorders; I was diagnosed with anorexia when I was thirteen, and I am now twenty. In this time I have been all over the spectrum, from anorexia to bulimia to binge eating and back again. I'm so exhausted of all of this, and I just want to move on with my life. Anyway, my latest "cycle" has been in the form of compulsive/binge eating and some purging (although not very often.) I use these different terms because sometimes I will "binge" (eat a large amount in a short time) and other times I will "eat compulsively"(eat a large amount throughout the course of the day.) These differing episodes have been occurring every day for nearly three weeks, and needless to say my health has been negatively effected because of it. I became so desperate that I began researching medications that might help with this, and the one that seemed most promising was naltrexone. So, I asked my psychiatrist and she prescribed me 50mg/day. I have been taking it for nearly two weeks now, and while I have seen a bit of improvement, I still find myself overeating (in fact I had a pretty bad binge today, which is what prompted me to post here.) It is strange because it seems as though my ability to feel satiated or full is completely missing; no matter how much I eat I still want more, and my body/brain don't turn off the hunger cues. My stomach can become very distended, but I still feel "empty." Anyway, My questions are:

Have any of you had success with this medication? 

What has been the optimal doseage for you? As I said I take 50mg/day, but I think that 100mg would be better (I sent an email to my psychiatrist today requesting an increase.) 

How long did it take for you to see marked improvement? As stated above, I have been taking it for nearly two weeks with a bit of improvement, but not nearly what I was hoping. Does it take time to "build up" or to introduce the full effect? 

I understand that medication is not a fix-all for these issues, and that work is required on my part. I would simply like to lessen or stop the constant rumination on food and eating that I experience in all my waking hours. It's driving me crazy! :o 

Sorry for the long-winded post, I'm just making sure that all relevant information is avaliable to you. I am also more than happy to answer any questions you may have for me. I appreciate any feedback or thoughts, and I look forward to interacting with you all in the future! Thanks for reading. 

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4 hours ago, NW150 said:

I have been taking it for nearly two weeks now, and while I have seen a bit of improvement, I still find myself overeating

When this happened to me my pdoc raised the dose to 100 mg.  Otherwise it was useless for me.

Saw improvement in 4-5 days.

4 hours ago, NW150 said:

It is strange because it seems as though my ability to feel satiated or full is completely missing; no matter how much I eat I still want more, and my body/brain don't turn off the hunger cues. My stomach can become very distended, but I still feel "empty."

I had (and still have) this problem too, even on the naltrexone.  It is just not as intense as it was when I was off of it.  I just do what I can to get around it (varies all the time).

I also was Dx with IBS ... it initially was from all the stress I had been under for years, but it was also from laxative abuse.  I still have it to this day.  What you describe about your stomach being distended but "empty" was a symptom I had also.  Might want to be checked by a GI DR to rule out any medical cause.

4 hours ago, NW150 said:

Have any of you had success with this medication? 

Yes I have.

4 hours ago, NW150 said:

What has been the optimal doseage for you? As I said I take 50mg/day, but I think that 100mg would be better (I sent an email to my psychiatrist today requesting an increase.) 

Optimal dose for me is 150 mg (50 mg over the max).

4 hours ago, NW150 said:

How long did it take for you to see marked improvement? As stated above, I have been taking it for nearly two weeks with a bit of improvement, but not nearly what I was hoping. Does it take time to "build up" or to introduce the full effect? 

The first dose I took I felt an immediate effect.  After that though it kind of helped, but overall had to build up in my system.  After a couple weeks, like you, I needed an increase in dose to continue to work.

4 hours ago, NW150 said:

I understand that medication is not a fix-all for these issues, and that work is required on my part. I would simply like to lessen or stop the constant rumination on food and eating that I experience in all my waking hours. It's driving me crazy! :o 

Personally, this med is a "fix-most" (vs "fit-all") for the issues associated with eating.  Hypothetically, if I had to choose one med to keep (out of all of the ones I take, it would be this one (and I have thought long and hard about this).

(bold) This only happened when I reached the 150 mg (I know it is over the limit though).  But ... even so, I still have ruminations about food, still have the occasional binge (just not on as much food as I would have had I been off of the naltrexone).  It doesn't stop all of that for me.  YMMV though ... about the dose and about how it helps you. 

 

Also, welcome to CB!  I'm glad you found us :)

 

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I'm on 100 mg, and I have noticed that my night eating has pretty much disappeared. My impulsive eating has mostly disappeared, and it did take a while before I saw a big benefit, and particularly when I went up to 100 mg, but I think I have a lot of help with phentermine (Adipex-P) 37.5 mg too. Some of the schedule IV stimulants (phentermine (Adipex-P) and diethylpropion (Tenuate)) or the schedule III stimulants (phendimetrazine (Bontril-PDM) or benzphetamine (Didrex)) can help. Also the 5-HT2C agonist Belviq can help if you can manage to afford it. They make a medicine combination of topiramate (Topamax) and phentermine (Adipex-P) called Qsymia if you can afford it. Saxenda (liraglutide) is a fantastic medicine, I take it for pre-diabetes in the form of Victoza. Any of those meds or a combination thereof could help along with the naltrexone. That's my personal experience though. Even Topamax by itself or Zonegran could help too.

Good luck! I understand the difficulty you're going through!

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9 hours ago, melissaw72 said:

When this happened to me my pdoc raised the dose to 100 mg.  Otherwise it was useless for me.

Saw improvement in 4-5 days.

I had (and still have) this problem too, even on the naltrexone.  It is just not as intense as it was when I was off of it.  I just do what I can to get around it (varies all the time).

I also was Dx with IBS ... it initially was from all the stress I had been under for years, but it was also from laxative abuse.  I still have it to this day.  What you describe about your stomach being distended but "empty" was a symptom I had also.  Might want to be checked by a GI DR to rule out any medical cause.

Yes I have.

Optimal dose for me is 150 mg (50 mg over the max).

The first dose I took I felt an immediate effect.  After that though it kind of helped, but overall had to build up in my system.  After a couple weeks, like you, I needed an increase in dose to continue to work.

Personally, this med is a "fix-most" (vs "fit-all") for the issues associated with eating.  Hypothetically, if I had to choose one med to keep (out of all of the ones I take, it would be this one (and I have thought long and hard about this).

(bold) This only happened when I reached the 150 mg (I know it is over the limit though).  But ... even so, I still have ruminations about food, still have the occasional binge (just not on as much food as I would have had I been off of the naltrexone).  It doesn't stop all of that for me.  YMMV though ... about the dose and about how it helps you. 

 

Also, welcome to CB!  I'm glad you found us :)

 

Hello melissaw72, thank you so much for your response! It is very helpful and informative, and I greatly appreciate it. As I said I have contacted my doctor to hopefully get a dosage increase, and I am awaiting her response. Hopefully she is understanding. Thanks again for being so helpful and friendly; I am glad to hear that the medication has helped you

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Just now, NW150 said:

As I said I have contacted my doctor to hopefully get a dosage increase, and I am awaiting her response.

I hope she approves it ... I think you will see/feel a big difference.

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54 minutes ago, mikl_pls said:

I'm on 100 mg, and I have noticed that my night eating has pretty much disappeared. My impulsive eating has mostly disappeared, and it did take a while before I saw a big benefit, and particularly when I went up to 100 mg, but I think I have a lot of help with phentermine (Adipex-P) 37.5 mg too. Some of the schedule IV stimulants (phentermine (Adipex-P) and diethylpropion (Tenuate)) or the schedule III stimulants (phendimetrazine (Bontril-PDM) or benzphetamine (Didrex)) can help. Also the 5-HT2C agonist Belviq can help if you can manage to afford it. They make a medicine combination of topiramate (Topamax) and phentermine (Adipex-P) called Qsymia if you can afford it. Saxenda (liraglutide) is a fantastic medicine, I take it for pre-diabetes in the form of Victoza. Any of those meds or a combination thereof could help along with the naltrexone. That's my personal experience though. Even Topamax by itself or Zonegran could help too.

Good luck! I understand the difficulty you're going through!

Thank you for your response as well! I have looked into a few of the other medications you have listed, and I am interested in a few of them. I tend to be very sensitive to stimulants so I do my best to avoid them, although I would put up with some discomfort if it meant that my crazy eating would stop. Hopefully my doctor will contact me soon with a dosage increase. She discouraged me from taking topamax (due to the host of side effects) but I have read that zonegran tends to be better tolerated. Perhaps I will add this to the naltrexone to get a stronger effect. Thanks again for your response, I am glad to hear that you have found things that help you

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I forgot to add that I also take wellbutrin (like @mikl_pls was talking about) ... I'm recalling taking that along with naltrexone at the same time. 

And maybe it is the combination that has helped me more than the naltrexone alone does.  I just thought of that. 

Here is a link about it:

https://www.drugs.com/mtm/bupropion-and-naltrexone.html

I am pretty sure this article has to do with naltrexone and buproprion together.

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The is a new pill on the market, Contrave, it is bupropion and naltrexone combined. 

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Posted (edited)

23 hours ago, melissaw72 said:

I forgot to add that I also take wellbutrin (like @mikl_pls was talking about) ... I'm recalling taking that along with naltrexone at the same time. 

And maybe it is the combination that has helped me more than the naltrexone alone does.  I just thought of that. 

Here is a link about it:

https://www.drugs.com/mtm/bupropion-and-naltrexone.html

I am pretty sure this article has to do with naltrexone and buproprion together.

I have heard that this medication works well. However, I have tried taking bupropion as an antidepressant before, and I was unable to tolerate it (gave me very bad anxiety.) I would be willing to try it again though, because I also take citalopram for depression/anxiety and I have read that citalopram can reduce the anxiety that some people get from bupropion. After doing some more research, I would also like the try zonegran if I need to, as it seems to be better tolerated than topamax. We will see though, I am still waiting to hear back from my doctor^_^ Thank you again for all of your help, it means alot to me and I very much appreciate you 

3 hours ago, notloki said:

The is a new pill on the market, Contrave, it is bupropion and naltrexone combined. 

Thanks for your response! I have heard of Contrave, and it sounds wonderful. However, I am sensitive to bupropion:o I may give it another try if I need to, as I am desperate to get my eating habits under control 

Edited by NW150

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Did you ever hear back from your DR?

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3 hours ago, melissaw72 said:

Did you ever hear back from your DR?

Unfortunately, not yet. I sent the original email on Monday 4/10 (im off at uni so I can't meet in person)  and then sent a follow up email on Friday 4/14. I understand that she is probably busy, and I hope that she will get back to me at some point this week. I will let you know when it happens, and what the outcome is. Thanks for your concern, it means alot :)

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On 4/13/2017 at 1:29 AM, NW150 said:

I have heard that this medication works well. However, I have tried taking bupropion as an antidepressant before, and I was unable to tolerate it (gave me very bad anxiety.) I would be willing to try it again though, because I also take citalopram for depression/anxiety and I have read that citalopram can reduce the anxiety that some people get from bupropion. After doing some more research, I would also like the try zonegran if I need to, as it seems to be better tolerated than topamax. We will see though, I am still waiting to hear back from my doctor^_^ Thank you again for all of your help, it means alot to me and I very much appreciate you 

Thanks for your response! I have heard of Contrave, and it sounds wonderful. However, I am sensitive to bupropion:o I may give it another try if I need to, as I am desperate to get my eating habits under control 

The bupropion may work differently when you're on the naltrexone, it could be worth a try.  There's also Buspar and Remeron.  Serotonin plays a big role in satiation, (page 233), so I think that should be your focus.

(https://books.google.com/books?id=VLr589uARvwC&pg=PA255&lpg=PA255&dq=serotonin+food+satiation&source=bl&ots=ONrctTFv8Z&sig=N8M_WWOIFrYoGqpNnCu0u6rKwxM&hl=en&sa=X&ved=0ahUKEwjGjfGduLDTAhXl4IMKHe6ZBBIQ6AEINTAE#v=onepage&q=serotonin food satiation&f=false)

Since you're still having problems with satiation and anxiety, citalopram may not be the right SSRI for you.  Zoloft and Paxil both have very strong anti-anxiety properties.  You may want to try one of them instead. Do you have epilepsy?

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8 minutes ago, Cetkat said:

Serotonin plays a big role in satiation, (page 233), so I think that should be your focus.

Thank you for this ... I am going to read about it more.

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3 hours ago, Cetkat said:

The bupropion may work differently when you're on the naltrexone, it could be worth a try.  There's also Buspar and Remeron.  Serotonin plays a big role in satiation, (page 233), so I think that should be your focus.

(https://books.google.com/books?id=VLr589uARvwC&pg=PA255&lpg=PA255&dq=serotonin+food+satiation&source=bl&ots=ONrctTFv8Z&sig=N8M_WWOIFrYoGqpNnCu0u6rKwxM&hl=en&sa=X&ved=0ahUKEwjGjfGduLDTAhXl4IMKHe6ZBBIQ6AEINTAE#v=onepage&q=serotonin food satiation&f=false)

Since you're still having problems with satiation and anxiety, citalopram may not be the right SSRI for you.  Zoloft and Paxil both have very strong anti-anxiety properties.  You may want to try one of them instead. Do you have epilepsy?

Hello, and thanks for your reply! I have tried Buspar and Remeron in the past, and I was unable to tolerate them. However, I haven't tried Zoloft or Paxil yet, so I will ask my doctor about them. The citalopram does help my anxiety, but does not help my depression; my appetite is obviously still "off" as well. I had heard that serotonin had an impact on appetite, but I wasn't aware of the extent to which it is involved, thanks for the helpful info! I do not have epilepsy, although I know that Zonegran is an anti-epileptic drug. I have read many anecdotal experiences from people reporting that it helps with reducing appetite/controlling food cravings. I am aware of the long list of side effects, but I'm willing to try nearly anything at this point. I am trying to get my food intake under control before I become overweight or develop health problems related to BED

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Update: I was finally contacted by my psychiatrist via email, and she is willing to prescribe me another 50 mg of naltrexone on the condition that I get a blood lab done (she wants to check my liver function.) I'm a bit frustrated because I am out of town at uni, and I don't have time to get a lab done. Anyway I will do my best to comply seeing as how I REALLY need the dosage increase; my day-grazing and nighttime bingeing have come back with a vengeance. On a related note, I set up an appointment with a local psychiatrist for this Thursday. I did this because I was stuck to email correspondence with my home doctor, and it was much too delayed and slow. I will see how the initial appointment goes, and if all goes well I will ask him for the dosage increase. I may even ask about adding another medication like Zonegran or memantine to help me further. Hopefully this doctor is open to trying new things; I am so desperate to get a handle on my behavior!:(

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You're really going to need the lab work.  100mg a day isn't advised and you can quickly damage your liver - hence the importance of the testing.  You need to catch it early so you can stop the med and not have major issues.  The only actual approved alternative dosing schedule I see listed is 50mg M-F and 100mg on Sat (Blue text below).  I'm not sure if increasing the dose actually increases the efficiency or if it just increases toxicity.  You're basically just blocking opioid (feel good) receptors, which is why they use it in Alcoholism too.. but if eating doesn't actually make you feel good, it's gonna have limited effect.  I'd also test your liver before upping the dose to get a baseline.  But, no, it's not optional.

Looking at the Naltrexone/Bupropion combo, the dosing drops the Naltrexone to 8mg 4x a day.  Since bupropion is also used to fix sexual issues that happen with SSRI's, I do think that adding the opioid blockage could change how it works and you may not have the same side effects.

Even more interesting though, IMO, is that they're now combining Zonegran and Bupropion:https://en.wikipedia.org/wiki/Zonisamide & https://en.wikipedia.org/wiki/Bupropion/zonisamide  Anorexia does seem to be a possible side effect however.

I would be curious about lowering the Naltrexone to the 8mg type dosing, and adding Zonegran and Bupropion.  Unlike the Bupropion, It doesn't look like the Zonegran would change the level of Naltrexone you can take, but that's a very cursory laymen opinion. (However, it does state elsewhere on the page linked below, that when you need to reverse the Naltrexone blockage, you use benzodiazepines - and they're processed through the same liver function as the Zonegran.  So, it doesn't sound like liver issues would be a factor there.)

I know this is probably a bit complicated for you.  But it could give you an alternative to the higher dosing and constant lab work.  It may be worth running it past your doc for their opinion and further research.

 

"Alternative Dosing Schedules

Once the patient has been started on Naltrexone hydrochloride, 50 mg every 24 hours will produce adequate clinical blockade of the actions of parenterally administered opioids (i.e., this dose will block the effects of a 25 mg intravenous heroin challenge). A flexible approach to a dosing regimen may need to be employed in cases of supervised administration. Thus, patients may receive 50 mg of Naltrexone hydrochloride every weekday with a 100 mg dose on Saturday, 100 mg every other day, or 150 mg every third day. The degree of blockade produced by Naltrexone may be reduced by these extended dosing intervals.

There may be a higher risk of hepatocellular injury with single doses above 50 mg, and use of higher doses and extended dosing intervals should balance the possible risks against the probable benefits (see WARNINGSand CLINICAL PHARMACOLOGY, Clinical Trials, Individualization of Dosage).:"

https://www.drugs.com/pro/naltrexone.html

 

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3 hours ago, Cetkat said:

I'm not sure if increasing the dose actually increases the efficiency or if it just increases toxicity.  

IME, it increases the efficiency of it.

 

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4 hours ago, Cetkat said:

You're really going to need the lab work.  100mg a day isn't advised and you can quickly damage your liver - hence the importance of the testing.  You need to catch it early so you can stop the med and not have major issues.  The only actual approved alternative dosing schedule I see listed is 50mg M-F and 100mg on Sat (Blue text below).  I'm not sure if increasing the dose actually increases the efficiency or if it just increases toxicity.  You're basically just blocking opioid (feel good) receptors, which is why they use it in Alcoholism too.. but if eating doesn't actually make you feel good, it's gonna have limited effect.  I'd also test your liver before upping the dose to get a baseline.  But, no, it's not optional.

Looking at the Naltrexone/Bupropion combo, the dosing drops the Naltrexone to 8mg 4x a day.  Since bupropion is also used to fix sexual issues that happen with SSRI's, I do think that adding the opioid blockage could change how it works and you may not have the same side effects.

Even more interesting though, IMO, is that they're now combining Zonegran and Bupropion:https://en.wikipedia.org/wiki/Zonisamide & https://en.wikipedia.org/wiki/Bupropion/zonisamide  Anorexia does seem to be a possible side effect however.

I would be curious about lowering the Naltrexone to the 8mg type dosing, and adding Zonegran and Bupropion.  Unlike the Bupropion, It doesn't look like the Zonegran would change the level of Naltrexone you can take, but that's a very cursory laymen opinion. (However, it does state elsewhere on the page linked below, that when you need to reverse the Naltrexone blockage, you use benzodiazepines - and they're processed through the same liver function as the Zonegran.  So, it doesn't sound like liver issues would be a factor there.)

I know this is probably a bit complicated for you.  But it could give you an alternative to the higher dosing and constant lab work.  It may be worth running it past your doc for their opinion and further research.

 

"Alternative Dosing Schedules

Once the patient has been started on Naltrexone hydrochloride, 50 mg every 24 hours will produce adequate clinical blockade of the actions of parenterally administered opioids (i.e., this dose will block the effects of a 25 mg intravenous heroin challenge). A flexible approach to a dosing regimen may need to be employed in cases of supervised administration. Thus, patients may receive 50 mg of Naltrexone hydrochloride every weekday with a 100 mg dose on Saturday, 100 mg every other day, or 150 mg every third day. The degree of blockade produced by Naltrexone may be reduced by these extended dosing intervals.

There may be a higher risk of hepatocellular injury with single doses above 50 mg, and use of higher doses and extended dosing intervals should balance the possible risks against the probable benefits (see WARNINGSand CLINICAL PHARMACOLOGY, Clinical Trials, Individualization of Dosage).:"

https://www.drugs.com/pro/naltrexone.html

 

Thank you very much for taking the time to post all of this information; it is extremely helpful and I greatly appreciate it. I will get the lab work done, seeing as how it is my only option. I'm meeting with a local psychiatrist tomorrow afternoon to see if they are a good fit for me while I am attending uni. I doubt that medication prescriptions will be written (since it is the first appointment) but I will ask him about my options. I would like to give the combination of bupropion, naltrexone, and zonegran a try, seeing as how my food issues are becoming unmanageable once again (alot of binge episodes and weight gain over the past weeks:cussing:) I'm not overly worried about the weight gain right now, as that can be taken care of once I normalize my eating habits. I'm more concerned with the constant cravings, impulses and complete loss of control. I am beginning to suspect that the citalopram that I am taking is somehow contributing to this, seeing as how things became even worse when I last increased the dosage. Maybe it isn't a good fit for me after all! But, I digress. I will discuss my options with the new psychiatrist and get my blood work done. Hopefully I will be able to get this sorted out! 

 

1 hour ago, melissaw72 said:

IME, it increases the efficiency of it.

 

Hello melissaw72, thank you for remaining active on my post! You have been very helpful. If you don't mind, may I ask you some questions? If you do not wish to answer, that is completely fine. Do you have any experience with the anti-epileptic drug zonegran? Have you heard anyone using it successfully? Also, have you heard of anyone using the Alzheimer's drug Memantine for compulsive eating? I have found a few pilot studies on the issue, and it seems promising (although this is limited because of the way that the studies are set up.) Still, I would like to keep it as an option just in case. I haven't been able to find anyone online who has actually used memantine for eating issues and was wondering if you have read any stories on it

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3 minutes ago, NW150 said:

Hello melissaw72, thank you for remaining active on my post! You have been very helpful. If you don't mind, may I ask you some questions? If you do not wish to answer, that is completely fine. Do you have any experience with the anti-epileptic drug zonegran? Have you heard anyone using it successfully? Also, have you heard of anyone using the Alzheimer's drug Memantine for compulsive eating? I have found a few pilot studies on the issue, and it seems promising (although this is limited because of the way that the studies are set up.) Still, I would like to keep it as an option just in case. I haven't been able to find anyone online who has actually used memantine for eating issues and was wondering if you have read any stories on it

Thank you!  I'm glad I can be of help.

No, I don't have any experience with zonegran.  Idk of anyone using it successfully, but I think if you started a new thread asking that question, some members might join in who have taken it successfully.

No, I haven't heard of anyone using Memantine for compulsive eating, and I haven't read any stories about it. 

** BUT ... if you do a search for memantine on the CB search bar, for 'all content,' there are others writing about it for various uses.

 

Actually, google "memantine for compulsive eating"   and lots of things come up that you might be interested in looking at.

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Hi..how's your weight going on?any changes? When you are not taking that medicines, how your appetite?

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5 hours ago, Slimatterp said:

Hi..how's your weight going on?any changes? When you are not taking that medicines, how your appetite?

Hello! As of now I have been unable to get the dose increased, and have been unsuccessful in trying other meds. My weight has continued to increase rather dramatically and it is becoming noticeable around my waist/stomach and chest. I feel horribly about it and I am trying my best to stop, but the compulsions are impossibly strong and my depression makes it difficult to see the point in stopping. I use feeling severely depressed as an excuse to overeat (I know that it is wrong to do, but food is the only thing that "feels good" at all anymore.) Anyway, sorry for the pity party. I still take the 50 mg naltrexone, but it is doing very little (if anything) to help me. My appetite is once again endless, and I crave high sugar high carb sweets. However, in the beginning, the naltrexone helped me to have a smaller appetite and reduced my desire for certain foods. That's why I am trying to add another 50 mg each day, as well as another med like zonegran or memantine (and perhaps even vyvanse, but only if nothing else works.) Are you taking any medications for compulsive eating? How are they working?  

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Have you had much luck connecting with a skilled therapist who specializes in what you need?

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18 minutes ago, Wooster said:

Have you had much luck connecting with a skilled therapist who specializes in what you need?

Hello Wooster, thank you for your question! Unfortunately I have not found anyone yet, at least not while I'm away at school. I have a therapist back home but it will be at least a few months before I can meet with them. I did go speak to a local psychiatrist a few days ago, but he was not what I was looking for. I spoke to him about my eating issues and he basically said "just focus on eating healthy foods and get some exercise" (I do this daily, but my problem is piling a ton of sweets on top of my regular meals.) He is rather old-fashioned, which hasn't worked well for me in the past. I am considering going to see another local doctor, but after the first one I am a little worried; I may just remain in contact with my hometown psychiatrist via email. Thank you again for your question, I appreciate it!:D

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    • By Kidney Bean
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    • By NW150
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    • By whatever?
      Hi all 
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