What medications can help you recover from an eating disorder?

Sam Ikin  00:12

This is a new season for Butterfly: Let’s Talk. I’m Sam Ikan. Welcome to Season Four.

Dr Claire Foldi  00:19

Medications have been historically unhelpful in treating eating disorders.

Sam Ikin  00:24

We’re kicking off this year with drugs, not the illegal kind. I’m talking about prescribed medical pharmaceuticals. This episode is an investigation into how medications can help in recovery from eating disorders. As a kid with an extremely negative body image, I often wondered if the pharmaceutical industry would one day create a drug that could magically make my body normal. In hindsight, that was a little bit far fetched. But researchers around the world are working really hard particularly in the area of eating disorders.

Dr Claire Foldi  00:55

We’re a group of small… a small group, but getting larger, of neuroscientists and we have a particular focus on behavioural neuroscience and psychopharmacology.

Sam Ikin  01:05

Dr. Claire Foldi is a Senior Research Fellow and laboratory head at the Biomedicine Discovery Institute at Monash University.

Dr Claire Foldi  01:12

Essentially, how the brain controls behaviour and how this might be mediated by neurochemical signalling. Basically, what what we want to do in the lab is to uncover the mechanisms in the brain that cause eating disorders.

Sam Ikin  01:25

She was at a conference in New York when we managed to get hold of her.

Dr Claire Foldi  01:29

Basically what we do in the lab is animal research. So we look at causal brain behaviour relationships. It’s a behavioural model where rats or mice when given time restricted access to food paired with a running wheel, a proportion of them will choose to run instead of eat when that food window is available. This is fascinating from an evolutionary biology standpoint, because laboratory rats and mice don’t have the psychosocial pressures to to choose to exercise over over feeding. But they do this even though it’s completely detrimental to their health and well being. We’ve started using the model to essentially replicate things that have been shown in human imaging studies, for example, where different parts of the brain respond differently to food reward in individuals with eating disorders and we’ve been able to sort of push and pull the activity of those circuits in the animal model to show that brain function in the animal model is is disrupted in very similar ways to how brain function is disrupted in anorexia nervosa.

Sam Ikin  02:38

Dr Foldi is one of the few pioneers researching a new alternative approach with a substance that’s been around for centuries. The chemical that we’re most interested in talking to you about is psilocybin, which is the one that we know commonly from from magic mushrooms. I guess it’s a psychedelic,

Dr Claire Foldi  02:55

Yeah.

Sam Ikin  02:56

Why are you looking at that?

Dr Claire Foldi  02:57

Well, I guess there’s two main reasons. The first is that medications have been historically unhelpful in treating eating disorders. You know, there are there are medications that treat associated symptoms, depressive tendencies and thought disturbances and that style, and some evidence for Vyvanse, the stimulant medication that was originally approved for ADHD, but is now approved for binge eating disorder. But nothing really treats, no medication is particularly good at treating core symptoms, you know, the food restriction or binge eating itself or the thinking that goes along with disordered feeding behaviour, and this is where psilocybin might come in. And I guess the second part of why I’m interested in in psilocybin, not just as a therapeutic, but more broadly, is that, you know, I have a fairly long standing interest in consciousness and the conscious experience, what makes us who we are and perceive the things that we do, and possibly that’s what initially drew me into studying schizophrenia related disorders, you know, an obvious distortion in perception. But psychedelic drugs seem to offer this incredible way to access a an altered state of consciousness. And so I’m fascinated in how compound that’s found naturally in mushrooms, that evidence for human use dating back potentially as far as 1500 BC can change the way that people think about their behaviour and changing the way a person thinks could really have an impact for eating disorders.

Sam Ikin  04:32

So it’s not something that’s approved at the moment, yeah? We’re still in the development phase, is that right?

Dr Claire Foldi  04:37

Yeah, exactly. And, and I think part of that is because right now, we don’t know that much about how these types of compounds affect our brain. We know a few things, you know, we know that psilocybin has effects on the serotonergic system, so the molecule neurotransmitter in our brain that’s sort of been classically associated with depressive tendencies, I suppose, but he’s also known to be dysregulated in eating disorders. And we know that psilocybin has some effects of on turning off different connectivity in the brain. So different parts of the brain that are normally highly connected, psychedelics can disrupt that connection and so potentially, this is the way that, you know, has effects on on the ability to think about things differently. But besides that, we don’t know so much about how psilocybin might act, and specifically for people with eating disorders. Were already in clinical trials at four different sites around the world of psilocybin, with specialised psychotherapy for anorexia nervosa. And there’s, you know, really promising results coming out of the depression trials, so patients with major depressive disorder seem to have long lasting symptom improvements after psilocybin therapy. And it’s plausible that there will be equally promising results from the clinical trials in anorexia. But it’s still the case that we, we don’t have a good understanding of how it acts in the brain. And so we don’t know whether it will be specifically beneficial for some individuals over others, or whether it could be particularly risky for specific people.

Richard Newton  06:22

It is a drug that has unpredictable effects.

Sam Ikin  06:27

This is a good opportunity to bring in an old friend of the podcast, Professor Richard Newton, who’s a professor of psychiatry, and he’s been working in eating disorders since the 1980s.

Richard Newton  06:37

Some people have really quite traumatic trips on it.

Sam Ikin  06:44

Professor Newton’s not so upbeat about psilocybin because of the unpredictable effects that it can have.

Richard Newton  06:50

They hallucinate it is, you know, they have a bad trip is sufficiently common, and the bad trips are sufficiently traumatic for me to think that that is a significant issue in terms of how many people does it take to get better? How many people does it take before somebody has really quite harmful experience, that may make things worse?

Sam Ikin  07:14

Dr Foldi accepts there’s a slight chance of people having a bad trip. But she says that in future, they hope to get to a point where that isn’t such a problem.

Dr Claire Foldi  07:24

As far as I know, from the medical research and clinical research, people that are advocates for psychedelics will say, at this stage in the clinic with appropriate support and appropriate preparation and integration, there are no adverse effects. But this, of course, is that, you know, niche population that I described before that are eligible for clinical trials, I think that there may be a potential for things to go wrong in a context, if there’s drugs are taken in a context that isn’t well supported psychologically. There’s a very small risk of longer term perceptual disturbances. So there’s a condition that has an acronym that I can’t recall, but it’s essentially persistent hallucination and it’s been at least documented in some cases. Although I wouldn’t say it’s common, there is the potential if you have whatever the underlying predisposition for this might be a small chance of a longer term perceptual change.

Sam Ikin  08:36

There are lots of researchers around the world who are working on modifying the psilocybin molecule to make it shorter acting with fewer side effects. So in the future, the idea of what we call a trip may not even be part of the process. At this stage, it’s not something that’s available to everyone.

Dr. Claire Foldi  08:53

Clinical trials are sort of biassed in so much as you can be admitted to a clinical trial only if you meet very, very strict inclusion criteria. And so the positive effects that we’re seeing is in a really biassed sub population of individuals with either major depressive disorder or anorexia nervosa. You can’t have any real comorbid clinical diagnoses or you’re excluded from the study. So I think right now, I would not advocate for people to to try it. But again, you know, I think there’s a lot of people with eating disorders who are at, you know, desperate for treatment. And so, you know, I think there’s, there’s risks that but there’s potential benefits. And if you’ve tried everything else with no success, you know, maybe it’s worth a shot. The biggest risk is unmet expectations. And so all of the hype in the media about this new miracle drug, I think that that’s the biggest risk because people might approach clinical trials or psychotherapy with psychedelics as this miracle cure when, you know, it doesn’t work for everyone, not even in this very biassed clinical trials population, there’s a, you know, somewhere between 30 and 50% success rate.

Sam Ikin  10:13

While it’s not a psychedelic there’s also been some evidence that the drug ketamine could also be helpful in the treatment of mental health disorders, including eating disorders.

Richard Newton  10:22

Okay, so personal confession Sam; I had an operation some time ago and they had to stop my heart and restart it. In order to do that they gave me some ketamine and I woke up from this experience and in I knew that I was getting it so I wanted to be really ready for it and so I woke up trying to analyse what the hell I was experiencing. It was a complete absence of dysphoria. I had no anxiety, no depression, but not intoxicated. I didn’t feel high, I didn’t feel intoxicated. But for possibly the first time in my entire life, I didn’t have anxiety or depression. It was extraordinary. That sick lasted about 10 minutes, but you know, it was still pretty good while it lasted.

Sam Ikin  11:16

Is that how it works for eating disorders, and it helps someone to forget that they’re unhappy or incontent or, in other words, to forget their dysphoria?

Richard Newton  11:24

In depression and anxiety long term, particularly treatment resistant depression, people often require repeated prolonged courses of ketamine. But people arguing Well, it’s no different to take an antidepressant long term. And you go oh, yeah, okay. So, so again, cautious research, if the research is supportive, let’s use it. Okay. But cautious, well planned research, with a curious inquiry of the individuals taking the drugs, how does this, you know, does that has this contributed to you feeling better in a way that is meaningful to you? So called SSRIs, the serotonin specific reuptake inhibitors, which essentially have as a common characteristic improving serotonin concentrations in the brain neurons. God helped me forsakes hope not by psychiatrists colleagues up savers, because that’s not how they work. But they do have that common feature. Then they all seem to have effects at high doses. And I emphasise high doses, you’re really talking about three to four times the antidepressant dose that these drugs before they have a really effective, anti bulimic effect, anti bingeing effect. And they seem to both reduce bingeing by having an effect both on hunger and satie ty through an effect on a particular part of the hypothalamus, which is a part of the brain.

Sam Ikin  13:02

Most of what we’ve talked about so far has been focused on anorexia nervosa and bulimia nervosa. But what about some of the other diagnoses?

Richard Newton  13:10

So there’s been this explosion of investigation of medications for binge eating disorder. If you think about binge eating disorder, and there’s an overlap with bulimia nervosa, as I’m sure you would see, yes. In binge eating disorder, the kind of two targets are to try and reduce bingeing, but also to try and reduce weight. And certainly, drugs that reduced bingeing, like the SSRIs have not really had a big take up in binge eating disorder because they don’t have a particular effects on on weight, right. But what we’ve now seen in binge eating disorder is this bleed if you like this kind of overlap with ADHD, where the formulation for binge eating disorder would run something along the lines of one of the factors that contribute to people bingeing is impulse control, so let’s try an ADHD drug.

Dr Kristi Griffiths  14:09

The brain is responsible for all of our behaviours. So whether that be through internally generated thoughts or in response to things in your environment.

Sam Ikin  14:17

Dr Kristi Griffiths is one of the leading researchers in the use of the drug lisdexamfetamine dimethylate, which if I’ve said that wrong is also sold under the name Vyvanse, which is traditionally been used to treat ADHD.

Dr Kristi Griffiths  14:30

I’m a senior researcher at the Inside Out Institute for Eating Disorders. And this is a joint venture between the Sydney Local Health District and the University of Sydney. Typically, when we seek out food, it’s because of hormones circulating in our bodies that tell our brains that we’re hungry or it could even be through learned habits of knowing that this is your typical mealtime. So also to most people food is quite enjoyable. And we might also eat because our brain tells us that it’s a rewarding experience, even if we’re not hungry. So sometimes for people with eating disorders, there is a dysregulation between the physical systems that tell us what our body needs, the reward systems and the inhibitory control systems. And a push and pull between all of these systems can within our brain can result in over or under eating, as well as many of the psychological symptoms of eating disorders that people often feel like guilt or distress.

Sam Ikin  15:29

So what about medication? Do you think as an expert in this field, that medication should be part of treatment for eating disorders.

Dr Kristi Griffiths  15:36

So that is a tricky one to answer. And it’s quite controversial. So for binge eating disorder, psychological therapies are the first line treatments. And even for the people who developed Vyvanse for binge eating disorder. They also say that it should only be used in the event that psychological therapies have not been effective, or that they haven’t been accessible. So there’s always a push towards psychological therapies being used first. And they are relatively successful in around 60% of people. However, for some people, it may be that medications are a better option. And I guess that comes down to that individualised medicine trying to figure out if there’s anything that we can identify within that person to say this is someone that will do well with medication, as opposed to psychological therapies as a first line.

Sam Ikin  16:36

In the interest of full transparency here, I’ve recently been diagnosed with ADHD like so many other people my age, who had no idea, it could even affect adults. My psychiatrist said it was linked to my binge eating disorder, which I’d known about for years, it was diagnosed maybe 10 years ago. So he prescribed Vyvanse, which I’ve been taking for a couple of months now. So far, the effects have been positive. But I was really keen to see if Dr. Griffiths had some data on how effective it was for everyone else.

Dr Kristi Griffiths  17:05

With ADHD, if people stop taking the ADHD medication, even for a day or two, their symptoms return. But I mean, there has been one study actually, that has looked at the longer term effects of Vyvanse and binge eating disorder. So they got a bunch of people who had been responded well to Vyvanse, over a 12 week trial. And then they randomised them to either continue Vyvanse or to switch to a placebo. And then they recorded the relapse rates that occurred over the next six months. What they found was that of the people who continued taking Vyvanse, around 4% of them relapsed, which is a pretty low rate. Yeah. For those that switched to placebo, around a third of them relapsed. Okay, so I guess the good news there is that there were two thirds of them that didn’t. So after six months of being off of Vyvanse, they were still, you know, binge eating less than twice a week.

Sam Ikin  18:05

Are there any other medications that have been as successful with binge eating disorder? Or do you know of any that perhaps we haven’t heard about yet that researchers are working on?

Dr Kristi Griffiths  18:15

I haven’t seen anything that appears beyond Vyvanse. There’s other things that are maybe have slightly less research behind them. Typically, it’s a range of medications that are used for other disorders that have been applied to binge eating disorder. Something that is used for some people is Topiramate, which is an anticonvulsant medication that some people find useful with binge eating disorder. Obviously, there are the other stimulant medications, the weight loss, ones that you mentioned is another thing that’s, you know, very hot topic in the media at the moment. But it really does depend on what your, your goal is your outcome, because if you direct your outcome to be weight loss, it’s not changing the psychological processes that have led to that weight loss so you really need to think about what it is that you want to target and I think starting with the impulse control around foods, that is really where you want to start to have that effect.

Sam Ikin  19:16

So tell me some labcoat stuff about Vyvanse. How does it work?

Dr Kristi Griffiths  19:20

So it was, I’m sure you’re aware it was developed? I think it was actually approved by the FDA in 2007. For ADHD, right. So it is a medication that works primarily through dopamine. And it acts on trying to help impulse control and enhance attention sustained attention. So the core features of ADHD. And it also happens that, you know, the impulse control is something that there’s a lot of overlap with for Vyvanse. So a lot of clinicians were using an off label for binge eating disorder in people that were where they saw that impulse control. was an issue. So, yeah, so then I guess we had a series of studies that happens around 2015 with looking at how well it works in binge eating disorder, and that was what led to the approval that we had in 2017. With in America and 2019 in Australia.

Sam Ikin  20:21

So does it mean that, and we know there’s a lot of cooccurring, or cooccurrence rather, of binge eating disorder and ADHD, does that mean that those two things are, quote more closely linked than we thought?

Dr Kristi Griffiths  20:36

Possibly. And that’s what I’m interested in, I guess, is trying to use a bit of a data driven approach where we sort of just look at the brain and how its functioning, throw away the labels, throw away the diagnostic labels, and sort of see if we can cluster people based on the symptoms that they’re experiencing and then try to find medications that that fit that profile and I think you do see a lot of overlap in in ADHD and binge eating disorder in a lot of symptomology.

Sam Ikin  21:03

Almost 90% of the people who have a binge eating disorder diagnosis, also have been classified as obese at some point in their lives. We know that size discrimination, which is inescapable in most parts of the world increases the likelihood of developing an eating disorder. So does that mean that weight loss drugs like semaglutide, which is also sold under the label as Ozempic and Wegovy could play a part in eating disorder prevention?

Richard Newton  21:28

Obesity and morbid obesity and the treatment of that has been really extraordinary, you know, big public health interest in addressing obesity, as you I’m sure are aware. Gastric banding and very low calorie diets and all of this have had their moments in the sun in terms of showing some effects and having some effectiveness over the long term in this treatment. Semeglutide delays gastric emptying, decreases appetite by decreasing food and decreasing food intake, and changes the way that the body handles energy through a variety of effects on insulin and other effects. Diets haven’t worked diets don’t work in people with overweight, but Semeglutide, you know, even at 68 weeks, it’s still showing persistent weight loss.

Sam Ikin  22:23

As long as you’re still taking it.

Richard Newton  22:25

So long as you still taking it of course.

Sam Ikin  22:27

Once you stop taking, and it’s also very expensive, and it’s a weekly injection, right?

Richard Newton  22:31

Follow the money. Is that what you’re suggesting, Sam?

Sam Ikin  22:35

Well, no, no, no, I’m not. But But yes, let’s do that. Let’s go there, if you want. But I’m saying this, for me seems like any other crash diet that you know, any other obese person has been on. And I know lots of people who are in my situation who have been able to sustain a really long time of super low calories, but you can’t do it forever. And this, to me, this looks very similar to that kind of thing. I mean, it’s different different in that you’re not starving yourself.

Richard Newton  23:03

And you’re not consciously restraining in the way that you have to do with with any kind of calorie reduced diet where every single meal, you have to make active decisions about it. Whereas with semaglutide the decisions made for you by your body. You’re absolutely right, all of these medications that I’ve been talking about, they only work as long as you take them. Binge eating disorder, as we know is the most common eating disorder. It seems to me if that if you follow the money, then you can see, as soon as it became apparent that there was a diagnosable disorder that affected a large percentage of the population, all of a sudden there was pharmaceutical interest in finding treatments for it. All of a sudden, Vyvanse lisdexamfetamine is being approved. Naltrexone Bupropion is being approved and you only have to prescribe to a small percentage of people who have been eating disorder for these drugs for huge pockets to be made.

Dr Kristi Griffiths  24:05

Obesity and binge eating disorder are dissociable things. But you know, you have people who go to get gastric bypass surgery and whatnot, but if they have binge eating disorder, this is a really a short term measure. It won’t work. They’re gonna keep bingeing and sort of not have effects from that down the tracks. So, yeah, it’s definitely something that needs to be addressed first.

Sam Ikin  24:30

The medications that are most commonly prescribed for eating disorders are also associated with other mental health conditions. Commonly prescribed ones are antidepressants like selective serotonin reuptake inhibitors or SSRIs. Atypical antipsychotics, anti anxiety medications mood stabilisers, including lithium and anticonvulsants and stimulants like the ones prescribed for ADHD.

Emma Hagan  24:53

I was diagnosed with an eating disorder when I was 11 years old.

Sam Ikin  24:58

We’ve heard a lot from scientists so far but I think it’s time for us to bring in someone who doesn’t wear a lab coat to work.

Emma Hagan  25:04

I am Emma. I am 28 years old. I always have to think about that for a little while, which is concerning. But I am a peer support worker and an eating disorder day programme. I also just finished university double degree that took me far too long, but who’s counting the years really, I was incredibly anxious as a child, I was also very perfectionistic and I also grew up in a bigger body and was bullied for that. So by the time I was 10 years old, those factors culminated, and I ended up seeking help for a paediatrician to lose weight because weight loss in children was very much encouraged back in the early 2000s. And so I ended up losing some weight, and then it all sort of cascaded and those perfect that perfect storm of factors really did just sort of collide, and I ended up being diagnosed with an eating disorder.

Sam Ikin  26:05

Emma’s experience in battling an eating disorder is unique, as all journeys are, but there are some points that others will certainly be able to relate to.

Emma Hagan  26:13

From a child, I was hospitalised in a medical setting and then transferred to a psychiatric setting. I had quite a bit of outpatient treatment with a treatment team. And then I ended up in a day programme when I was quite young. When I graduated high school and I had my last and probably longest relapse. I ended up having inpatient stays. So psychiatric inpatient stays as an adult.

Richard Newton  26:47

My first research position was investigating the use of Fluvoxamine in the treatment of bulimia nervosa in combination with cognitive therapy and that was way back in the 1980s. Just as set a set a scene for some of our discussions about pharmacotherapy of eating disorders today.

Sam Ikin  27:08

Fluvoxamine is a serotonin reuptake inhibitor often sold under the brand name with Luvox of Faverin, and it helps eating disorders by reducing obsessive thoughts and compulsive behaviours, which are associated with food while stabilising mood and reducing anxiety. These things can contribute to binge eating episodes.

Richard Newton  27:27

If you look at the evidence base, which is kind of what academics do, and that’s part of the difficulty of having somebody like me on your podcast is that I keep going back to the evidence walks today, you know fluvoxamine are still probably have had the best evidence, and that they’re still certainly, both of them, part of any clinical practice guideline recommendation, particularly, of course fluvoxamine. This is quite a lot of medications that have been approved for bulimia nervosa and binge eating disorder. The story is not the same for anorexia nervosa but olanzapine is still really the only medication that’s got a really kind of consistent signal. There’s lots of other drugs that have been put up that people have hoped might be effective either in helping people recover from anorexia nervosa, or helping people stay recovered, but actually, not many of them have really held up over, over repeated use.

Sam Ikin  28:32

Olanzapine is used to treat schizophrenia and bipolar disorder by affecting brain chemicals that control mood and behaviour. It belongs to a class of drugs called atypical antipsychotics. As ever experienced doctors will prescribe the medication they think will work best. But different people have different experiences. So finding the right medication can be a frustrating task.

Emma Hagan  28:54

I think I was first prescribed some sort of psychiatric medication when I was 14 years old. I was prescribed antidepressants. And at the time, I was very glib about it and I was like, well, you’d be depressed too if you’re in hospital being forced to eat. Looking back on that, I’m like, oh yeah you were depressed. So it helps. And that sort of kind of showed 14 year old self that actually no, there was something chemically not quite right there. So I was first exposed to meds in that setting. And yeah, it was beneficial. I took the antidepressants for probably a year, and then weaned off them. And things went pretty well from there. As an adult. I developed depression once again. And so that I was prescribed a different antidepressant at some point in there, after I’d been admitted into a psychiatric admission, I was started on anti psychotics. So I started on one particular, anti psychotic and that sort of anti psychotics are used quite frequently in eating disorder treatment, and I was prescribed one very popular one. And then after some time, I was shifted on to another one that worked much better for me.

Sam Ikin  30:19

And anti psychotics prescribed for eating disorders to help manage symptoms, such as obsessive thoughts or distorted perceptions of body image, which can be present in conditions like anorexia nervosa or bulimia nervosa. They can also help stabilise mood and reduce anxiety. So the first one didn’t help, but what did it do?

Emma Hagan  30:38

It’s sedated be to an incredible extent. For a time there, I don’t think I had a single thought in my head, apart from perhaps what I was eating what I was eating next, it didn’t do what it was supposed to do in terms of where it may have, it may have dealt with the eating disorder thoughts, but it dealt to everything else. And it left me yeah, very tired, not being able to engage in the treatment I was in, because I just couldn’t get my eyes open and I was unable to engage in life, which was probably the more important part there that to recover, you need to be able to re engage with life. And this medication had left me with no ability to do that whatsoever. I was sort of titrated off that first one and titrated on to the second. And it was just far less sedating for me, which was the first huge plus but the second one was it actually did help not get rid of the thoughts, but sort of make them less adhesive like less sticky. I was able to sort of acknowledge that there was an eating disorder thought, and then there was a choice as to whether to follow it or not, whereas beforehand, I think it felt like there was an eating disorder thought and then there was the behaviour straightaway.

Sam Ikin  31:50

It took Emma a while but eventually she found a medication that helped her. So Well, it sounds like treatments for anorexia nervosa are limited, Professor Newton is upbeat about some other potential treatments.

Richard Newton  32:02

Coming up in the anorexia nervosa field, I think that this reawakening of interest in biological treatments. And so there’s some nice research coming out about cannabinoid, so synthetic cannabis type products that actually might have some promise in people with severe and enduring anorexia nervosa, which would be super to see.

Sam Ikin  32:27

Cannabinoids can have a lot of physiological effects on the body, one of which is referred to as the munchies or increased appetite that many people experience when they use marijuana, for example. It triggers the parts of the brain that play a role in the way we smell and taste our food. It can lead to signals of hunger, even if the body isn’t hungry.

Richard Newton  32:45

There are a whole range of medications, you know, we did a trial about seven years ago now on oxytocin. And oxytocin is a  drug that’s released by mothers as they give birth, and it helps the mother bond with the baby. And so the idea behind using oxytocin was people with anorexia nervosa, particularly, are extraordinarily hard on themselves really quite hard and unkind. You know, what, not even thinking that they’re worthy of having food in their mouths and eating. This was the hypothesis. And so given using oxytocin, to help people to nurture themselves.

Emma Hagan  33:26

Both when I was on the antidepressants when I was younger, and also with this second medication, there was a huge focus for my team, to as I sort of touched on before reengage with life and sort of acknowledge and recognise that there was life outside of my disorder, especially when I was an adult, because my eating disorder had sort of shrunk my world down to just, you know, the four walls of a treatment setting or just like my bedroom at home. And it felt very insular and safe and a huge part of it was yeah, actually going beyond those fools and realising that there’s a life out there and I was missing out on a lot. So in that regard, I was always encouraged to, you know, try and catch up with friends or for me study was a huge part of everything’s because I acknowledged early on that I couldn’t study unless I was somewhat, or hopefully fully nourishing my brain. To anyone listening who’s perhaps considering medication or has been suggested to them, try to try to put some space between you and any shame or any judgement, and know that psychiatric medication is the exact same as any other type of medication that we need for our health. Also try and trust the process a little bit. I know that’s very hard, especially for us with eating disorders to trust, but we kind of can’t see the effects of something until we give it a good go, especially with medication, it takes some time for it to build up it takes some time for to show itself. So try and trust your treatment team and also be really communicative with your teaching treatment team as much as possible that if something doesn’t feel right, as well try and advocate for yourself but also try and differentiate between whether it’s your eating disorder saying that something doesn’t feel right, or whether it’s yourself.

Sam Ikin  35:20

If you’re looking for the right professionals to help you with your recovery, the Butterfly Foundation has a referral database on their website, go to butterfly.org.au for all the details. And if you really like to read scientific papers, there’s the Journal of Eating Disorders. If you search Journal of eating disorders in your search engine, you should find it otherwise there’s a link in the show notes. The place Dr Kristi Griffiths works Inside Out Institute also has a lot of resources and referral database on their website that’s inside out institute.org.au The number to call for support right now is the Butterfly Helpline on 1800 33 46 73. That’s 1800 ED HOPE. They’re open from 8am till midnight seven days a week. So if you’re struggling right now and you need some help, please give them a call. You can also chat online butterfly.org.au or email support@butterfly.org.au. Butterfly: Let’s Talk is produced by Ikin Media for Butterfly Foundation with support from Waratah Education Foundation Limited. I’m Sam Ikin, your host and producer. Our executive producer is Camilla Becket. We have lived experience support from Kate Mulray and special thanks to Melissa Wilton for all the support that she gives us. Now I’m gonna ask you for a little favour. So if you could please leave us a rating and a review in the app that you’re listening to this podcast to right now. We would be extremely grateful. I’m Sam Ikin. Thank you so much for your company.