[28M] With chronic loss of appetite and insomnia

Patient Description

A 28-year-old male has been experiencing a loss of appetite and feeling full even though his brain feels hungry for the past 14 years. These episodes occur daily, at least once, and last from 30 minutes to a couple of hours, typically right after feeling extremely hungry but then being unable to eat. The patient also has a 25-year history of insomnia, which has affected his cognitive abilities. Melatonin sometimes helps, but nothing consistently works. The patient does not experience bloating, abdominal pain, heartburn, acid reflux, or difficulty swallowing, although occasional nausea occurs when extremely hungry. He uses marijuana 2-3 times per week and alcohol 2-3 times per month. His typical daily diet includes skipping breakfast, sometimes skipping lunch even after preparing or buying food, and on a good day, eating one big meal. He has a family history of depression and was diagnosed with ADHD at the age of 12. He is currently taking Buspar (5 mg up to 3 times per day, but only once per week) and melatonin (3 mg, 5 out of 7 nights a week) to help with sleep. He has no known allergies or adverse reactions to medications.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

Loss of Appetite and Feeling Full

  1. Gastroparesis: This condition slows down the movement of food from your stomach to your small intestine, causing you to feel full quickly. It can be associated with nausea and difficulty eating.
  2. Anxiety or Depression: Mental health conditions can significantly impact your appetite and eating habits. Given your family history of depression and your ADHD diagnosis, this could be a contributing factor.
  3. ADHD and Medication Side Effects: ADHD itself and medications used to treat it, like Buspar, can sometimes affect appetite and eating patterns.

Insomnia

  1. Chronic Insomnia: Long-term difficulty sleeping can be due to various factors, including stress, anxiety, or other underlying health conditions.
  2. Substance Use: Marijuana and alcohol can disrupt sleep patterns, especially if used frequently.

Difficulty Gaining Weight

  1. Metabolic Issues: Conditions like hyperthyroidism can cause difficulty in gaining weight despite adequate food intake.
  2. Nutritional Deficiencies: Not eating enough or having an unbalanced diet can lead to deficiencies that affect your weight and overall health.

What you can do

Loss of Appetite and Feeling Full

  • Consult a Healthcare Provider: It's important to discuss your symptoms with a healthcare provider to rule out conditions like gastroparesis or other gastrointestinal issues. They may recommend tests like an upper GI endoscopy or gastric emptying study.
  • Mental Health Support: Consider speaking with a mental health professional to address any underlying anxiety or depression that may be affecting your appetite.
  • Eating Strategies: Try eating smaller, more frequent meals throughout the day instead of large meals. Focus on nutrient-dense foods that are easier to digest.

Insomnia

  • Sleep Hygiene: Establish a regular sleep schedule, create a comfortable sleep environment, and avoid screens before bedtime.
  • Limit Substance Use: Reducing or eliminating marijuana and alcohol use may improve your sleep quality.
  • Consult a Sleep Specialist: If insomnia persists, consider seeing a sleep specialist for further evaluation and treatment options.

Difficulty Gaining Weight

  • Nutritional Support: Work with a dietitian to develop a meal plan that ensures you're getting enough calories and nutrients. They can also suggest high-calorie, nutrient-dense foods to help you gain weight.
  • Monitor Your Symptoms: Use MDandMe to journal your symptoms, track your progress, and share your notes with your healthcare provider.

What you should look out for

Given the chronic nature of your symptoms, it's important to seek medical care to get a formal diagnosis and appropriate treatment. Reasons to seek care more urgently include:

  • Significant weight loss or inability to maintain a healthy weight
  • Persistent nausea or vomiting
  • Severe anxiety or depression affecting your daily life
  • Worsening insomnia despite trying various interventions

Remember, while I can provide information and suggestions, it's crucial to consult with real healthcare professionals to receive a formal diagnosis and treatment plan. If you have more questions or need further assistance, feel free to continue the conversation.

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4 mo ago


People Also Ask


What is gastroparesis and how can it affect appetite?

Gastroparesis is a condition where the stomach takes longer than normal to empty its contents. This can lead to symptoms such as feeling full quickly, nausea, and difficulty eating, which can affect appetite.


Can ADHD or its medications impact eating habits?

Yes, ADHD itself and medications used to treat it, such as Buspar, can sometimes affect appetite and eating patterns. This can result in changes in eating habits, such as loss of appetite or feeling full quickly.


How does substance use like marijuana and alcohol affect sleep?

Substance use, including marijuana and alcohol, can disrupt sleep patterns. Marijuana can alter the sleep cycle, affecting REM sleep, while alcohol can interfere with the body's natural sleep-wake cycle, leading to poor sleep quality.


What are some strategies to improve sleep hygiene?

Improving sleep hygiene involves establishing a regular sleep schedule, creating a comfortable sleep environment, avoiding screens before bedtime, and limiting caffeine and heavy meals before sleep. These strategies can help improve overall sleep quality.


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