Considering the shame and stigma around mental illness and mental health in general, I’ll come out and say it: I have clinical depression, anxiety disorder, binge eating disorder. As a result, I take medications to control them. One of them is a SSRI. I’ve tried out a number of them, and because I have competing illnesses, none of them have quite fit the bill.
I also want to preface this blog with some values statements. As a coach and as a person, I do believe that there is Health at Every Size (HAES). Just as we celebrate diversity in every other area of our lives, we should celebrate the diversity that makes up our health. I don’t believe you can judge a person’s health or wellness just by looking at them or even talking to them for a few minutes. Rather, one must spend time to get to know people and look at all dimensions of health and wellness before deciding on change goals – if there are any to make.
In my case, I am not at my ideal size. My weight is about 20-30 pounds higher than my frame can carry. My last set of bloodwork revealed high LDL (the so-called “bad cholesterol”, although that is an oversimplification) and low HDL. Confession time: I always have to look up which is which no matter how many times I see it. My waist-to-hip ratio is .92, which puts me at high risk for obesity-related illnesses such as heart disease and Type II diabetes. My joint pain and subluxations are starting to interfere with my quality of life. Due to my Ehlers-Danlos Syndrome, by bones are smaller and holding my weight is more painful. Simply put, I’m wearing a meat suit that is a little too big for me right now.
There are most likely multiple causes to this:
- I have been doing a bit more remote work due to COVID-19. However, I’ve worked from home for the most part since 2017 and had a pro Zoom account for a year before the pandemic. I wouldn’t say changes in my activity level have been as drastic as they have for others, but I’ll cop to more stress.
- I’m moving as much as I had before the pandemic, and did several fitness challenges in 2020. Yet, the weight gain was significant. Could it still be less calories burned? Absolutely. But Her Royal Corginess requires us to walk her 4+ times a day in order for us to stay employed as Mommy and Daddy, so I have added that activity to my day. No budge on the pudge.
- I did all the diets and eating plans. Noom, WW, Precision Nutrition, ACE’s Weight Management. Heck, I even took nutrition classes where my professors said my nutrition looked a little too good (no, I didn’t fudge the data). The same three pounds, up, down, up, down.
- I’ve cut out alcohol entirely using The Alcohol Experiment. Stress and alcohol are two of my binge triggers, and honestly, with the help of spousal unit, I’ve cut down on binges, too. But the same pounds come and go.
That leaves…dum, dum, dum….my meds.
Two of the medications I’m taking list weight gain as a side effect. One is an SSRI and another is a Beta-Blocker for tremor. I’m looking first at the SSRI to determine whether this could be the culprit and if so, to see if there are any effective counter measures. As always, I like to turn to Google Scholar before Dr. Google. Here is a sampling of what I found, in no particular order:
- Shi, et al (2017) – SSRI weight gain covaried with poorer reported dietary practices, a more sedentary lifestyle, and smoking. From what I gather, if your habits already suck, an SSRI will magnify that suck. Correlational descriptive studies never address the chicken-egg problem, though. Does unhealthy lifestyles lead to more SSRI use, or does SSRI use lead to more unhealthy lifestyles, or both, or something else? No way to tell.
- Gafoor, Booth, & Gulliford (2018) – more from the British Medical Journal. In the introduction, they nod to something I’d seen in multiple articles. Wellbutrin is the only antidepressant that is linked to weight loss. All others have links to weight gain, although not all affect weight equally. They reviewed 10 years’ worth of Electronic Medical Records linked to a sample of 30,000 patients. Individuals who had been treated with antidepressants were statistically significantly more likely to gain weight. Again, correlation, not causation. The data were collected from existing medical records, so there was no way to determine whether measurements were accurate or reliable. Researchers never saw the individuals upon whom these records were based to determine any other factors.
- Igel, 2019 – scroll to Chapter 7. This is not necessarily a study or a peer reviewed resource, but I’m including it here because the author makes some very important points. They discuss the sneakiness of two SSRIs in particular – Zoloft and Prozac. In both cases, treatment leads to initial weight loss followed by gain in some patients. Also mentioned is the fact that the side effects of medications to treat depression can lead to more distress than the depression itself. You can’t assume people will be fat and happy. Or for that matter, libido-less and happy.
Short of a comprehensive lit review, let’s just say that there is some evidence to support my hypothesis of SSRIs causing my weight gain. But it stops short of saying it is the ONLY cause of my weight gain. OK, fair enough.
So, after consulting with my doc, I decided to go off the SSRI. I also stopped the Beta-Blocker. What happened?
The withdrawal is lasting amazingly long. Two months, in fact. I tried some herbal remedies to offset the withdrawal symptoms – SAM-e, 5HTP, and CBD oil – and none of them quite fit the bill. The CBD was the most distressing, because I started getting brain fog and word substitution errors like saying snow when I meant rain. I even took a dementia test. The SAM-e was, well, fine. With 5HTP, I ended up bingeing again and eating like I was in college.
The good news is that my weight is not so slowly decreasing. My clothing is fitting better. I have more energy.
The bad news? No control over my anxiety. The nice part is now I can identify “oh, that’s just my anxiety talking” rather than determining that I am right and the world is sucky and wrong.
My pain is through the roof, but was the worst when I first came off the SSRI.
The only real cure I have for anxiety? Intense, steady-state cardio. Running, spinning, etc… With my EDS, though, what keeps me sane does not necessarily keep me from injury. That injury, though, is still better than the pain of being several sizes too big for my frame.
I’m still working on the balance, and that will come in time. For now, though, I just need to be vigilant.