Most of us who have been treated with psych meds gain weight, there are a lucky few who escape this side effect, and then many that gain a moderate amount and then what seems a large significant minority for whom major weight gain is a problem. I fall into the last category.
Before I started my journey into the med trap I was a thin, muscular athlete. I was a cyclist and swimmer. I cycled about 40 miles a day four days a week. I swam an hour several times a week. I lifted weights, used the stair master, went running and played tennis. I also went on long hikes. I was strenuously active almost everyday of my life. I was proud of my strength and fitness and liked my body.
Enter Depakote and Risperdal. Gained 60 lbs. One pound after another for several years. The reason was two-fold. I was so sedated and depressed I had no energy and I slowly stopped my athletic routines. Secondly the drugs simply made me gain weight–it wouldn’t have mattered if I continued to work out or not–some weight gain would have happened regardless–this I know as later I did start exercising . After about 12 or 13 years of continuing increased doses of Risperdal, Seroquel was added and I gained another 20 lbs. Seroquel gave me serious uncontrollable munchies. I never had an eating disorder–this was something else. It was caused by the drugs. I was also on an assortment of other drugs which have weight gain associated with them, but the ones I name are those most guilty of it. Again the sedation caused by the other drugs, most notably the Klonopin, made things worse.
Three years ago when I started neurofeedback and some of the lethargy abated I found that I could exercise again. I went to the gym daily and hiked several times a week. I lost 40 lbs over a two year period. I was still on a lot of meds and in spite of working out hard one to three hours a day six days a week I could not lose more than those 40 lbs. I was still fat in spite of working my ass off and eating healthy food. I have never eaten classic junk food. No McDonald’s or any other fast food. Only very occasional sweets or high fat foods. Working out was not enough. After the two years of losing I maintained the 40 lb weight loss for a year–continuing to work my butt off at the gym and in the mountains on trails.
A year ago I improved my diet further. I cut out all refined grains, all sugar, all alcohol and all processed foods. No change in weight. I ate better than most to begin with, now I have a stellar diet.
I had been casually cutting down my drugs during this period, then nine months ago I committed myself to it ferociously. Since then I’ve begun to suffer from chronic fatigue. I go for occasional gentle walks. I can’t work out hard anymore. What used to be a source of joy and an endorphin high now makes me feel worse. It’s a drag and from what I hear about withdrawing from drugs, it’s not unusual. I’ve gained back the weight I lost–all but maybe 5 lbs, in spite of eating healthy. I am fat. People assume I’m a glutton. (this I know from living in a fat-phobic society) I try not to let it bother me, but it does.
To make matters worse, when I was about thirty years old after a 40 lb weight gain, I had a sadistic therapist who blamed me and told me that I ate too much. (I ate normally–in fact I once spent a week with a thin friend we did everything together 24 hours a day–I saw what she ate and I ate less then her) I tried to tell the therapist that the drugs make people gain weight and she insisted they did not. I unfortunately let her make me feel it was my fault. There was not a lot of information about the drugs back then and she did not work with people on them. I knew different, since I did work with people labeled mentally ill, but she pounded away at my self-esteem and so I continued to blamed myself for many years.
I saw a production on PBS that focused on fat. Everyone whose life was featured on the show ate horrible, shitty food. A couple of them did it unabashedly and one chose bariatric surgery over changing his diet. One woman courageously radically changed her diet and worked out three hours a day–she lost weight but was not thin. (even after several years) The message of the program was that our bodies become programed to be the weight they are once fat. Our chemistry demands that we take in a certain amount of calories to maintain the weight our bodies are used to being. The depressing reality–90% of people who lose large amounts of weight gain it back and according to the program it’s not really their fault. I have to wonder though, how many people maintain healthy diets. I imagine not most. I have to hope that maybe my diet will work for me in the end.
I’m hoping I fall into some different category than those people talked about on the program, but I fear that I don’t. My body is now used to this weight. I’m not so sure it will come off once I am off the drugs. I do know that once I can work out again I will again at least lose those 40 lbs–I know I can do that as long as I maintain a heavy work-out schedule. I like working out when it feels good–when I’m healthy. And I am quite confident I will again feel good enough to work out again though it may take a couple of years. Even so, I’m imagining I’m probably never going to be thin again regardless of what I do.
I will hopefully be healthy enough to return to work eventually–this adds another troubling dimension to the problem–three hour physical work outs several times a week will not be an option. My losing 40 lbs in the last several years was predicated on my being on disability. I had the time. There would be no way in hell I could do that and maintain a full-time job. I imagine I will be fat for life. Less fat rather than more fat maybe, but fat none the less. I am hopeful that I might not need to work out quite as hard once off the drugs.
I was actually okay being 40 lbs lighter than I am right now. I was able to accept my body and feel good about what I had managed, so it’s not all so bad. I’m just not happy with my body now. If I am able to lose the 40 lbs again and am at that level of fat, I will be happy. For me fat is now relative. It’s not so much about what I look like, it’s how my body feels. One roll of fat is okay, but two leaves you feeling bound up when you lean over or stretch or sit cross-legged. I just want my agility back like I had when I lost the 40 lbs. At that point I will be able to say I don’t give a shit what people think because I feel good. Right now I don’t feel good and I do care what people think. I think they go together.
Update: I did lose all the weight eventually after coming off all the psych drugs. It took several years with many dietary and lifestyle changes that all simply amounted to learning to listen to my body. I did not diet to lose weight. I found an optimal diet for a complete sense of well-being without any sense of deprivation. See: Mental health and diet — Nutrition and gut health