Most Psychotropics Cause Weight Gain

The effects of antidepressant therapy on weight, particularly those within the SSRI (selective serotonin reuptake inhibitors, such as fluoxetine, sertraline, paroxetine, or citalopram) class, have been often debated. Often, early during treatment, SSRI’s have been associated with weight loss due to increased agitation in some patients. However, in the long run, the patient may gain weight due to mechanisms that are still not well understood. Atypical antidepressants such as nefazodone (brand name Serzone) and bupropion (brand name Wellbutrin) are not associated with weight gain, although bupropion appeared to be linked with weight loss. The atypical antidepressant mirtazapine (brand name Remeron) is associated with significant weight gain, which may be an advantage for elderly patients who are often dangerously underweight.

Weight gain may also be a “natural” part of recovering from depression. If a patient loses appetite due to depression and stops eating, recovery will include a desire to eat and therefore regaining of lost weight. Some antidepressants may change appetites or metabolism, and these mechanisms warrant further study.

Many have complained of cravings certain foods (such as carbohydrates) while on antidepressant therapy or mood stabilizers. While patients may not stop therapy due to weight gain, clinicians are beginning to realize that weight gain is not simply a cosmetic issue. Patients who gain a large amount of weight may be less likely to keep complying with therapy (keep taking medication as directed) and their self image will not improve. Recently, weight gain associated with medication therapy had taken on a more insidious nature - accompanied by increased risk for heart disease or diabetes.

Although new drugs in the pipeline for treating depression and mood disorders may have improved side effect profiles and minimize weight gain, for the time being, physicians do not have a many options for treating weight gain cause by medication therapy, other than changing medications or stopping the medication therapy.

Psychological v. Physiological Craving

With my own treatment-induced weight gain experience, my cravings weren’t due to hunger. I would often be full, and still crave sweets. Gorging on sweets was comforting. It was easy to lose control with a gallon of ice cream or a whole pizza pie. I saw this as a psychological side effect rather than being hungry. Since people react to medications differently, what made me gain weight may easily make someone else lose too much weight. Therefore, even testing medications that will help your symptoms improve without too many side effects remains an individual trial and error.

I have been free of antidepressant therapy for many years. I was able to take off most of the extra weight through good old fashioned “eating smaller portions” and exercise. I still have carbohydrate cravings - these seemed to not go away. However, a high protein, low carbohydrate diet seemed to help take the edge off the cravings.

In addition, I also get adequate sleep. Studies have shown that lacking sleep can actually contribute to weight gain and obesity, plus other health problems associated with sleep deprivation.

Drinking water and keeping yourself hydrated throughout the day is a simple yet important way to keep your body working properly.

Incorporating weight- or resistance training with regular aerobic exercise is an excellent method to increase metabolism. Muscles require energy and you are able to burn fat even while not aerobically exercising. For women, please do not worry about “buffing up” too much. Unless you were genetically programmed for bulk, regular weight training will tone muscle, not build bulk.

Finally, when the cravings are clearly psychological - when you’re bored, when you’re stressed - keep a list of things to do to distract you from your cravings, or simply remove yourself with a walk down the block or in the park.

I know these aren’t clear-cut solutions, especially if you are still on an antidepressant for managing your depression. Trying many different methods - especially non-medication methods - can maximize your chances of controlling treatment-related weight gain.

The haunting images captured by the Jessica’s brother is more telling of the suffering endured by patients with bipolar disorder than any amount of scientific papers I can read. Every couple of years, I’d visit the site; I’d be encouraged about updates of Jessica doing well. Then Jessica committed suicide in May of 2003.

We can easily judge a person’s pain and condemn a person for being a coward or taking an easy way out. Judging comes easy when we have not experienced constant and perpetual psychological pain. For some living with a mental illness, Hell sounds like a welcome relief.

Living in the shadow of mental pain is torture. Sometimes we make it through the abyss. Sometimes we break. Even for those of us who have “made it”, we are not guaranteed a relapse free future. For many, living every day is like punching a time card, two or three times a day. You don’t get leniency when you missed a punch or showed up late.

I don’t know what makes one person give up in utter despair while another person hang on.

I am no stranger to this darkness - the “utter” kind of despair - the kind that makes people step away from you ever-so-carefully.

I have learned to appreciate the courage to hang on and live.

Click to visit Boris Dolin’s photo essay and tribute to his sister, Jessica Dolin, in Catching a Darkness.

Article History: Originally Published November 22, 2007
In a previous article, I said that I’d write separately on what Suni submitted (”Some of the best writers and artists have undiagnosed or untreated mental issues… I am scared to death to be fully cured because it will take away what I like about myself”) and a question Quint asked via email (”Taking medication can alleviate the depression, but it also changes perception and personality. Are there trade-offs? Is the gain worth the loss?”)

There are two aspects of an important question raised by Suni, Quint, and many of you who have lived with both the “gifts and burdens” of the depression experience. These two aspects are:

1) Does medication interfere with my creativity, and ultimately, my personality, if I believe that medication alleviates a factor (depression) that enables my heightened sensitivity of my life experience?

and

2) Does depression play a role in making me more creative, given that I seem to have a heightened sensitivity of the life experience when I feel depressed?

The reason why I wanted to break this question down into two parts is because we must address the individual components of this complex question if we want to clearly see where we choose to stand on the answer to each individual component.

Before I begin, it is important to disclose that I’m writing from my personal experiences of having had severe depression, having taking antidepressants as well as receiving psychotherapy treatment, having had a relapse from depression, and currently being “in remission” from depression. Fortunately, I’ve formed a habit of regular journaling throughout my life, which means I have documentation and a historical written record of my own “creativity” at least through the written word. When I consider how critical writing is as my main creative outlet, retaining the ability to express myself creatively is extremely important to me.

First: Does medication interfere with my creativity, and ultimately, my personality, if I believe that medication alleviates a factor (depression) that enables my heightened sensitivity of my life experience?

Quint shared this article with me, called “I miss depression” by Tim Bugansky and particularly:

It’s been four years now since I began a course of treatment, swallowing daily a white pill that changes not only my brain chemistry, but also the very ways I perceive the world, the ways the world impacts me. Besides all the questions antidepressants raise about reality and perception, “mental illness” and normalcy, my personal reality is that I am different now. Antidepressants altered my existence.

Tim said that “Depression isolated me within myself, yet through its ever-present melancholy, it also made me feel completely connected to the world.”

When I was on an antidepressant, I experienced side effects that actually led me to explore a new dimension that I previously ignored: spirituality. At the time, I did not know that the strange dreams I was having while on medication was a side effect of the medication. I put a lot of weight into the “meaning” of some dreams, perhaps more than I should, although I could also argue that those dreams could very well be my psyche’s way of purging all the garbage that I could not allow myself to purge during my waking hours.

This shows that we are the writer of the meanings of what we experience. If I recognized the side effects as they really were, I would not have explored alternatives to make sense of what I was experiencing (vivid bizarre dreams and sleep disturbances). In a way, my ignorance of “what actually was” led me to explore a new possibility that became enriching. Even afterwards, when I realized “what actually was”, this did not take away from the growth that I had experienced as a result of my original ignorance.

I wrote creatively when I was on medication therapy, and my writing seemed to oscillate between several qualities: “spiritual exploration and healing” (for example, this poem I wrote) and “lots of anger needing to be expressed about what happened to me” (for example, memories of childhood emotional abuse experiences here, here, and here).

Medication can be tricky, because one person can get relief while retaining a sense of self and connection to the world while another person on the same dose can get relief while paying a price of loss of sense of self or disconnection from the world. This is why I’m thankful we have many more medication options to choose from today when compared with twenty years ago, because in many cases, we don’t have to “settle” or pay an exorbitant price to get relief from depressive symptoms. The trick though, is to recognize that “apathy” and feeling of disconnectedness from the world is not the same as “depression relief”.

Now: Does depression play a role in making me more creative, given that I seem to have a heightened sensitivity of the life experience when I feel depressed?

Back in 2001, a friend who started antidepressant therapy asked me the same question Suni and Quint had asked. At that time, I wrote an article in response, called, “No longer fighting the waters”. Notable excerpts from my article included my early observations of how much depression permeated my writings while I was depressed, and the true nature of what I thought was “a beautifully sad veil of the world”:

We may write prolifically and appear more creative when we were depressed. These expressions had remained our only outlets to communicate when we had shut ourselves off from the world. When I had revisited my writing during a depressed state, I was amazed at how dark and depressing my writing was. Poignant? Sensitive? Yes, but overshadowed by despair and dread permeating each sentence.

I concluded the article with the following:

Depression was being on a boat in stormy waters. You were in constant fear of capsizing. Normalcy is being on calm waters. You can sit still and rest, because the boat was no longer rocking. At first, the water may seem was too quiet, everything may seem too quiet. Then, you re-shift your focus from this new quietness, and look to the horizon for all the places you can go and explore.

Let the quietness come. Let the living come. Let the joy come. Let the changes come. Creativity was never a part of the “temporary”. Creativity is always a part of you. Depression was always a part of the “temporary” and is never a part of you. You can now sit back and enjoy the scenery instead of fighting the waters.

I came to this conclusion after experiencing a relapse earlier that year (2001) and with professional help, recovering from the relapse of a depressive episode. If you go to my personal account, “Misdiagnosis and Back: My Journey Through Depression” and scroll down to January 2001, you’ll find a piece of writing I had done during this relapse. That was how I saw myself. That was how I perceived the world. Were the words strong? Poignant? Dramatic? Yes. Was the piece cleverly sad and even darkly beautiful? I thought so, at least the part where I used this metaphor,

“I am a poisonous plant, I sicken a healthy being when they come in close contact with me.”

I had forgotten about this metaphor, but earlier this year, I wrote one of the most popular articles here called, “I’m Here to Remind You that You Are Not Your Illness” where I used a plant metaphor.

My personal experience tells me that the experience of depression heightened my sensation and perception of a particular shade of the color of the world. Particularly, I became highly sensitive to the suffering and pain in the human experience, because my own human experience was shaded by the feeling of suffering and pain.

The “burden” of depression while I experienced it was the veil it cast upon my eyes, such that I saw mainly sadness and despair in all aspects of my human experience.

Sometimes this sadness was so intense that I was propelled to exorcise my demons, at least temporarily, by writing it down and getting it off my chest (or more accurately, out of my head). Intensely-shaded perceptions make for intensely-shaded feelings, which make for intensely-shaded self-expression. Thus I have a slew of strong pieces of writing, all of which share the characteristic themes of pain and suffering of the human experience.

The “gift” of depression once I recovered from it was my ability to appreciate and be grateful for no longer being in depression’s stormy waters, and to remember enough of it to empathize with those who still fight against depression’s storm without falling prey to its poisonous grip.

There are two big differences between the writings that I’ve considered most important and that have been written “with” and “without” depression.

First, the tears that accompany a piece I’ve written “with” versus “without” depression are different.

The tears that came when I wrote, “Sick of Suffering” were tears of pain and despair. The kind that says, “please end this pain because I don’t want to end my life.”

On the other hand, the tears that came when I wrote one of my favorite pieces, “Divine Comedy” (link out to another one of my blogs) were tears of healing and inspiration. The kind that says, “I see suffering in the context that it is. I see Me as more than my suffering. I can even be grateful for this suffering because it steeled my will to live - and live well.” Another piece I wrote that falls into the same category of “inspired writing not depressed writing” is “That I Am” (link out to another one of my blogs), which I used to compete in a speech contest earlier this year.

Second, I’ve noticed that pieces I’ve written “with” depression has a “timeliness” to it, while pieces I’ve written “without” depression is “timeless” for me.

Today, when I read “Sick of Suffering”, tears that used to come no longer come to me. There is, of course, a possibility that “Sick of Suffering” touches someone who may be experiencing what I had experienced, and as a result, seeks help. In this case, sharing this writing becomes important to help those who suffer from depression know that they are not alone, and that someone else has experienced what they are experiencing, and that they CAN get through this.

On the other hand, I get choked up every time I read “Divine Comedy”. What I’ve written in moments of depression-free inspiration is enduring and even strengthens me against the stressors that lead to a downward depression spiral.

In conclusion, I’ve put depression and creativity in the following context for myself: My creativity comes through me and from me; NOT through depression or from depression.