just please don't tell me to calm down
August 7, 2010 5:59 PM   Subscribe

Do I have to choose between thin+unhappy and fat+unhappy?

I apologize if this question is ridiculous, but this is a really emotional issue for me and I find it hard to think about it with any clarity or objectivity.

I am trying to deal with my anxiety disorder. In the last year, it's gotten much worse. I want to understand what my medication options are, and they all seem terrible. Because of you, my metafilter friends, I am on the NuvaRing and have had over a year of freedom from incapacitating period pain, so I was hoping you could work your magic again and help me gain some knowledge and some comfort...

Basically, as far as I can tell, there are two kinds of medications I can take to treat my anxiety. First, there are SSRIs, which will make me gain weight, which I'd have to take daily, and which will stay in my system for a while if I decide to stop taking them. Second, there are medications like Xanax, which act quickly to stop a panic attack but which are habit forming.

Is there anything else? Do I have to choose between anxiety&panic, or gaining weight, or becoming addicted to Valium?

Please, please don't tell me to talk to a doctor about this. I get so freaked out about this that I just lose the ability to take in information that is being said to me with words. If I can get a sense from text on a screen, maybe I can handle a conversation with a doctor, but I really need this to be my first step, or I will go to the doctor, totally flip out, not understand anything the doctor says, and leave with a prescription I will never fill.

I am seeing a therapist who has urged me to consider medication several times, so this isn't happening in a vacuum.

I really appreciate your time and help.
posted by anonymous to Health & Fitness (41 answers total) 6 users marked this as a favorite
Many people in my family have had a good experience with Lexapro (a SSRI) without weight gain.
posted by BusyBusyBusy at 6:02 PM on August 7, 2010

Listen to your therapist.

Try the medication.

If (IF! possible side effects don't always happen) you gain weight, this chart may give you some perspective.
posted by phunniemee at 6:06 PM on August 7, 2010

SSRIs will only "make" you gain weight if you eat too much and don't exercise enough. They don't magically change the laws of thermodynamics.
posted by halogen at 6:07 PM on August 7, 2010 [6 favorites]

Do you have a good, close friend? If the answer's yes, maybe you can take that person with you to the doctor, to take notes or just hear what your doctor has to say, and then discuss/rehash it with you afterwards, in a location that is less anxiety-provoking, like your own home. Maybe this person can first go to the therapist with you, so he/she can become a real teammate/advocate for you.
posted by BlahLaLa at 6:12 PM on August 7, 2010

I got put on an NMDA receptor antagonist for migraines; it also fixed my mild OCD, which was mostly a lot of repetitive anxiety and obsessing over a handful of topics.

I... really don't know if anyone would consider it for straight-up anxiety/ panic. I'm not a shrink, and even the migraine usage is off-label-- it's an Alzheimer's drug. I am fortunate to have excellent neurologists seeing to me at a large research and teaching facility, so psychiatrists haven't entered the equation for me.

That being said, it is a daily dosing thing-- twice a day-- and it is messing with brain chemistry in fundamental ways. It hasn't made me any more of a fatass than I already am. I'm just entirely unsure that drugs of that class are applicable to anxiety that isn't from OCD.

You'll need a sharp shrink or psychopharmacologist to guide you, I think, and preferably at a fairly cutting-edge facility. Good luck.
posted by fairytale of los angeles at 6:15 PM on August 7, 2010 [1 favorite]

For what it's worth, my partner and several family members take SSRIs and haven't gained weight; several people in my family and many friends and coworkers have taken Xanax and similar anxiety drugs and no one I know has had to deal with an addiction or habit from them.

I'm not saying that you won't have any side effects or problems with these drugs. But they are incredibly common to take and are very effective. Listen to your therapist and try the medication -- it might take some experimenting to see which medication at which dosage works for you, but in my purely anecdotal world the results can be literally life-transforming.
posted by Forktine at 6:16 PM on August 7, 2010

halogen, given the number of people who gain weight on SSRIs for totally unknown reasons, the OP is right to consider it a likelihood. I'd not be so dismissive.

That having been said, a lot of people's weight gain is minimal to non-existent. 10 persistent pounds is a weight gain, but it's not one that I'd consider life-wrecking. And while SSRIs do in fact stay in your system for a while after you stop taking them, "a while" isn't "forever." You can always ride out the transition period and be basically right back where you were.

Additionally, anxiolytics CAN be habit forming. . . but they aren't always. In particular, they aren't necessarily habit-forming over a short period of time. If you're having so much anxiety about this issue that you can't evaluate your options, you might consider getting a wee tiny Xanax scrip for the express purpose of letting you make your decision without being crippled by panic.

Good luck.
posted by KathrynT at 6:19 PM on August 7, 2010 [10 favorites]

Hi! I have an anxiety disorder. No, you don't have to be unhappy. You can find a medication that works for you. The beauty of medication is that it removes the physical symptoms that can cause your anxiety to snowball (omg my heart is racing! therefore there must be something wrong! omg now I'm short of breath! etc). Then you can think clearly and take further action. With other lifestyle modifications (meditation, exercise, dietary changes) you may not need as much of the medication, or you may be able to stop taking it altogether. It's OK! It's not a death sentence. You will be fine.

OK, so SSRIs. They did not work for me because they made me feel puky and dizzy, so I never stayed on one long enough to gain weight. I'm sure someone else will be along to chime in on them.

I am on Lamictal and Klonopin, which works wonderfully. I cannot even tell you how much this has improved my life. Lamictal is a daily thing, and the Klonopin is "as needed." Yes, some people do become addicted to Klonopin, but unless you have prior dependency issues, there's no reason to believe that you will be one of them. I don't take it every day. Sometimes I don't take it for a week. It's possible to abuse it just like it's possible to abuse many substances; that doesn't negate the fact that it may be very, very helpful to you.

I get so freaked out about this that I just lose the ability to take in information that is being said to me with words.

Can you take a friend or family member with you? They can help you remember what you missed, and can ask questions on your behalf. Tell the doctor upfront that you're very anxious about being there, and can she please speak slowly and write down the major points for your future reference? I find it extremely helpful to give people a "heads up" on what helps me manage my anxiety. It makes them less anxious, too!

I could probably go on and on - memail me if you want more specific information or just want to chat. You will be OK. There is a light at the end of the tunnel.
posted by desjardins at 6:22 PM on August 7, 2010 [2 favorites]

There was a recent post regarding weight gain and SSRIs--I think there was a consensus that one does not necessarily follow the other. Fear of weight gain is not a good reason for failing to try a medication that may significantly reduce your anxiety. SSRIs may temporarily (10-14 days) increase anxiety. The initial side effects almost always go away--be patient. Initial side effects can be minimized by slowly introducing the medication, temporarily augmenting the SSRI or, if appropriate, switching to another SSRI. They are not all the same--time, patience and just a bit more patience.
posted by rmhsinc at 6:26 PM on August 7, 2010

Buspar is an anti-anxiety drug that is not an SSRI, or a benzodiazepine. It worked well for me. Weight gain is not listed as a side effect. Feel free to memail me if you want to hear about my circumstances & experience.
posted by kellyblah at 6:34 PM on August 7, 2010 [1 favorite]

I get so freaked out about this that I just lose the ability to take in information that is being said to me with words.

In addition to bringing a friend as suggested above, you might think about printing out a statement of your concerns (print out your OP) and a list of questions that you want to ask, leaving space for the answers. You might do a bit of research about the various drugs in this post and list them on the paper to ask your doctor about which ones might be ok for you to try.
posted by CathyG at 6:40 PM on August 7, 2010

I *lost* weight when I was on Prozac, and again when I was on Wellbutrin. I gained weight on Effexor and on lithium (also lithium did nothing for me, so that was doubly annoying).

Some SSRIs cause weight gain, some do nothing, some kick-start weight loss. Search "prozac and weight loss" or "anti-depressants and weight loss" or whatever on google. I think you're borrowing worry.
posted by tzikeh at 6:47 PM on August 7, 2010

Side effects are not guarantees.

Benzodiazapenes CAN be habit-forming. They can also not be habit forming if you don't take them all the time. You can also taper off of them if you need to. I have successfully tapered off of Xanax and Klonopin when I decided I didn't like the side effects anymore. You taper off of them, and you won't get crazy shakes or have to tie yourself to the bed like you're addicted to heroin or anything.
posted by internet fraud detective squad, station number 9 at 6:47 PM on August 7, 2010

argh...if anyone else wants to be dismissive of the possibility of weight gain and how it can be dealt with by controlling diet or exercising more, try framing the OP's concern from this perspective:

SSRI's may cause a change to appetite (causing someone to feel hungry or not hungry all the time) or they may affect metabolism (causing the same amount of food ingested to be 'stored' as extra weight or 'burned off' faster, leading to a weight loss). I personally do not know the details on the *which* of these many options may or may not happen to the OP if she chooses to take an SSRI. But the evidence is there that SSRI's tip the balance.

Perhaps the dismissals could stop if people understand that OP is concerned that her body's reaction to her current diet could change...whether or not she could 'deal' with that change. I think she is concerned about being *forced to deal* with a problem she does not currently have.

Good luck, OP; I am sorry I don't have any specific info to give you.
posted by Tandem Affinity at 6:48 PM on August 7, 2010 [10 favorites]

Data point: I was on a great deal of Valium (around 20mg per day) for approximately 6 months. I found it very easy to go cold turkey, though I have what I guess might be called an "addictive personality" and have had far less success in cutting down on booze and smokes. I'm not saying "go for it!" but, well, certain people may find it far less difficult to give up than they are told they will.
posted by turgid dahlia at 7:01 PM on August 7, 2010

God I love AskMe/MeFi, but there is always so much misinformation about this topic.

First, from the posts above, let me make a couple of points...

1. You can easily become addicted to benzodiazepines without having prior dependency issues. Benzos are highly addictive - period. If you take them for much longer than a few weeks without having issues with withdrawal when you stop - you're in a small minority. If you continue on any benzo for a longer period of time, most people face issues of tolerance and a need for a higher dose. This is a vicious cycle that can become much worse than the anxiety it is intended to help.

2. While SSRI antidepressants are not technically "addicting" according to the fine print of Big Pharma, they most certainly can be just as difficult to get off of. Big Pharma came up with the term, "Discontinuance Syndrome," to describe the problems coming off of Zoloft and the like. Yes, there are technically differences from a true addiction and this 'syndrome,' but the physical effects are very similar.

Bottom line: none of these drugs are to be seen as aspirin for the mind. They are powerful, they alter brain chemistry, and there are many questions regarding whether SSRI's even work except as a placebo. That's what the latest research shows. For all those who say, "My life was saved by fill-in-the-blank" please don't kill the messenger (and all of these recent studies address your understandable certainty).

Valium, Klonopin, Xanax, etc. (benzos) work without a doubt. No question. But they work at a trade-off and there has to be an understanding as to what you're getting involved with. Please, run from any doctor who hands these out like candy corn at Halloween. Benzos have their place in the treatment of acute trauma or short-term use for chronic anxiety, but (in my opinion) it should be short-term and within a context of an overall treatment plan that involves Cognitive Behavioral Therapy.

Civil Disobedient mentioned exercise and I don't believe it was meant as a snarky comment. There simply is not anything available in pill form that, in any recent studies, has out-performed talk therapy and exercise.

I don't mean to be alarmist. I'm not a Scientologist and I am not an "anti" when it comes to psycho-pharmaceuticals, but it is vitally important you have an understanding of all of these issues and unfortunately, too few doctors are willing to take the time, or understand themselves, the ramifications of handing these drugs out without full disclosure.

Good luck and my best wishes to you.
posted by Gerard Sorme at 7:02 PM on August 7, 2010 [3 favorites]

Yeah, what this guy above me said about benzos.

Fact is, though, they won't make you a crazy pill-popper addict psycho just because you're taking them. They will create a physical dependency if you take them long enough (not necessarily that long) but the solution to that is to either not take them that long, or taper off of them.

That said, they aren't something to use as a long-term anxiety solution (in my opinion) because at least some of them can cause depression (boo) and that's the last thing you need. The physical dependency is inconvenient at best because they're controlled substances. It sucks to be like WHAT THE FUCK I NEED XANAX because without it you will go through physical withdrawal.

Especially, especially guard against ever-increasing doses of benzodiazapenes. Some shrinks will keep upping your dosage forever but at some point you will be facing severe and possibly dangerous withdrawals should you be cut off cold turkey for whatever reason. Not good.
posted by internet fraud detective squad, station number 9 at 7:10 PM on August 7, 2010

You can always ride out the transition period and be basically right back where you were.

Not necessarily. I had side effects that have not completely gone away, even a year after I stopped taking SSRIs. They absolutely changed the way I use and am able to use words, a side effect that as far as I know is completely undocumented. Maybe it's unusual effect, or maybe I'm just unusually sensitive to it (I was an English literature major).

Many drugs have side effects that aren't documented or understood. For instance, I take a medication that caused weird bruising. I called the company (maybe five-ish years ago) and asked about it, and they denied that it could even be a possibility. I asked my doctor, and my doctor said no one had ever reported weird bruising. Now, five years later, the same company, in television commercials, lists unusual bruising as a side effect.

You have to weigh possible side effects against your situation. Some people experience no side effects, while others do. YMMV. As far as SSRIs, I experienced weight gain to the tune of 10-15 pounds that I still haven't manged to drop. That doesn't bother me nearly as much as the aphasia I experienced.

Personally, I wish I'd put more energy into changing my situation instead of pouring money and my body down the hole of therapy and drugs. At the time it was easier to let my therapist and my doctor tell me what to do. Anyone who goes with the drugs needs to be sure that they can handle the side effects.

And as far as anxiety drugs go, fear of addiction is usually blown wayyy out of proportion. Whether or not they will do you any real good is another matter entirely.

Do I have to choose between anxiety&panic, or gaining weight, or becoming addicted to Valium?

Those are not your only choices, but it definitely sounds like you're looking for a solution in pill form. If I'm wrong, you're free to email me about the tricks I use to stay sane. (I have no philosophical objection to pills, by the way, if that's what works).
posted by tejolote at 7:23 PM on August 7, 2010

Perhaps this link might be helpful to you. The broad overviews of medication classes are probably information you've already come across, but they list medications in that class in parentheses, so you could Google each one and find out more.
posted by epj at 7:26 PM on August 7, 2010 [1 favorite]

Gaining weight after starting an SSRI is not an inevitability. It's not even more likely than not. Yes, there are people who have "unexplained" weight loss after starting SSRIs, but as a whole residents of the Western world, on antidepressants and not, are experiencing weight gain en masse. We don't really understand why, except that there must be something wrong with the way we're eating. Don't pay attention to the side effect anecdotes you're getting here or in the other recent Ask thread on this topic. Instead, take a look at the data. It is reassuring

For example, here [PDF] is a 2005 study that reviewed the research to date on the safety and efficacy of the new antidepressants. I'm going to quote the relevant section:
In general, most trials did not report statistically or clinically (7% change in body weight) significant changes in weight. Of trials that did report changes in body weight, those of mirtazapine, paroxetine, fluoxetine, and sertraline differed in the percentage of patients who reported such changes. On average, the most consistent percentage of patients who reported weight gain were taking mirtazapine; these patients had an estimated increase in body weight of 2 kg over 8 weeks. In the trials of SSRIs that reported changes in body weight, the percentage of patients who reported weight gain was highest in the paroxetine group and lowest in the fluoxetine group; we could not estimate specific changes in weight on the basis of these data. In 1 placebo-controlled study, bupropion treatment appeared to be associated with moderate loss of body weight: patients with a baseline body mass index of 30 kg/m2 or more lost an average of 2.4 kg fter 52 weeks of treatment.
There are a couple of things I want to point out about that paragraph: 1) Most of the people taking any of these drugs didn't get fat. Or, to be more precise, the people who took the antidepressants were no more likely to get fat than were the folks who were taking a sugar pill. 2) There were some differences in how likely people were to gain weight depending on which drug they took. Mirtazapine is singled out as particularly problematic. That drug, sold as Remeron in the United States, isn't an SSRI and isn't likely to be offered to someone like you who is trying an antidepressant for the first time. Paxil (paroxetine) was the SSRI most likely to cause weight gain and Prozac (fluoxetine) was the least likely. Bupropion, which isn't an SSRI either, was actually associated with weight loss in one study.

It's reasonable for you to be thinking about the potential side effects of these medications and weighing them against their potential benefits, but you shouldn't let your anxiety get in the way of getting your anxiety treated. It would be too ironic! Here's how I would approach this issue if I were you: First, take a look at the study I quoted above and any other objective, scientific report on the drugs that you come across. (Don't waste your time on personal anecdotes because worst case scenarios are always overrepresented, and that's just going to fuel your anxiety.) Then, write down a list of your concerns and bring them to your next doctor's appointment. Your worries about gaining weight on an SSRI and getting hooked on a benzo should definitely be on that list. Ask your doctor to discuss how you can manage those risks. Any doctor prescribing psych meds has heard these concerns before. I hope it will be a productive conversation. Good luck!
posted by reren at 7:30 PM on August 7, 2010 [1 favorite]

I was on Effexor XR for depression and anxiety and it actually killed my appetite. I gained weight when I stopped taking it.

When I lost my insurance and had to stop the Effexor I took Valerian Root for panic attacks. It's herbal and not habit forming. It kind of mellows me out and helps me get myself under control. It might be something for you to look into until you figure out what kind of prescriptions will be best.
posted by TooFewShoes at 7:39 PM on August 7, 2010

I actually lost 20 pounds after I started taking Celexa, because I stopped emotional eating and self-medicating with junk food.
posted by Jacqueline at 7:46 PM on August 7, 2010 [1 favorite]

I lost weight on an antidepressant. I gained weight on another. Just don't let a doctor keep telling you, "Keep trying this" once you think the side effects are too much to handle. (Here, again, you may want to write it up or get a friend to help you out.) If you don't get along with one, try a different one. There are LOTS.

there are many questions regarding whether SSRI's even work except as a placebo. That's what the latest research shows.

What, you mean the research discussed in this article?
"Study shows antidepressants useless for mild to moderate depression? Not exactly."
posted by galadriel at 7:55 PM on August 7, 2010 [1 favorite]

galadriel: Yes, she discusses some of the research I was referring to. There is so much misinformation in that blog post you linked to I wouldn't even know where to begin. She sounds just like the drug reps backtracking and talking in doublespeak on this issue. I would urge you to take a look at the latest issue of Science and read the article on how Big Pharma is making a big pull-out of the psychiatric drug business. If you have access, you can read it at the link provided. If not, MeMail me.

And....We haven't even discussed the other drugs tested and the results that were thrown out because they showed no efficacy whatsoever.

What is important here, is not to debate the issue by asking sly questions with links to provocative positions (which can't go unanswered without leaving a skewed viewpoint), but that the anonymous poster gets help with all the information. In that, I wish them luck.

If you would like further info on the research please contact me. This isn't the thread to discuss all of that in-depth.
posted by Gerard Sorme at 8:47 PM on August 7, 2010

I've been on several different SSRI meds, and am prone to binge eating and weight gains even when not on meds. Two of the drugs did result in a modest gain; the other three did not. The SSRI that I'm currently on is one with a reputation for weight gain, yet my weight has remained stable even though I'm currently not exercising. So weight gain is by no means a guarantee.

Another thing to consider is that, once you find something that works for you, you'll be in a better position to take up or increase your existing exercise. I know when I've hit my depression wall I'm much less likely to be hitting the gym, and conversely so - when things are stabilized I'm more likely to be more active (and shed more pounds).
posted by Hardcore Poser at 9:01 PM on August 7, 2010

There are some SSRI's that actually combat the weight gain problem of SSRI's...some doctors will rx some Wellbutrin along with another drug. For me my appetite went way down, and energy went up.
posted by radioamy at 9:15 PM on August 7, 2010

I have a great doc who worked with me to find an ssri with side effects that were acceptable.

I did not manage to gain weight on anything we'd tried, but I know I'm anecdata here.

Still, you can't know unless you try. Because those study results tell you about the aggregate, not about you.
posted by bilabial at 9:16 PM on August 7, 2010

I lost a ton of weight on Zoloft, which I was prescribed for depression and anxiety. I also had an Rx for oxazepam when the panic attacks were too much to bear. I think I still have a couple of those oxazepam left - from ten years ago. But ultimately I don't know how much the medication helped - I learned how to talk myself out of the panic attacks and I haven't had one in eight years.

Just because a drug can cause a side effect doesn't mean you're necessarily going to have that side effect. The SSRI didn't cause me to gain weight and the benzo wasn't habit forming.

However, the anxiety that I had about potential side effects didn't help me one damn bit.
posted by elsietheeel at 9:53 PM on August 7, 2010

not everyone gains weight on those types of medications. truely. if you have a spouse or a sibling or a parent (a nonjudgemental one of these things) have them go to the appointment with you to discuss meds so they can take in the info that you miss, or don't understand.

and even if you gain weight, you're not going to balloon to 300lbs, it will only be 10 or 20lbs, which is manageable.

anyway. meds could really help you. you take one, it has side effects you don't like, you switch to another. but you do have to take into account the benefits and the side effects and see if the benefits outweight the side effects. is a few pounds but no anxiety a good trade off? yes, yes it is (at least for me).

the point is, give it a try. the therapy hasn't been enough for you, and i know how bad anxiety is. you might find relief with some meds.
posted by misanthropicsarah at 9:53 PM on August 7, 2010

I would urge you to take a look at the latest issue of Science and read the article on how Big Pharma is making a big pull-out of the psychiatric drug business

Well, I don't have access to the full article, but the abstract says they're ceasing R&D because they're not finding *new*drugs. That's not the same as pulling out of the area completely.

You're not really backing up your assertion that recent research shows that SSRI's are no better than placebo. You're making a lotta wild claims and apparently using the term "Big Pharma"in seriousness, though.
posted by galadriel at 9:56 PM on August 7, 2010 [1 favorite]

Benzodiazepines will not cure anxiety, but they can help you break the cycle by giving you temporary relief while you work on more permanent solutions. If you go that route, I recommend that you take a longer-acting one (like Klonopin) and not a shorter-acting one (like Xanax or Valium). The shorter acting ones have an even higher risk of psychological dependency because of the way you take them when you feel bad and the way you condition yourself with them. It is better to take the longer acting ones and take them at specific prescribed times of the day. Taking them "as needed" runs a higher risk of your becoming addicted.

SSRI's can help at higher doses, but nothing has helped me like my yoga kriya. I practice this kind. Nothing in the world helps me in the same way. If I go a couple of days without my practice my anxiety spikes, but when I practice it regularly, I feel OK.

The next most powerful help is Cognitive Behavioral Therapy. I recommend you find a therapist who specializes in CBT. Talk therapy can be nice, but CBT has been shown in studies to actually work and create concrete results. In my experience many therapists like to mix modalities and shoot from the hip. A true CBT therapist can change your life.

Almost daily exercise is also helpful as others have said. Finally, recent research seems to be suggesting that vitamin D deficiency can cause anxiety. You should ask your doctor to test you. If you are significantly deficient, they say you need a prescription dose of it to get your concentration up to normal levels.
posted by Original 1928 Flavor at 10:00 PM on August 7, 2010

I am on an Zoloft. Over the past two years I lost 130 lbs. You can lose and maintain weight loss while on a SSRI.
posted by fifilaru at 11:21 PM on August 7, 2010

Dear Anon, I refute Halogen's comment; some medications predispose you to weight gain. They affect appetite and metabolism, so that it becomes significantly more difficult to manage weight. Some meds have the opposite effect. I take Zoloft, an SSRI, and it tends to reduce weight, when the dosage is adequate.

I carry Xanax, for panic attacks. I don't take it habitually, and it hasn't been a problem. I have learned that a cold wet washcloth on the face is effective for panic attacks; it's a physiological, not psychological effect. Meds vary a lot, and you may need to try a few different things.

You didn't ask about whether SSRIs are effective, so I won't join that battle.

In order to get meds, won't you have to see a doctor? I am a proponent of Morita therapy (recommend Playing Ball on Running Water), and would recommend that you ask the therapist to use a session to go to the doctor with you, or to see you immediately before or after, and to talk to the doc on your behalf. You don't have to deal with this alone. Sounds like you're tackling a difficult situation head-on. Good luck.
posted by theora55 at 5:20 AM on August 8, 2010

Your anxiety about gaining weight is part of the disorder.
posted by Obscure Reference at 6:51 AM on August 8, 2010

Is there anything else? Do I have to choose between anxiety&panic, or gaining weight, or becoming addicted to Valium?

Tell your doctor. Hey doc, I'm really really worried I'll become dependent or, gaining a lot of weight. Is there something you can give me that has the least chance of either happening? Then, you pretty much have to bite the bullet take what's prescribed to you and, if you find the side effects are not worth the benefits go back to the doctor*. Rinse and repeat until you do find something that has side effects you can live with.

The other part of it is, you're question is impossible to answer in part because there isn't a foolproof method to determine how you will respond to whatever drug is prescribed and, none of use have an idea of how bad/how often you get anxiety which usually determines what might be the best course of action to take.

*I worry every time I take something new because I'm especially sensitive to medication so I joke that I'm YAGPfBP to try and take the edge off before I swallow.

On preview, I agree with Obscure Reference.
posted by squeak at 7:00 AM on August 8, 2010

Mod note: few comments removed - folks, question is about SSRIs and weight gain. Go to metatalk if you want to argue about another question.
posted by jessamyn (staff) at 7:44 AM on August 8, 2010

I think that the OP has a valid concern. I gained 60 pounds on Zoloft before I finally went off. I had doctors deny that it had anything to do with the Zoloft, but while I was on it, no matter how much I dieted or exercised, my weight went up up up. And here I am four years later and it never came off.

I have recently been going through trials of new anti-anxiety medicine. I started on Wellbutrin, which didn't effect my weight but didn't do much for my anxiety. Then I went to Cymbalta, and without changing my diet, I instantly went up a clothing size. The doctor freaked when she saw that and put me on Lexapro. I'm up another size. Lexapro has been the most effective anxiety-wise, however. I feel totally normal for the first time in a long time.

My advice for you, OP, is to go straight to a psychiatrist and don't let the GP run you through medication after medication. I'm going to make an appointment for a psychiatrist and get myself on some kind of program that closely monitors my weight and mood objectively. I can do some of that by myself, but it's best to let the experts step in and see what's really going on. That, and I can't bear to look at the scale.
posted by bristolcat at 9:07 AM on August 8, 2010 [1 favorite]

Seconding having medication talk with psychopharmacologist or psychiatrist, not GP.

They've absolutely heard your concern before and will be willing to help you with everything.
posted by dzaz at 11:38 AM on August 8, 2010 [1 favorite]

Of course this isn't a ridiculous question. I could have posted this myself a year ago when I was having severe anxiety and panic. I'm happy to tell you that I've found some things that work better for me than drugs.

Before I tell you what's worked for me, I want to reiterate that everyone is different. Body chemistry and circumstances will dictate that one person gain weight on an SSRI and one not. However, it's a very common side effect and the reason I chose not to take one.

I personally will try drugs as a last resort, but I know people who absolutely love their medication and would never try to dissuade anyone from allopathic treatment if it works for them.

My most recent bout with lifelong, recurring anxiety peaked last summer. Here's the story.

In 2006-2009, I was on Xanax for a few months at a time, taking .25 to .5 mg as needed, which added up to about 1 mg/day on the worst days. My doc assured me it wouldn't create dependency. Well, it did. I ran out of my prescription and went through several nights of scary insomniac panic attacks. Luckily I realized it was Xanax withdrawal. I asked my doc for some Klonopin and proceeded to use it as a taper from Xanax. This worked great for me. I tapered from the Klonopin and I've been benzo-free for over a year. If you decide to go with a benzo, I would recommend Klonopin, and advise you to stay away from the Xanax. I would still take Klonopin again if I relapsed into severe anxiety. That said, other people have reported becoming dependent on it. If you want something even less potent than Klonopin, Valium is reportedly 20 times less potent than Xanax, 10 times less than Klonopin.

I was on Wellbutrin for depression at the same time. I lost 5 lbs with this, but it made me more anxious. It also made my hair fall out and I had the worst facial acne ever. I tapered off the Wellbutrin on my own.

I began to research natural ways to stabilize mood. Here's what worked for me. I haven't had an episode of severe anxiety in over a year.

-My anxiety attacks were often tied to one repetitive phobic thought that was linked to something that happened to me as a kid. I found a therapist who practices EMDR. My treatment lasted a couple of months and this phobia no longer troubles me. Even my generalized anxiety was helped by working on this one specific thing.

-I found out about a product called L-theanine, an amino acid that you can buy at health food stores. I started taking that when I felt on edge. I take one or two capsules at a time, 200-400 mg. It works great for me. I take it as needed. It is derived from one of the components of green tea but highly concentrated. You have to get the kind made from Japanese Suntheanine for it to work.

-Omega 3 fatty acids in the form of fish or flax oil. I take three capsules daily and/or eat a lot of nuts, avocados, and salmon. I've also taken it in the form of a tablespoonful of flaxseed oil, but, ugh.

-St. John's Wort. I take three capsules of 3% hypericin daily. It has no sexual side effects or weight gain side effects.

-I'm female. The hormonal fluctuations of my cycle exacerbated my mood issues. For hormone balance, I take Vitex, Royal Maca, and Pro-Gest progesterone cream as directed on their packaging. One awesome side effect of the Maca is an increased sex drive. I recommend only gelatinized maca because ungelatinized can cause nausea.

-I take a calcium, magnesium, and vitamin D pill twice daily.

-I take a vitamin B complex pill once daily.

-Nutrition-wise, I have to make sure I don't overdo foods and bevvies that mess with my moods. For me, the major thing I have to watch is my alcohol intake. If I overdo it I can guarantee a blah day the next day. The second runner-up for bad mood food is sugar. I'm very rigorous about desserts and empty carbs. I avoid fried food altogether. I limit my caffeine to two cups of coffee daily.

-What I do eat: lots of spinach. I saute foods with olive oil. I eat a lot of fruit, especially the nonsweet ones like tomatoes and avocados. I can't eat pork or beef due to allergy, but I enjoy chicken and fish. I get organic food whenever possible.

-I don't smoke tobacco. I smoke pot very, very rarely.

-Most importantly, I exercise daily even if it's just a 30-minute walk around my complex. Everyone who mentioned that is right on.

-I also avoid situations and people that trigger my depression and anxiety, whenever possible.

-I go to talk therapy once a week.

I've noticed some great side effects from the supplements: Glowing, acne-free skin, lots of energy, and none of that annoying brain fog on my period. (Of course if you're a guy you're not going to want to take the hormone ones I do).

Good luck. I have been where you are. Memail me if you like.
posted by xenophile at 11:57 AM on August 8, 2010 [3 favorites]

SSRIs will only "make" you gain weight if you eat too much and don't exercise enough. They don't magically change the laws of thermodynamics.

With respect, this is bullshit. SSRIs can change the way your body works. For instance, when I was on Celexa, I had the joyful paradoxical experience that my appetite was completely destroyed--I could be so hungry I was dizzy and light-headed and barely able to walk in a straight line, and sitting in front of a plate of my favorite food, and yet be unable to eat. I was lucky if I could force myself to eat one meal a day. And yet I gained almost 50 pounds in about a year.

Admittedly, Celexa was a nightmare for me in a way it seems to be for only a minority of people. But it was not about diet and exercise, thank you very much.

Has anyone in the thread mentioned crazymeds yet? I've asked some questions here recently about psychotropic meds and the suggestion to read at that site was one of the most helpful responses I got. It might help you in this sorting-through-info-before-talking-to-doctor stage.
posted by not that girl at 12:06 PM on August 8, 2010 [1 favorite]

I have a few friends who've stayed on Prozac simply because they swear it suppresses their appetite. And I've known loads of people who've been on Xanax for years and successfully tapered off of it. They admitted that they felt "withdrawal" symptoms (from the Xanax) if they had forgotten to take doses when they were on it, but they tapered their doses fine, and eventually stopped taking it. NONE of them has become an "addict" nor have the meds had any negative effect (other than minor other side effects) on their lives.

Of course YMMV. From what I've seen, I say try the meds. FWIW, I personally don't believe your life will be negatively affected. However, IANAD and IANYD. Consult your physician, first, of course, and don't be shy about reporting details, however small, to him/her. Best of luck!
posted by InsertNiftyNameHere at 11:24 PM on August 8, 2010

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