Is this the subtext to all of the fitness talk?
November 21, 2021 3:58 PM   Subscribe

I've had a really exciting two months where I've gained 18 lbs due to depression medication and its side effects (increased appetite) on top of the usual fall pudge gain. I'm having a bit of a moment about it and I could use some coaching/validation/advice/?

hail to thee, mirtazapine, land of the marginally-less grey, home of midnight snack raids. The doctor has already written a prescription with a lower dose to see if we can keep the pros without the cons.

To start with, I'm a usually a cheerful chub at around 250 lbs. I've been in strength training for about a year and a half, and I only look rounder because now my fat is sitting on top of some muscle (I'm specifically training to be stronger, not to be thinner). However, getting to ~270 has really been shit. I've really hit the max of what my joints can manage comfortably, and my gait has changed to accommodate the additional tum - I waddle more than stride. My lower back is unhappy.

This weight gain is coinciding with a moment in my life where I'm having issues with my relationship to food. Specifically, the strength training is pushing me towards a healthier diet. This is something I'm working on - managing to cook / feed myself better. Sometimes I starve myself due to executive dysfunction, and then go bananas ordering out. This is increasingly not an option (financewise as well as healthwise).

I try to remain neutral about my weight. I don't know if I could be any slimmer, but I know that if I try to think that way (thinking of dieting and exercising specifically as a way to try to be thin), it feels really toxic and harmful. I don't think I can crack that door without losing my shit, and I don't know how to translate my body's preferences for "better" food without cracking that door.

So on the one hand... I'm really pleased that I'm better attuned to my body to be able to parse what it wants. I'm also pleased that this is coinciding with a time where I can spend a little more time cooking at home and practicing being in the kitchen, and then actually eating what I cook (separate issue. I know.) This is a positive feedback cycle, one I've worked really hard to break into, as opposed to the depression negative feedback cycle.

I'm not pleased about this weight gain in that it's putting me into a new zone of discomfort. I'm not pleased that my body is putting the pressure on me to eat a bit better, because the snerson-food relationship is still dearly under construction, even before you add in the executive dysfunction issues.

I'm distressed about this weird confluence of urges (eat more but eat better but eat less but eat anything) and needs (emotional need of "don't worry about what you're eating, just make sure you eat" versus "please get these extra pounds the fuck off me"). I don't know what to do with it. Take it to therapy is an option that I am working on, but I really feel like I need support now, and I can't find any discussion online that has the sort of nuance I would find helpful. Lots of the usual fatphobic bullshit, but nothing that is really speaking to this experience. Hivemind, do you have anything to offer to this situation? Any advice on balancing mental health with physical health? Reading suggestions that are very kind or language neutral? I've already added in some daily walks to help mitigate. Thanks in advance for helping with this tangle.
posted by snerson to Health & Fitness (11 answers total) 7 users marked this as a favorite
I've posted before that I eat the same thing for breakfast and lunch everyday. That takes some load off my mental plate. Breakfast is a Premire protein shake. This is the brand my bariatric program recommends. I buy the premade ones (see mental load) but there is a powdered option as well. Lunch is Greek yogurt (usually the Oikos Triple Zero), 3 tablespoons chia seeds and a half cup of Kashi Go Lean cereal (the high protein option). I'm the kind of person that eating the same thing doesn't bother me as long as I have a variable dinner.

I'll also say mirtazapine is a bitch. I can't tell you how much weight I gained taking it before I finally gave up. How long have you been on it? It sounds like it isn't doing a super job. Has your doc tried any other meds with you. It's said a lot here, psych meds meds can take a lot of trial and error.

If you have some money to throw at the problem, an Instant Pot has been great for my family. There are a lot of dump food in, set, do something else, take food out and eat recipes on the interwebs. Last night we made pulled pork and it took a grand total of 5 minutes to dump in the pot and set. An hour or so later, I had dinner.

You also mention weight training, but not cardio. I walk/jog in front of the TV a couple nights a week. A FitBit has helped motivate me to move more during the day.

I hope you get some other advice. It's hard dealing with depression, everything going on around us, med side effects, etc.
posted by kathrynm at 5:45 PM on November 21 [3 favorites]

So first off, I love mirtazapine. I've tried a number of meds and it's the one that works for me. The best thing I can say about eating (and I don't know if it will be helpful for you) is that I prefer to eat only at set mealtimes but eat until I'm full. For me, that hits the balance between my body sometimes signaling hungry too often -- I learned that if it wasn't a mealtime, it was probably the med talking. And generally those feelings faded and most hunger comes with meals now.

If you have trouble remembering to eat at all, do alarms work for you? People to eat with? Making sure you get meals at the right time will make it easier to ignore odd cravings at other times. And if this med is helping in other ways, that's worth it. Feeling better mentally is worth it.

Feel free to memail if you want to chat a bit.
posted by blueberry monster at 6:20 PM on November 21

The single most helpful thing for me regarding feelings about weight and my body is to constantly reframe stuff to be about what my body can do rather than what it looks like. It sounds to me like you're on the right track with that regarding strength training and so forth, but here are a few hacks that I've found to make it easier.

1. Get rid of your scale and never weigh yourself. As long as you have a scale, you'll weigh yourself and focus on the number, because it's simple and discrete and it is what brains do. Without a scale, you can only pay attention to how you feel and what you're doing.

2. Similarly, try not to look yourself in the mirror. I dunno, maybe this is unhealthy in one way, but basically anything that keeps me noticing what I look like makes me more likely to fall into the "feel like shit --> eat more because I feel like shit --> gain weight and feel like shit" cycle.

3. Buy clothes that make you look good at the size you're at. Again, it keeps you from falling in that cycle, and helps mentally as well.

4. Track (and reward) yourself for actions, not consequences. Your goals should be to do the thing: lift another weight, go on a walk, eat something healthy... not to see a certain consequence of it. This is because actions are under our control, and consequences are not.

I hope these suggestions help. None of them is magic, because this is legitimately hard and I think there is no magic solution. Just remember that you're doing the best for yourself -- all of you, mental as well as physical -- and cut yourself slack for not attaining some ideal of perfection that nobody can manage for long.
posted by contrapositive at 6:35 PM on November 21 [13 favorites]

Do you like podcasts? Have you listened to Maintenance Phase? I think it does a great job of articulating just how complex weight and dieting are. The message is basically life and weight are complicated- so it’s okay for you to be complicated too.
posted by turtlefu at 7:59 PM on November 21 [6 favorites]

The Body Is Not An Apology by Sonia Renee Taylor is wonderful. Maintenance Phase is fantastic. Congrats on your strength training! That sounds awesome.

In my own long-disordered relationship with food, eating *more* fat in specific ways has been incredibly helpful - protein powder with coconut oil in the morning helps me not drag through mornings or or freak out mid-afternoon, soups made with lots of olive oil, beans, heaps of greens, some sausage (or a good veggie-heavy chili) help me eat the same thing for lunch for at least a week after just one cook *and* inform my body that I Have Eaten, having a whopping serving of nuts at a time, with an apple for dessert - the low-fat, carb-driven, frankly sad diet that my mom raised me on just left me hungry and grumpy.
posted by rrrrrrrrrt at 9:54 PM on November 21 [3 favorites]

There's an episode of the Here to Slay podcast by Tressie McMillan Cottom and Roxane Gay that interviews the author of My Body is not an Apology. It is a revelation, highly recommend
posted by jebs at 11:34 PM on November 21 [3 favorites]

Another member of the mirtazapine fan club here but I will also say that my appetite was much more normal on a lower dose than the higher dose. I remember on the higher dose thinking that if you put something sweet in front of me and told me not to eat it, it would be like telling me not to breathe again, ever. It just wasn't possible for my body and brain, the physical urge to eat was so strong.

So you may find this will get a lot easier when the dose drops. And that before that happens, is not the optimum time for trying to solve all your other complicated feelings around food, because you're playing the game on the extra hard level. If you can hold out for a few more weeks until the lower dose kicks in, you might be able to start dealing with this without a little mirtazapiney voice shouting in your ear "EAT ALL THE THINGS" the whole time, which will be more straightforward.

Or at least, if you don't want to hold off, start trying things, but take comfort from the fact that your current constellation of feelings around food might be finite, with a natural end in sight, so you can do some things to help right now, without feeling like you have to solve everything right away. And that if you try something now and it doesn't work, that doesn't mean it'll never work for you, just that you might want to revisit it in a few weeks' time. Best of luck.
posted by penguin pie at 3:15 AM on November 22 [3 favorites]

I've always eaten based on how my body feels. My body is very clear about telling me when I'm full and I've generally have a good relationship to food and my body EXCEPT for the year or so I was on mirtazapine. It was the weirdest thing. While I was on it I was suddenly unable to feel any "full" messages from my body. It was as if a sense I'd always had just ... turned off. Instead of getting a message that said "ok, I've had enough, let's stop eating now" I had to just kinda of guess.

I'm sharing this in case it's of any help to know that, for me at least, mirtazapine seriously messed with my body's ability to tell me what it wanted. It's not that my appetite increased, it's that my sense of satiety disappeared. Perhaps looking at it through that lens will be helpful to you?
posted by mcduff at 7:55 AM on November 22

Definitely like to echo the comments about focusing on actions not consequences, getting rid of your scales, and dressing in a way that compliments your body. It seems like you're already doing lots of good things to try and stay healthy so lots of props and respect to you. You've got a really good attitude towards this.

One thing I did found helpful when I was struggling with joint pain because of my weight was a combination of yoga and an underdesk elliptical trainer. Both allowed me to exercise without putting undue pressure on my knees and lower back, and the elliptical trainer in particular - even when I was on meds which increased my appetite and slowed my metabolism - seemed to increase my metabolism and improve my mood.

I'm guessing the second part was a combination of lower blood sugar and a mini exercise high, but I'm not sure. It certainly helped me feel like I was doing something sensible and useful to help myself, and that alone improved my mental health. It was also easy, non-sweaty (set on a fairly light level and not busting a gut to pedal at any particular speed), and I could just do it without thinking.

Obviously it has physical health benefits like pretty much any exercise does, but more generally I found it made me feel good about myself, especially because I'd always felt bad about being sat down for 8 hours a day, even though I have to because my job requires it. I'd definitely recommend one if you're in that situation.

But most importantly, you've got a great attitude and a lot of self-awareness, and you're already well down the road to getting where you want to be, even if you haven't quite figured out the mode of transport you're going to use yet.
posted by underclocked at 8:40 AM on November 22

I have taken mirtazapine for sleep at dosages from 15 to 60 mg and am currently at the top end of that. I concur with penguin pie; dropping it will likely help. For me, the worst of the EAT EVERYTHING SWEET NOW impulse is about an hour after I take it. If your experience is the same, if you're not currently taking it at bedtime, and your medical provider gives the okay to this, trying to be asleep when it happens might be worthwhile.
posted by jocelmeow at 10:08 AM on November 22

It's been a while since I was on Mirtazapine, I'm now on a different sedating-and-appetite-increasing med, so take this with a grain of salt. But my current experience is that the midnight snack raid situation is as much about sedation (and resulting decreased impulse control) as it is about appetite or hunger. Sure, some of it's probably metabolic, but some of it's just getting the munchies.

Which means that the way to cut down on night bingeing is to reduce the amount of time that I spend sedated but awake. So I'm working on sleep hygiene. Cutting down on caffeine is helping. Strictly avoiding caffeine after noon is helping. Turning off screens an hour before bed helps when I can make myself do it. The sooner after taking meds I fall asleep, the less time I have to raid the fridge in a semi-aware zombified state.
posted by nebulawindphone at 2:57 PM on November 22

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