Weight gain and paxil

Does Paxil Pack on the Pounds?

Q1. Since I began using Paxil for depression three years ago, I have gained 75 pounds. Other people have told me of similar weight gain on Paxil. Do you know why or how this occurs? Thank you for your help!

Yes, Paxil can cause weight gain, as can other SSRI antidepressant medications. In its class, Paxil causes the most weight gain perhaps because it can be sedating, which tends to limit physical activity. Other antidepressants such as MAOIs and tricyclics can cause weight gain as well. We are not really sure why this occurs, and the reasons may differ among the various types of medications. In some cases, antidepressants can cause an increase in appetite, due to the effect on the brain’s appetite center. If there is no particular reason why your doctor recommended Paxil, you may consider trying another SSRI, such as Prozac, Zoloft, Celexa, or Lexapro. Sometimes physicians use Paxil to treat anxiety-based depression, so the others may not work as well for you if this is the case. If you simply must stay on Paxil, I would start a diet and exercise program with the help of a reputable, hospital-based weight-loss program. The nutritionist may recommend a diet and exercise program along with an appetite suppressant to counteract the effects of Paxil. Another strategy would be to begin taking Wellbutrin as well, another antidepressant that will enable you to use a lower dose of paroxetine, the active ingredient in Paxil. Wellbutrin is one of the only antidepressants that does not cause weight gain and may actually help patients lose weight.

Q2. Do seasonal allergies cause you to feel tired all the time? What can I do about constant fatigue during allergy season?

When most people think of allergies, they think of the typical symptoms of sneezing, runny nose and itchy eyes. But fatigue, sinus pain and asthma also result from allergy. Symptoms may interfere with your sleep, which can cause fatigue, but an allergic reaction itself can release chemicals in your body that cause fatigue.

The best remedy for the fatigue is to get control of the allergies. Have yourself tested by an allergist to find out what you are allergic to, what to avoid and how to control your environment. An antihistamine and/or a leukotriene modifier may also help. If that’s insufficient, there are always allergy shots.

Another point to keep in mind is that many antihistamines cause drowsiness, which could be the cause of your fatigue if you take them for your seasonal allergies.

Learn more in the Everyday Health Diet and Nutrition Center.

How can antidepressants affect weight gain?

The following antidepressant medications may be more likely to lead to weight gain:

Tricyclic antidepressants (TCAs)

Share on PinterestWeight gain is be a potential side effect of some types of antidepressants.

Also known as cyclic antidepressants, TCAs are some of the earliest forms of antidepressant medications.

They are not as commonly prescribed as more modern forms of antidepressants, as they can cause more side effects, including weight gain. Older research suggests that excessive weight gain caused many users to quit TCA treatment.

However, cyclic antidepressants can be effective, especially for some people who do not respond to other treatments.

Examples of TCAs are:

Monoamine oxidase inhibitors (MAOIs)

MAOIs are another early class of antidepressants and have generally been replaced by newer antidepressant drugs. Although effective, they tend to cause weight gain and several other adverse reactions.

In addition, people who take MAOIs may need to restrict their diets, as these drugs can cause elevated blood pressure levels when taken with some foods and medications.

However, MAOIs help relieve depression in some people who do not see improvements with other drugs.

Types of MAOIs that may lead to weight gain include:

  • isocarboxazid (Marplan)
  • phenelzine (Nardil)
  • tranylcypromine (Parnate)

One type of MAOI called selegiline (Emsam), a topical treatment that is applied to the skin as a patch, has been associated with weight loss in some users.

Selective serotonin reuptake inhibitors (SSRIs)

The most commonly prescribed form of antidepressant medication, selective serotonin reuptake inhibitors (SSRIs) have been associated with weight loss in short-term use, but may cause weight gain when used long term.

Commonly used SSRIs include:

  • citalopram (Celexa)
  • fluoxetine (Prozac)
  • paroxetine (Brisdelle, Paxil, Pexeva)
  • sertraline (Zoloft)

However, weight gain associated with SSRIs depends on the length of time they are taken, as well as the type. For example, paroxetine is the most likely to lead to weight gain, while sertraline is least likely.

According to a 2017 study, SSRIs were associated with weight gain when users engaged in “unhealthy behaviours,” such as eating a standard Western diet, lack of exercise, and tobacco use.

Atypical antidepressants

One type of atypical antidepressant called mirtazapine (Remeron) has been linked to both increased appetite and weight gain. It is less likely, however, than TCAs to cause weight gain.

Jump to: Predicting Weight Gain What You Can Do

There’s good news and bad news about antidepressant medications and weight gain. The good news is not every antidepressant causes weight gain and not everyone who takes an antidepressant gains weight. The bad news: If you do start gaining weight when you first begin taking antidepressants, you may just keep piling on the pounds over time and ultimately find it hard to lose that excess weight. But you can turn bad news into good by working with your healthcare provider to monitor both your mood and medication on a regular basis and stop weight gain before it gets out of hand.

The antidepressants most likely to cause weight gain include amitriptyline (Brand name: Elavil), mirtazapine (Remeron), paroxetine (Paxil, Brisdelle, Pexeva), escitalopram (Lexapro), sertraline (Zoloft), duloxetine (Cymbalta), and citalopram (Celexa). Tricyclic antidepressants such as amitriptyline and tetracyclic antidepressants such as mirtazapine are linked to the most weight gain. Other antidepressants, like fluoxetine (Prozac, Sarafem) and bupropion (Wellbutrin, Aplenzin, Forfivo, Zyban) are likely to have no effect on weight or might even cause some weight loss. (1, 2, 3)

It’s not always possible, however, to choose a specific type of antidepressant simply because of its effect on your weight. When choosing the most appropriate and effective medication, or switching from one type of antidepressant to another, psychiatrists and medical doctors who prescribe these medications must consider other factors based on individual needs. You may find that one type of antidepressant works better to alleviate depression than another, or that one type gives you other unacceptable side effects, regardless of the effect on your weight.

There are many theories but not much hard evidence showing exactly why so many people gain weight when taking antidepressants, and many factors may come into play. A state of depression, in and of itself, can contribute to weight gain if your condition is causing you to overeat or you can’t work up the motivation to participate in any physical activity.

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On the other hand, you may not feel like eating when you are depressed and initially lose weight, but then gain back your lost weight, and then some, when your medication kicks in and you are feeling better. Antidepressant medications may cause weight gain more directly by interfering with brain chemistry as well as your body’s normal metabolism and regulation of sugar and fat. A family history of obesity could also make you more generally susceptible to weight gain. 3,4

Predicting Weight Gain

One study followed 260 patients suffering from major depressive disorder who were not overweight when antidepressant medication was first prescribed for a major depressive episode. The researchers found that those who experienced at least a 3% weight gain during the first month of antidepressant therapy were at higher risk of long-term gain than those who did not gain any significant weight in the first month.5 These findings suggest that careful monitoring of weight throughout the first month of taking antidepressant medications can help predict who is likely to gain a significant amount of excess weight over the course of treatment and signal the need for preventative measures.

A 3% weight gain in someone who initially weighs 125 to 130 pounds is approximately 3 1/2 to 4 pounds. So, if that person gains more than 3 pounds after just one month of taking antidepressant medication, they may be at especially high risk of gaining even more weight. When that’s the case, a medication may be changed to one less likely to promote weight gain and further steps can be taken to control body weight, such as watching one’s diet and getting more exercise.

Not only were the study patients at higher risk of gaining weight, data gathered from the same study indicated that those who gained excess weight were also at higher risk of developing metabolic syndrome during the 6-month treatment period.6 Metabolic Syndrome is a group of unhealthy conditions that occur at the same time—excess abdominal fat, elevated blood pressure, blood sugar, and cholesterol. Having metabolic syndrome puts you at higher risk of developing heart disease, diabetes, and stroke.

What You Can Do

Psychiatrist and addiction expert Michael McGee, MD, agrees that weight gain is a real problem with many of the medications he prescribes. “Women get especially concerned about it,” admits Dr. McGee, who is also the chief medical officer at the Haven Treatment Center in California and the author of The Joy of Recovery. Some patients can eventually go off antidepressants by adopting evidence-based lifestyle interventions to prevent weight gain, he says.

“I recommend the Mediterranean Diet because it has antidepressant qualities and I encourage good eating habits like eating slowly and mindfully, avoiding ‘red light’ foods with lots of added sugar or foods that are overly processed,” he explains, adding that it’s also important for patients to make friends with hunger. “Accepting that a little hunger is OK and is necessary to maintain weight.” Dr. McGee also recommends spending time in nature, becoming involved in a spiritual community and connecting with others through volunteer work or by socializing with friends.

Be sure to voice your concerns with your physician. Ask your prescribing doctor if there is more than one option and if they can recommend an antidepressant that isn’t associated with weight gain. If your doctor feels the most effective medication is one that has been found to cause weight gain in some people, start taking preventative steps right away.

For additional support, ask your physician to refer you to a cognitive behavioral therapist, motivational counselor, and/or a registered dietitian or licensed nutritionist before switching to a different antidepressant or prescribing additional medication to control weight gain.7

You may not be able to fully prevent medically-induced weight gain, but you can take these steps to help keep it under control:

  • Skip fad diets and quick weight-loss schemes. Instead, base your food choices on a proven healthful eating plan, such as a Mediterranean-style diet, the DASH diet designed to control blood pressure or a Flexitarian Diet. These are all plant-based diets that don’t necessarily eliminate meat and other animal foods but put more emphasis on fresh vegetables and fruits, whole grains, nuts, and legumes.
  • Increase your protein intake, if necessary, to boost your metabolism.
  • Increase the fiber in your diet, if necessary by eating more complex carbohydrates by including more beans, lentils, whole grains, fruits, and vegetables at every meal and also when you snack.
  • Eliminate or cut way back on low-fiber, simple carbohydrates such as bread and pastries made with only white flour, sugary desserts, candies, sodas, and soft drinks.
  • Drink more water, and eat more watery foods, like plain low-fat yogurt, fresh fruits, and vegetables.
  • Walk more often and incorporate muscle-building techniques (no special equipment needed for moves like pushups, planks, and lounges) in addition to aerobic exercise. Healthy muscle is necessary to efficiently burn excess fat.
  • Don’t forget mind-body exercises, like yoga, tai chi, and meditation, that help reduce any stress that may be contributing to overeating and weight gain.
  • Make sure you get enough sleep every night. Good sleep habits can also help regulate weight.

Article Sources Last Updated: May 7, 2019

Antidepressants and anti-anxiety medications too often get a bad rap—and frankly, that’s a damn shame because they offer help to literally millions of people in the U.S. alone (12.7 percent of Americans take antidepressants, according to the Centers for Disease Control).

Paxil, or paroxetene, is one of those medications—and it actually does double-duty, by treating both anxiety and depressive disorders. But, while it can make living with anxiety or depression more manageable, the side effects of Paxil aren’t necessarily harmless.

What is Paxil?

Like Zoloft and Prozac, Paxil is “an SSRI, or selective serotonin reuptake inhibitor, which means it works on the serotonin system in your brain,” says Alison Hermann, M.D., a clinical psychiatrist at Weill Cornell Medicine and New York-Presbyterian Hospital.

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“Manipulating the levels of serotonin in your brain will work on a number of systems, including the ones that regulate mood and behavior, as well as arousal and sleep,” says Hermann. Since serotonin is the “feel-good” hormone, boosting those levels can make a major difference in the way you feel.

Paxil is one one of the top five prescribed SSRIs, according to a 2017 study published in the Journal of the American Medical Association (JAMA), but there’s no particular reason your doctor would prescribe Paxil over a different SSRI, says Hermann. “You actually may need to try a number of different SSRIs before you find the one that works the best for you as an individual,” she advises.

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Most people tolerate antidepressants, including Paxil, pretty well, Herman acknowledges. But, like any other drugs, it has the potential to make you feel kind of sh*tty. Here are a few common Paxil side effects to watch out for if you’re on the drug or are interested in taking it.

Side effect #1: You haven’t changed your diet, but you’re gaining weight.

Antidepressants and anti-anxiety medications in general are often linked to weight gain, but some, including Paxil, might cause more weight gain than others, according to the Mayo Clinic. A 2014 study in the journal JAMA Psychiatry also found that, out of 11 different antidepressants, Paxil was one of two medications with the highest risk of weight gain.

1 out of every 6 adults will have depression at some time in their life.*

Researchers aren’t sure why Paxil or other antidepressants can cause weight gain, but they believe it may be linked to its effects on serotonin, which controls and regulates appetite.

If you notice an increase in your weight after starting Paxil, talk to your doctor about lifestyle changes, like eating a healthier diet and getting more exercise, or other medication options.

Side effect #2: You’ve got stomach issues galore.

Gastrointestinal issues are the most common side effects with any SSRI. “That’s because there are actually more serotonin receptors in your gut than in your brain,” says Hermann. “So just like the drug can affect arousal in the brain, it can also affect arousal in the gut.”

The best way to minimize this reaction is to start with a low dose and take the meds with food. And if things don’t settle within one to two weeks, talk to your doctor about potentially switching to a different drug.

Side effect #3: You’re actually feeling more anxious.

That sounds counterintuitive, right? But feeling “activated” or a little extra anxious is actually a common feeling when starting Paxil, says Hermann. “Usually, anxiety is the reason you’re taking this med, so I know this might scare people, but it’s just a matter of your body getting used to the drug and its longer-term effects,” she says.

Depression affects about 16 million American adults every year.*

Again, you can minimize that risk by starting with a low dose and increasing only as tolerated. Typically, you’ll wait one to two weeks, meet with your doc, and then up the dosage, if necessary; that gives you time to wait out initial side effects and assess your progress as you get up to an effective dose, says Hermann.

Side effect #4: You’re never in the mood.

A decreased libido, difficulty getting aroused, and difficulty orgasming are all side effects associated with Paxil and SSRIs in general. “A significant portion of people who take the med are affected,” says Hermann. “We don’t really know why this particular side effect comes up, but it’s a longer-term side effect and it’s worse at higher doses.”

Your doctor may want to weigh the benefits of the drug helping what it was originally intended to help with against how disruptive a particular sexual issue to your life, and they may eventually switch you over to a different prescription.

Side effect #5: You feel weak and start slurring your speech.

This is a sign of low sodium levels, a.k.a. hyponatremia, which can also cause other symptoms like headaches, confusion, loss of coordination, and feeling unsteady. It’s an unusual side effect, but can happen when your liver and kidneys have trouble metabolizing the medication. “Some people’s bodies just can’t hold on to sodium as well when they take antidepressants like Paxil,” says Hermann.

It’s important to keep your electrolyte levels in check when taking this medication, so to play it safe, make sure to schedule annual bloodwork to check those levels with your doctor, suggests Hermann.

Side effect #6: You’ve been having suicidal thoughts.

Like with any antidepressant or anti-anxiety med, Paxil comes with a warning of increased feelings of depression. “The thing to keep in mind is the underlying condition: The reason Paxil would be prescribed is for anxiety or depression, which themselves really increase the risk for suicidal thinking or behaviors,” says Hermann.

Depression can happen at any age and in any type of person.*

Another thing to note: Paxil may have negative effects on undiagnosed bipolar disorder. “If someone has bipolar disorder that’s gone undiagnosed or hasn’t manifested yet, taking an antidepressant like Paxil does put you at risk for switching from depression to mania or hypomania,” says Hermann.

Don’t write off any unusual feelings; if you’re experiencing thoughts of suicide or manic episodes on the drug, talk to your doctor ASAP.

*According to the Centers for Disease Control.

Ashley Mateo Ashley Mateo is a writer, editor, and UESCA-certified running coach who has contributed to Runner’s World, Bicycling, Women’s Health, Health, Shape, Self, and more.

Low-dose paroxetine (Brisdelle) treatment does not cause weight gain or sexual dysfunction when used in women with menopausal hot flashes, according to exploratory analyses of pooled data from a pair of phase 3 trials.
“Many physicians and patients are aware of reports of sexual dysfunction and changes in body weight in patients taking selective serotonin reuptake inhibitors (SSRIs) and, specifically, paroxetine at the higher doses used for depression and other psychiatric disorders,” said study co-author Joel Lippman, MD, FACOG, executive vice president of product development and chief medical officer for Noven, which manufactures Brisdelle. “This may be an important factor when considering treatment for moderate to severe hot flashes, and these analyses, with their limitations, may help provide physicians with a better understanding of Brisdelle.”
For their analyses published in the October 2014 issue of Menopause, researchers evaluated the impact of once-daily Brisdelle 7.5 mg capsules on body weight and sexual function in postmenopausal women aged 40 years or older who experienced moderate to severe vasomotor symptoms (VMS).
After 24 weeks of treatment, the investigators found no clinically meaningful or statistically significant changes in weight or sexual function from baseline in either trial’s paroxetine group. By comparison, they observed small yet statistically significant increases in weight in the pooled placebo arm at week 4.
In terms of limitations, the authors noted that the study was not specifically designed to evaluate sexual dysfunction in VMS, and it had a relatively short duration of treatment and follow-up.
Although Brisdelle received FDA approval in June 2013 for the treatment of moderate to severe VMS associated with menopause, the low-dose SSRI has not been studied or approved for any psychiatric use. However, paroxentine 20 mg (Paxil) is indicated to treat major depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder, generalized anxiety disorder, premenstrual dysphoric disorder, and posttraumatic stress disorder.

Paxil Weight Gain And Loss: Causes And Prevention

Patients getting treatment for depression are often prescribed with SSRIs as medication. Paxil has been proven effective since 1992; however, more often than not, users are faced with another serious health issue caused by the active link between Paxil and weight gain. There are several possible causes, but luckily, most are preventable.

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Table of Contents

  • Does Paxil Cause Weight Gain?
  • How Does Paroxetine Cause Weight Gain?
  • How Much Weight Do People Gain on Paxil?
  • What Are The Factors Affecting Weight Gain on Paroxetine?
  • Can Brisdelle Cause Weight Loss?
  • How to Control Weight On Paxil?

Does Paxil Cause Weight Gain?

While a lot of people find that Paxil works effectively against anxiety, depression, OCD, phobia, and panic disorder, like many other drugs, there are Paroxetine side effects. This potent drug is more likely to cause weight gain as compared to other SSRIs, especially during long-term treatment, approximately six months or more.

How Does Paroxetine Cause Weight Gain?

There are several ways in which Paxil drug may cause weight gain.

  • Serotonin Deficiency: Paxil side effects on weight can be attributed to the drug’s effects on hormones, including serotonin, which helps control and regulate appetite. Serotonin deficiency can cause significant weight gain.
  • Recovery From Depression: With depression, people usually have a low body mass because they’ve lost interest in food and pleasure. But, as soon as anti-depressant medications like Paxil start to kick in, they feel better and start getting a boost on appetite, which makes them eat more than usual.
  • Increased Fat Storage: The use of a psychotropic drug like Paxil may also affect the way the body processes fat. When taken for an extended period, physiological changes may ensue, leading to more fat storage.
  • Decreased Metabolism: There’s also a link between Paxil and metabolism. Despite having healthy and adequately sized meals, the decrease in metabolism and processing of food may still cause patients to round out.
  • Sweet Cravings: Patients who took Paxil were more prone to seek out unhealthy food products that contain high amounts of sugar. Though there has been a clear association between carbohydrates and the secretion of serotonin, less is known about how and which quantity of Paroxetine plays a role.
  • Drug Combinations: Certain drugs can amplify Paroxetine weight gain. Risperidone, for example, when used with Paxil can inhibit CYP4502D6 enzyme. This combination has found to increase a patient’s body mass for approximately 30 pounds within five months of treatment.
  • Side Effects: The side effects of Paxil are similar to other SSRIs, but it tends to be more sedating. It makes people feel fatigued, sleepy, and not willing to be social and active. Aside from having a motivation decrease, a sedentary lifestyle goes with it. An inactive lifestyle can increase one’s risk of obesity.
  • Sharpened Sense of Taste: Administration of Paroxetine can significantly modulate human taste perception. It increases both sweet and bitter sensitivity. This may lead to more carbohydrate cravings.
  • Withdrawal Symptoms: Patients who have stopped taking Paxil abruptly may also experience Paroxetine withdrawal symptoms. The main signs include dizziness, vertigo, headache, nausea, and flu-like symptoms, insomnia, and more. This will leave the patient feeling lazy to move as well, and there’s a big possibility of giving in to stress eating.

How Much Weight Do People Gain on Paxil?

Experts and pharmaceutical companies are advertising that drugs like Paroxetine are weight neutral, but there is evidence showing otherwise. Studies have found an association between Paroxetine and weight gain. Paxil can increase body mass when used long-term. A patient can gain as much as 24 pounds within 6-12 months of treatment with Paxil as compared to only 10 pounds with other SSRIs.

Factors Affecting Weight Gain on Paroxetine

Several factors may affect Paxil side effects weight gain:

  • Other Medications: As mentioned earlier, the use of combination drugs may contribute to weight gain, especially if they are psychiatric.
  • Dosage: The dosage will also reflect on the drug’s effect. Doctors usually prescribe Paxil 20 mg for patients with generalized anxiety, but if it is raised, there’s a higher probability of the drug increasing body mass. Also, imbalances in the neurotransmitter levels and the nervous system are more likely caused by higher drug doses. Homeostatic processes are affected, including metabolism, which can result in weight gain.
  • Duration of Treatment: Paxil weight loss or gain is possible depending on the length of treatment. The risk of growing bigger increases as treatment prolongs. As time passes, patients are more likely leading to needing an increase in their dosage, causing further weight gain.
  • Genetics: Some gain weight quickly. The risk of obesity increases by 25% if one or both of the parents are obese.
  • Unhealthy Lifestyle: In most cases, a sudden shift to an unhealthy lifestyle along with stress, influence the occurrence of weight gain.

Paroxetine And Weight Loss

Not everyone gains weight while taking Paroxetine. Weight loss is an undesirable result of Paxil treatment, especially in the early stages. Evidence revealed a significant Paxil weight loss, an average of 1 pound, on patients in controlled trials compared to smaller weight changes in those who had a placebo.

Losing weight on Paxil can be best explained by the drug’s ability to make depressed people calmer and less anxious. They get better sleep and feel more relaxed during treatment. This improved mood usually helps bring back self-confidence and interests in doing physical activities and socializing with others. It also enhances mental health, allowing patients to make better decisions about food choices.

How to Control Weight On Paxil

There are easy tips on how to lose weight while on Paxil:

  1. Before starting Paxil for anxiety, get weighed. Be sure to record it for reference during follow-up visits.
  2. Be sure to know the difference between having an appetite and hunger. Paxil can increase one’s appetite, making a patient crave for more food without feeling hungry.
  3. A serotonin diet is a strategy that seems to work against Brisdelle weight gain. Serotonin is made after carb intake, except fructose. Sugary food, when digested, gives off tryptophan, which is used by the brain to produce serotonin. Patients are advised to take approximately 30 grams of sweet or starchy foods for breakfast.
  4. Do not mix carbohydrates and protein, or no serotonin will be produced. Protein foods interfere with the ability of tryptophan to reach the brain.
  5. Intervention is also the key. Patients with metabolic risks should see a doctor. A weight loss agent may be prescribed and monitored closely by a medical professional for weight gain. In some cases, doctors may ask patients to look for a safer alternative. It is best to make drug comparisons like at Paxil vs. Xanax.

However, weight control is not the biggest problem of paroxetine. This medication is habit-forming, and treatment for substance abuse may be required. The person in need of therapy will be enrolled in one of the numerous drug recovery centers.

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I was home for Passover, sitting in my parents’ office—whenever I come back to New York, I always sneak in some financial guidance from my father. I was feeling especially accomplished, and just as I was getting up to celebrate my responsibleness with my parents’ rescue dog, my dad announced there was “one more thing.” He handed me a Post-it with illegible scrawl on it and asked me to read the note aloud. After a moment of deciphering, I managed to make out “125 to 135.” He announced that this was the healthy weight for my age and height and that he was pretty sure I was over it.

Before everyone starts hating on my dad for body shaming me in my family home, let me provide a little more context. I have been on and off antidepressants since I was four years old. I’ve had moderate to severe OCD pretty much my entire life, along with ever-present anxiety and bursts of depression. There have been times where I’ve needed medication and times when I’ve managed without. (“Managed” being the operative word—not to be mistaken for “flourished” or “excelled.”)

It did not feel good to feel unattractive. But it felt a hell of a lot better than wanting to die.

Although the medications have changed throughout the years, the one unfortunate constant is the side effects. These vary from sweatiness to sleepiness to—you guessed it—weight gain. Sometimes these effects aren’t immediately obvious. I spent four rather formative years (8–12) thinking I had a bad metabolism and would spend my life overweight. But the moment I got off Paxil, the pounds floated away and I was suddenly skinny. At the time, no one had realized my chunkiness was a medical side effect. Now, almost 17 years later, my family is well aware. So Dad intervened in his own special way and urged me to change medications.

Gaining excess weight as a medical side effect is not fun. Before I went on Zoloft last year, I was around 120 pounds. That day in the office, after my dad made me get on a scale, I weighed over 140, which is a significant difference on my 5’3” frame. I’m not oblivious; I knew I had gained weight. Many of the viewers on my YouTube channel had pointed it out. It was also impossible to ignore Instagram comments like “What happened to Allison” and “Damn, she really let herself go.” It did not feel good to feel unattractive. But it felt a hell of a lot better than wanting to die.

Please note: Being overweight is, of course, not inherently unattractive. But like most of us, I grew up in a society where skinny = pretty, and this is a hard notion to shake. It’s especially hard when your appearance is tied to your career, and complete strangers feel the need to comment on any noticeable change. I had spent so many years trying to change myself on the inside that it was exhausting to now feel pressure to do the same on the outside.

A little more context. One year before what I now refer to as the “Post-it incident,” I went through a devastating break-up. Romantic relationships have always been my biggest trigger, and this one knocked me out. Part of the problem was that I hadn’t been taking care of my mental health; as a result I lost my then boyfriend and any ability to function happily. It was the hair that broke my brain’s back, if you will. The night he left me I cried uncontrollably and announced/screamed my desire to no longer live. My mother flew out to California the next day for a “light suicide watch.” I’ve never tried to kill myself, but that’s due to familial obligation more than a lack of desire, so she probably figured it was better to be safe than sorry.

Within days, I had returned to a psychiatrist’s office for the first time in seven years and was back on medication for the first time since I was 21. For almost my entire twenties, I had been resisting meds because I was convinced I could “therapize” myself. This may have been the biggest mistake of my adult life. My OCD affected so many things. In addition to endlessly obsessing about finding the right partner, I fretted constantly about cleanliness. I spent most of my twenties unable to comfortably sit on friends’ couches for fear of contamination. I lived in a constant state of panic about things most people rarely even notice: When was the last time she washed that jacket? I have to make sure I pick up my suitcase without it touching my legs. Please, please, please don’t put your purse on my furniture. Will I be alone forever?

Okay, maybe a lot of people think about that last one. But I think about it a lot. I would get so anxious about my relationships that I ruined them.

And then came Zoloft. For the first time, maybe ever, I experienced what a balanced brain feels like. I had been on medication in the past, but combined with talk therapy and the healthy thought processes I’d been working on, this time it worked even better. I felt unbelievable relief. Who cared if I gained a few pounds in the process?

Unfortunately, a lot of people cared—including my family. Suddenly, I was faced with a choice: Should I risk upsetting a very precarious good thing by changing my medication or continue to live with a body I no longer recognized? For many months, the answer was obvious. My mental health was more important. I ignored the mean comments and told my parents to stop badgering me. It helped that I had started a new relationship with a boyfriend who was completely supportive and constantly assured me he was still attracted to my new frame. I felt proud that I was prioritizing my mental health over my vanity.

Because let me be clear: I am very vain. I obsess about my looks as much as anyone. I spend way too much money on eyelash extensions, and I’ve tried pretty much every overpriced hair product out there. I’m also on camera quite a bit, and there are hours of footage from my pre-medication days where I look like a different person. It would be a lie to say I haven’t masochistically re-watched quite a few on them recently, over and over again.

Suddenly my brain was filled with one of my oldest friends: self-hate.

So at a certain point, I broke. I couldn’t keep ignoring the number on the scale or the reflection in the mirror that I no longer recognized. The mean comments didn’t roll off my back anymore and my parents’ concern became my concern. Suddenly my brain was filled with one of my oldest friends: self-hate. I avoided my reflection and internally yelled at myself for looking disgusting. I felt like all the progress I’d been making toward loving myself was being overshadowed by this devilish side effect.

A week or so after the Post-it, I went back to my psychiatrist and asked to change medications. She put me on a newer drug, Trintellix, which has fewer side effects, and paired it with Wellbutrin, which is known to combat weight gain. I slowly started to wean off Zoloft under her supervision. (Quick PSA: NEVER change meds without medical supervision.) It wasn’t fun, and it wasn’t easy. I had multiple brain zaps and felt off for weeks. (Full disclosure: I went off caffeine at the exact same time, due to bad judgement and possible masochism.)

It’s hard to say exactly when I started feeling better with the new combination of meds, because I was going through an incredibly stressful time and yet another break-up. (Isn’t dating fun?!) But at a certain point, I felt the same level of stable on the Trintellix/Wellbutrin as I felt on the Zoloft. Six months later, I’ve lost ten of the twenty-plus pounds and I’m trying not to eat too many carbs. (Turns out it’s a lot harder to lose weight when you’re 29 than when you’re 12.)

Mental health should, without a doubt, always be a priority. For almost a year, the weight gain didn’t bother me. But then, all the external pressure created even more stress, so with the help of a doctor, I looked for a new option that would take everything into account. And despite the rollercoaster of side effects, I am still a huge proponent of medication. I don’t think I could have survived without it when I was younger, and I no longer feel like I’m “just surviving” with it now. I’m able to enjoy life in a way I couldn’t without chemical assistance.

I urge everyone suffering from anxiety, depression, OCD, or any other type of mental illness to seek professional help and treat their symptoms the same way they would treat a physical ailment: with proper care and medication. Do not let the fear of side effects get in the way of getting help. Because I can assure you, even when I was feeling my lowest about my body it was nowhere near as low as I felt the day my ex left me.

As for me now? My new medications are working, I’m slowly losing weight, and I’m sweatier than ever. But I can definitely live (well) with that.

If you or someone you know is struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) or chat online.

Allison Raskin Allison Raskin Allison Raskin is a New York Times bestselling author and co-creator of the YouTube comedy channel, Just Between Us, which she shares with her best friend and comedy partner, Gaby Dunn.

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