Antidepressants and weight gain

The other night at the Kibbutz's second-night seder, someone I know asked me if I'm on an antidepressant.

"Yep," I said. "Lexapro."

"I figured," he said. "That's no normal weight gain."

In the past I might have been upset, but he's right: I've gained a lot of weight since I went on Lexapro in October of 2008. Then again, my weight has gone up and down pretty dramatically throughout my life, and living at the Kibbutz exposes me to a lot of good food, and a lot of communal meals, where the social aspect of eating often gets the better of my willpower. Yet I do think that the antidepressant has something to do with my ascent to 225 pounds, possibly my highest weight to date.

While some Lexapro users attribute their weight gain to the drug's biochemical effects, I believe that, at least in my case, its psychological impact is just as significant. In the past, when I put on weight, I felt bad about it. I would eventually reach a point where I started feeling fat and unattractive, but I'd continue eating too much and not getting enough exercise until I finally snapped. Then I'd begin combating my overweight with a combination of exercise and self-deprivation, a tactic I learned as a teenager with anorexia. My weight would drop, and I'd feel better about my body on a superficial level, but I'd remain extremely afraid of relapse -- i.e., gaining the weight back. Since depriving oneself isn't a sustainable long-term strategy, I'd suffer the sad fate of many a yo-yo dieter: I'd end up even heavier than I started.

Even though unemployment is hard and I have a lot of work ahead of me if I want to attend Bastyr (for nutrition and health psychology, of all things!) in 2011, I'm thinking about going off Lexapro on a trial basis, to see how I feel without it. I'm unlikely to start losing weight simply because I drop the drug, yet I can't help but be curious about what would happen. Not freaking out about being overweight is a double-edged sword. It opens up the possibility of more fully accepting my body, flaws and all, which is something I'm eager and determined to do. On the other hand, overweight isn't healthy in the long run, and being too okay with it -- indifference isn't the same as acceptance, after all -- might not be such a good thing. I'll consult my therapist about it and do some soul-searching, but I imagine that if I go without the meds for a while and I feel the weight of the world return, I can go back on them.

I'm pretty pleased, all in all, that I've been able to use an antidepressant without taking an absolutist view of a complicated issue: the question of whether the positive effects of SSRIs outweigh their downsides. In my 18 months of use, I've decided that they help, but they alone are obviously not enough. And no, they don't steal your soul or make you an unwitting slave to the Man. If anything, people who aren't completely demoralized are more likely to stand up for what's right and fight against what's wrong. There are few simple choices in this world, and to inhibit serotonin reuptake or not to isn't one of them.