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.

On going back to school

I told someone recently that I'm trying to decide between the Master of Science in Nutrition and Clinical Health Psychology program at Bastyr University and the Film and Video Communications program at Seattle Central Community College. She responded: "Wow, you sure have a wide range of interests!" I said: "If someone gave you a course catalogue and told you price wasn't an object, you could take anything you want, you'd have a hard time deciding." The truth is, we all have a wide range of interests; the tricky part is figuring out which ones to pursue academically, which professionally, and which avocationally.

I worry that studying film theory, for example, might negatively impact my love of film. I studied creative writing and Spanish in college, and by the time I had my B.A., I was ready to take a break from both. I never really came back to either area, even though I was obsessed with Spanish in high school and wrote poetry and fiction fairly regularly back then, too. I'm also not sure academic analysis is the way I want to look at film; I enjoyed being a film critic for the Weekly largely because I got to choose the level of diction and analysis for each movie, and because popular criticism seems more accessible (and, frankly, enjoyable) than academic articles and books. For me, the idea of becoming a film studies professor isn't beyond the pale, but it doesn't feel like one of my best options, either.

Seattle Central's filmmaking program includes some theory, but its emphasis is on production. I attended an info session last week that laid out the two-year curriculum and included talks by two of the program's main professors. One is a documentarian whose film Sweet Crude played at SIFF this year; the other didn't mention his body of work, but I liked his no-nonsense personality and his sense of humor. Both teachers stressed how challenging the program is, and that it's a great deal, financially speaking: $7,800 or so for six quarters of quality instruction. Renting equipment and studio space for a single day, one of the professors pointed out, might easily cost $1,300, the price of one quarter in the program. We watched a short film made by members of a previous year's class; the acting was surprisingly good, the writing was decent, and the cinematography and editing were impressive.

We also talked about the logistics of finding work after graduation. Both teachers admitted that graduates have to work hard to find jobs, and many of them are freelance gigs. But they balanced this sentiment with the notion that there's always some work, somewhere, for a highly skilled production person. I was dazzled by the info session, as I imagine many of the other people in the room were; the session was packed with the most diverse group of people I've been around in a long time. The program takes a team-oriented approach, placing students in small groups to work on production projects. Finding ways to work well with virtual strangers, we were told, is a common challenge in the industry, and the program tries to recreate that challenge from the start.

If I want to enter this program, fall of 2010 is my first chance. Students can only enter it in the fall, and no spaces remain for this year. (There's quite a waiting list in case anyone drops out; I decided not to bother including my name on it.) It's a full-time program, which means holding down a full-time job in addition isn't an option. (One of the professors said that even working 20 hours a week while in the program is a tough row to hoe.)

The Bastyr program is a horse of a very different color. Fall of 2010 won't work because of all the prerequisites I need to take before applying; 2011 is more like it. I'll need nutrition, chemistry, psychology, anatomy, and biochemistry, all but the last of which I can take at either Seattle Central or North Seattle Community College. (Biochem isn't offered at the community colleges, so I'd probably have to attend a proper university for it.) I just paid for two classes for fall quarter: nutrition and a general prep class for chemistry. The former will give me a small taste of what I'd be getting myself into if I decided to pursue the MSNCHP; the latter will enable me to take the required chemistry series, if I end up so desiring.

My decision to go back to school was the pretty direct result of a realization achieved in therapy: I keep waiting for something external to tell me which direction to go professionally, but it's impossible to know what will suit me and what won't without trying something. I can't try everything, varied interests or not, but I can try something. And two community college classes are a whole lot cheaper than a year of grad school. Might as well try a subject that interests me on for size.

Some people who don't know me well, or haven't known me long, are surprised by my interest in nutrition counseling. The fact is, I've knowingly struggled with eating and body image issues for 15 years. Even after my bout with anorexia nominally ended, I veered back and forth between overeating and self-starvation. Only in 2006, in Brooklyn, was I able to achieve a level of mindfulness (thanks to daily meditation) that allowed me to understand what healthy eating habits might look like for me. And only now, a year after joining the food-intensive Kibbutz community, am I able to recognize that I'm heavier than I want to be without completely melting down about it. (I credit meditation, life wisdom, and Lexapro for that.)

In the proverbial perfect world, I'd study nutrition, counseling, and filmmaking and would win an Oscar for a groundbreaking documentary on disordered eating. For the moment, I'm excited to be a month away from starting classes. Studying algebra and pre-calculus to take the community college math placement test was more fun than grueling, thanks to the lessons that 12th grade calculus class apparently branded on my brain. I think relearning chemistry as an adult, from a competent teacher (my 10th grade chem teacher wasn't), might be a great experience. And I expect to really like nutrition class. My sense of how the body uses food, and what foods help or hurt us in which ways, is shaky at best. While mindfulness is definitely a part of the healthy-eating equation, information is also key, and no matter what I choose to do in the coming years, I won't regret having taken either class.

Meds for anorexia?

Damn, things have changed since I was a teenager.

He ain't heavy, he's my father

During my visit to L.A. last weekend, I looked at some pictures I'd never seen before -- old photos my sister Lore brought out for us to peruse together. In one of them, my father is surrounded by his three children from his first marriage -- my half-siblings, including Lore -- as well as his first wife, Patricia. What struck me immediately was how large he was. When I was alive, my father was big, but I didn't think much of it until my teenage years, when I went from overweight to anorexic via a self-deprivation plan of my own design.

When I was at my most deluded and paranoid, I looked at people who were overweight and thought: I'd rather die than end up like that. Seeing the old picture of my dad this past weekend really moved me, and helped me realize how far I've come since the last time I visited my sister in California -- 15 years ago, when I was deep in the throes of my eating disorder. In 1994, she weighed me daily during my visit, as my parents and the growing number of specialists following my case insisted she had to. I, of course, hated being weighed and watched and told to eat what was in front of me. These days I still struggle with eating and weight and body image -- during my recent physical exam, I found out I'm back over 190, which is what I weighed when I unsuccessfully gave Weight Watchers a shot in 2007 -- but I've probably never had a healthier, more even-keeled outlook on those interlocking subjects, and that's worth appreciating, or even celebrating.

What struck me about the photo was that my father must have struggled even more than I have with his size, since he clearly passed out of adolescence and into fatherhood at an unhealthy weight. He never did what I did; he never fled the problem of being too heavy with all his might -- with such fervor, in fact, that he overcompensated, went too far, and ended up with a different, no less dangerous problem. Also, all of his children are doing better today than he was in that picture, and that's a nice way of regaining perspective when I give myself flak for overeating or not exercising enough. I've told several people lately that I still can't quite grasp how others, friends and acquaintances of mine, can actually enjoy exercise. For me, the act of exercising is still weighed down, so to speak, with middle-school baggage (being the fat kid, failing to do even one pull-up, all the humiliation that accompanied that kind of failure, etc.).

This year, I hope to develop a better relationship with exercise by doing things I actually enjoy -- softball, classes, bicycling -- rather than forcing myself to pay for yet another gym membership I can't afford and will likely underuse, or never use at all. I guess my heart broke a little for my dad when I saw that picture, but I was also glad that by the time he became my father, he'd lost at least some of the weight he'd carried around as a younger man. And as I try to get a better sense of what he was like at my age, I imagine it's inevitable that I would start to think of him less as my infallible, all-knowing father and more as a human being, flawed and well-intentioned and funny and good. He's been gone for nearly six years, and it saddens me that he'll never see me get married or have children. But if old photos and stories I've never heard can help me get a better sense of him, I'll settle for that.