Anti-depressants and Weight Gain

Screen print 'Happy Pills' by Chris James

It's a cracking post title, right? Just what you want when you're feel downtrodden already, you've finally managed to talk things through with a doctor, you've got through the period of adjusting to being on anti-depressants with their lovely side effects and to top it off...weight gain. That's just splendid. Not all of them cause weight gain, in some cases they can cause weight loss due to a decreased appetite. Frankly I'd be game to get on those ones!

I first started taking anti-depressants in September 2013. After hiding my illness for 5 years things had become so bad that I barely had the energy to keep up the facade. My mum woke me up one day and just said that she knew something wasn't right and outright asked if I thought I was depressed. I started crying and could barely stop myself. I knew it was bad and it had slowly been chipping away at the person I was until very little of that fun loving personality remained. That same day I walked into my GP's office and told them everything I'd been trying and failing to say for years. The most I'd managed to say to them before was that I'd been having panic attacks but they didn't prescribe anything or refer me to a counsellor. This time she pushed a box of tissues towards me and said "oh it can be all that bad surely" somehow in that moment I managed to fight my corner, I told her of my self harming and suicidal thoughts, of how I barely lived these days and spent the end of my summer term at uni locked away in my room. Reluctantly she prescribed me my first dose of anti-depressants. Her hesitance was due to me being a temporary patient back in Ipswich as I was then registered with a doctor up in Durham whilst I was at uni and they might have had a different opinion on how my depression should be treated. I was prescribed what is generally prescribed in the first instance providing that you aren't pregnant or experiencing a serious health condition such as heart problems or diabetes. I was initially given a small dose of Sertraline as my score on the multi choice test for depression was pretty high and rated me as having severe major depression with social anxiety.

Unfortunately medications don't work straight away, they can actually cause the depression to worsen over the initial two weeks of taking them and even after they kick in they don't always agree with you. I experienced some pretty bad side effects and the Sertraline didn't seem to be improving my mood, so it was decided that I was be put on Venlafaxine. Bad luck for me as I had a GP that whipped me off Sertraline in a week, not recommended! Usually you will be phased off anti-depressants slowly so you're body can adapt without going into withdrawal. I went straight into withdrawal, was extremely emotional and a danger to myself. If I'd had been in a better state of mind I might have been able to give that GP a well deserved telling off, but I was barely able to speak up loud enough to check into the doctors surgery let alone give the doctor a good telling off.

I've been on Venlafaxine (also known as Effexor) for about four years now. I've experienced some side effects but nothing bad enough to prompt me to change again. Even though I knew my current GP would carefully remove it from my system, I was still scared of having another horrendous experience of withdrawal and a major depressive episode without any anti-depressants in my system. That was until I realised something recently. When I was at uni I kept track of my weight. At the time I was experiencing body dysmorphia, I still do but in different ways now, I believed that I was fat when I was actually around the perfect weight for my frame (just under 9 stone). Flash forward to today and I'm 11st 6lbs. The most commonly used anti-depressants such as Prozac and Zoloft can cause weight gain of at least 10lbs! Nightmare! The cause of this weight gain isn't known for certain, it can be because of an improved mood and the ability to find pleasure in things again such as food. It has also been shown to cause a change in metabolism (making it slower) causing patients to gain weight despite maintaining normal eating habits.

Depression did cause a major change in my diet and activity levels, for the worse. However, since January I have been moving more than I had in the past couple of years, eating significantly better, upping my daily step count and really pushing with the exercise. Imagine my horror when I put a dress on a couple of months ago that was tight when a few months prior it had been loose! I know that weight loss takes time but this was devastating. I checked out the side effects of Venlafaxine and yipeee weight gain is one of them. I discovered forums full of people experiencing the same problem. Enough is enough for me, my anxiety and depression is closely linked to my body image and self confidence. If the thing that's supposed to be helping my mood is causing weight gain and destroying my confidence, it will inevitably reignite the depression. Awesome.

I decided to head to my GP to discuss coming off Venlafaxine. He was incredibly relieved. In the years since I'd been taking it, more and more tests on the drug and those taking it had revealed that it can have major effects on the cardiac system. Anti-depressants often affect more than one nervous system i.e. the brain and something else, in this case it is the heart. With his assistance I've been slowly withdrawing from Venlafaxine since April. It has to be a gradual process as my body has become so used to it's presence after relying upon it for so many years. The body and mind goes into shock as it realises this thing it has clung to for so long is suddenly being taken away from it. My dosage was adjusted every two weeks and with it came a variety of side effects which I've listed below:

• Weeks 1 + 2: alternating days of 225mg and 150 mg, high levels of anxiety, shakes, sweating
• Weeks 3 + 4: 150mg each day, dramatic mood swings, tearful, low mood, upset stomach, fatigue and insomnia 
• Weeks 5 + 6: alternating days of 150mg and 112/5mg, sensation of chickenpox on the skin feeling itchy but no visible cause, hot flushes, nausea, fatigue, sickness, insomnia 
• Weeks 7 + 8: 112.5mg each day, less nausea, appetite returned, loss of concentration, increased sensitivity to sudden noises and movements, very dry mouth
• Weeks 9 + 10: alternating days of 112.5mg and 75mg, very low moods, low self esteem, high anxiety, poor sleep pattern
• Weeks 11 until present day: 75mg every day, very low mood, crying over nothing, very sensitive, tired, headaches, anxious, low self esteem, lack of concentration, lack of enjoyment

I've been taking 75mg each day for a number of weeks now due to difficulties getting a follow up appointment with my GP. When I did get an appointment we discussed remaining at this dosage until I returned from a planned trip abroad as we agreed it could disturb my mood further. The plan is to then alternate with 75mg and 37.5mg, followed by two weeks of taking 37.5mg daily and then being free of anti-depressants for a while. At the beginning of this process if it had been suggested that I'd be taking no medication at all at some point I might have had concern. Whereas I now can see how much of an impact it was having on my body. I also have less nerves about this as the process has been undertaken in a very controlled manner. Once my body has adjusted to being drug free and free of any withdrawal affects we will then introduce a new drug and be able to see if there are any obvious side effects from it. Hopefully I'll be able to find something that helps rather than hinders the recovery process!

 

Breast Intentions

During my recent working vacation I had some breakthroughs. Most notably with my GP, if you follow this blog you may remember me referring to a particularly brutal doctor in the past. After inducing a breakdown, being too anxious to attend appointments and generally feeling beaten down by their words, I decided enough was enough. I either had to cease treatment with this doctor and find another one, something which I was reluctant to do, or address this doctor's shortcomings and failures in dealing with me. Despite talking about my mental health more than ever before, it's still very difficult for me to discuss my problems with GPs. I've been through a few doctors now, I understand that some people struggle to talk about mental health and that they might not understand it or may even dismiss depression as an illness all together. Is it so wrong to expect that your GP would be sympathetic and understanding of mental illness? I don't think so. Perhaps it's an area that's skimmed over but covered enough so they have a general understanding of mental illnesses. Either explanation is still unacceptable. 

I decided to face the problem head on, albeit through a letter. I'm not especially eloquent in person, I stumble over my words, stutter and rarely get my point across in face to face conversations. It's not as if I don't know what I want to say, I can go into a conversation having rehearsed every potential scenario in my head, stressing over the details, ifs and maybes are my forte after-all! To compensate for this I decided to write a letter to my GP explaining my thoughts on their treatment towards me. Essentially, several comments were made on my personal life and how I choose to address and treat my mental health conditions. If I couldn't proceed with any further appointments with them I at least hoped to highlight ways they could alter their behaviour for any other patients they might have with depression. Fortunately they responded well, and we've agreed to continue our doctor-patient relationship. I could have easily rolled over on these issues, I could have allowed them to believe that I'm a particularly sensitive individual and that they need to treat me accordingly. This doctor does have a fairly forceful nature in the hopes that they can push patients towards getting better. I know that they have made a real effort to understand every aspect of my life, they've accepted that for now I do not wish to seek the help of a counsellor.

I wasn't sure how they'd react to my letter, before I received their response I was convinced that I was going to have to search for another doctor. Fortunately bridges hadn't been burned. At the end of the letter I decided to address something I'd been too nervous to discuss in an appointment. The addition of which turned the one page letter into a three page essay! It's something that I have previously discussed with other doctors only to be shot down with their personal opinions. During the height of the bullying I experienced, I turned to food for comfort and up until that point I'd never really understood the term 'comfort eating'. I suppose I just felt some immediate satisfaction and happiness after each forkful of cake, cheesecake or whatever else I was sneakily shovelling in after school. This routine soon took it's toll on my body, and without realising I had become 2 stone heavier and had gone from a B cup to probably around an F cup. I was mortified, I didn't want to have my breasts measured properly to reveal the true extent of how big I was. I received even more attention and scrutiny. I was called out on by my P.E. teacher in the changing room because my sports top was now "inappropriately tight", cheers for that. I avoided P.E. lessons when our group of girls was suddenly mixed with the boys because of bad weather. At that time I favoured getting a 'no kit' mark against my name rather than bouncing on a trampoline in front of the boys and giving myself black eyes.

Six years on and not much has changed. I still avoid getting measured properly as they are still growing. I've had breakdowns in changing rooms because of them and would rather avoid crying in front of a lady with a measuring tape and enormous bras. I managed to lose most of the weight I had gained, but I never regained the confidence I once had nor the pleasure of buying and wearing clothes that made me feel good, and I certainly haven't lost the other two things I gained *ahem*. Since I was 16 years old I've wanted a breast reduction, for many many reasons. I've been told that I should be grateful for what I have, that I should flaunt it and that they really "aren't that big". I've also been told that due to being severely depressed I was "a suicide risk and it would be a waste of NHS funding", and yes that comment was made by a Doctor! GPs haven't exactly been my biggest cheerleaders on the matter. I understand that it's a slightly controversial thing to get funding for, but it's not for cosmetic purposes. My quality of life isn't what it ought to be because of how much I am limited by having a big chest. I am going to be turning 23 in January. I feel like I haven't even had a chance to feel like a young person, a young woman. During these years I haven't developed a personal style, I don't experiment with clothes or have fun with them. I simply hide my large chest and feel quite frumpy.

If you want an extensive list of all the reasons behind me wanting and needing a reduction I will happily provide it for you. I'm prepared to fight my case for this. Usually I wouldn't think I was worthy of anything, I'd think that there must be people worse off than I am. For once I'm saying "sod it, why not me?"and finally I have the support of the doctor I thought would sack me in as a patient. They are in my corner and ready to do battle with the NHS board of referrals, it might be a long battle but for me it's worth it.