Today’s blog is the latest installment from our guest blogger, Alison Dotson, author of the upcoming book, Being Me with OCD. When I read Alison’s blog below, what struck me was the importance of recognizing how self-care and flexibility are critical components of relapse prevention. Medication, cognitive behavioral therapy (CBT), or a combination of both, are all first-line treatments for OCD. However, we can sometimes forget that OCD happens inside a person. It isn’t enough to just treat our psychological and physiological symptoms — we also need to take good care of ourselves, be thoughtful of our choices, and not lose our voice in order to try to live a full, sustainable life. – IOCDF executive director, Jeff Szymanski, PhD
Seven years ago I was diagnosed with OCD. I finally—finally!—knew what was going on, and that meant I could get help. One of the first lines of defense against my intrusive thoughts was Paxil. The first few weeks were a mixed bag of effects: I experienced dry mouth, brain “ticks,” and fatigue. I also started to feel better, sooner than I had expected. My obsessions came on less often, and with less intensity.
After a few months, I noticed something else: I had gained some weight. I knew exactly what had happened, too. Before I started on Paxil, for years and years, I suffered from anxiety-induced stomachaches. I felt nauseous every morning; my stomach dropped like a lead weight before I walked into work each day; and there weren’t many foods I could eat without feeling queasy afterward. And if I added any stress to my everyday routine, I could forget about eating much of anything for days—even weeks—at a time, learning to get by on bananas and yogurt.
This was a diet I never planned to go on. And it never occurred to me that taking medication could make this part of my life better. I went on an antidepressant because I was depressed. I was in that terrible middle place between wanting life as I knew it to end, but not wanting my life itself to end. I swallowed those pills because my doctor told me they could help me stop obsessing, not because they’d give me an appetite.
But, oh, did they ever. It wasn’t so much that I was suddenly hungrier than ever, it was that I could eat without regretting it. A cookie no longer made my stomach churn. Eating a big sandwich with fries no longer meant I’d be stuck at home all evening, curled up on the couch in agony.
Eating was now a pleasure, not a curse, and I took full advantage of that. And it showed—just a little at first, five pounds, and then ten. I now weigh 30 pounds more than I did before I went on Paxil. At this point I can’t blame my weight gain on my medication, though. It’s been several years; I’m in my 30s now, I haven’t been working out enough, and research suggests that while Paxil does often contribute to weight gain there is no proof that it has a negative effect on weight loss. Sure, it had a hand in my growing waistline, but the rest was up to me.
After seeing some unflattering pictures of myself after a family cruise (Who’s that woman mini-golfing with us? Oh, no…), I joined a gym and signed up for the cheapest weight loss program offered. They could help me, they said, and they’d start with a metabolic assessment.
A personal trainer drew my blood, secured a blood pressure cuff on my arm, and took my pulse. Decked out in an oxygen mask and hooked up to a heart monitor, I huffed and puffed my way through the exercise portion of my assessment. Then we sat down to discuss nutrition and my test results.
As I chatted about what I ate in a typical day and told her that due to my job as a proofreader and writer I was mostly sedentary, I also mentioned that I had initially gained weight after I went on Paxil.
She drew a sharp breath. “Oh, no,” she said. “That is toxic. Toxic.” She sighed heavily. “You have to go off of it.”
Dumbfounded, I said, “Okay.” I took a moment to gather my thoughts. “Well, I don’t plan to stop taking it, so can we work around it?”
“You won’t lose the weight if you don’t.”
“Well, Paxil has been shown to cause weight gain, but my doctor told me there’s no evidence that it prevents weight loss.”
“I’d be interested in seeing that study,” she said. “Wouldn’t surprise me if it was paid for by the drug manufacturer.”
“I don’t think it was just one study…”
“Do you want to lose the weight?”
“Well, yes, but I’m not just going to stop taking my medication. I have an anxiety disorder, and…”
“If we get your nutrition in line you’ll find that you won’t need it. You got that way for a reason. You weren’t eating the right foods or exercising enough. You need healthy fats and animal protein and you’ll feel better and won’t have that stress anymore.”
“I’ll definitely try all that, and I believe nutrition is important,” I said, my voice shaking. “But I won’t knock my medication—it saved my life. I was suicidal before I went on it.”
“But what about quality of life?”
I took a deep—deep—breath. “I’d rather be alive and a little overweight.”
In an attempt to stay relatively calm as this woman refused to listen to my concerns, goals, and medical history I had dug my nails into my palms so forcefully I had left marks. I wanted to write her off as misinformed, as a fitness nut who cared more about how her legs looked in a short skirt than about being healthy and happy. But she had hit a nerve—hard.
That night I jumped on my laptop and spent hours reading about weight gain and Paxil. Almost every site verified that Paxil is the SSRI most likely to cause weight gain, and there was even a whole site of former Paxil devotees who had defected, either switching medication or quitting antidepressants altogether. Not surprisingly, I got too invested in the topic and began to agonize over it. Was it as simple as cutting Paxil out? Would the pounds magically melt away as soon as I threw out my last bottle?
I had just switched doctors, and when I met with her for the first time, I recounted this whole conversation for her and explained that while I had always liked being on the smaller side I was worried about the possible negative effects of going off my medication. I was worried that I would be playing with fire—it had worked so well for me, so why was I even considering switching to something else? What if I went off of it, felt terrible, and then couldn’t get the same great results if I decided to take it again? Was all of this second-guessing and experimentation worth it—for 30 pounds?
She explained that while there are some drugs that cause weight gain and doctors and researchers can pinpoint the pharmacological reason behind it, Paxil is not one of them. Others who have gained weight may have lost their appetite, like I had, when they were depressed, and now they’ve gotten it back.
And, she said, “You know, you’ll have a hard time losing weight if your OCD symptoms flare up and interfere with your life again, too. You won’t get to the gym much in that case, either.”
Yes, I was sick of weighing too much, sick of pulling on pants that had fit several months before only to realize they refused to zip. But I couldn’t let that disappointment consume me. No matter what, nothing is more important than my mental health and well-being. So I vowed to start small and see what happened. If I started to eat better, being sure to introduce more healthy whole foods into my diet, and committed to an exercise routine, there was a chance I could lose the weight and take the medication that had helped ease my once unbearable pain, slowing my fast-going train of obsessive thoughts so I could tackle them head-on, and one by one.
The meeting at the gym had been tense and frustrating, and I let it get to me. But the trainer had asked a very important question: “What about quality of life?”
Her version of a good quality of life included a tight, toned, and, yes, healthy body. And that’s great. But I had to ask myself that question. My quality of life is about being a relatively happy, well-rounded person. It’s about staying on top of my obsessions, and while exercise and proper nutrition are undeniably beneficial, they can’t do everything. Hopping on an elliptical can’t replace talking myself through an intrusive thought, and fish oils aren’t the end-all, be-all solution to happiness. As with anything in life, it’s all about balance. And next time someone tells me I’m not leading my life the “right” way, I’ll try to take it in stride, remember my doctor’s advice, and listen to my instincts.
Oh, and if you’re wondering whether it’s possible to lose weight while on Paxil: I took the trainer’s advice with a grain of salt, applying what worked for me and my life—less sugar here, more protein there, and walking more than driving—and within a few weeks, my pants were looser. Yesterday I effortlessly zipped up a dress that my husband and I had to team up on just a month ago. I’m making progress, slowly but surely, and I’m doing it my way.
Tell me: Have you had any frustrating experiences like I had with the personal trainer or someone else trying to be “helpful”? Have you found yourself explaining what OCD is and what it means to have it? How did you handle the situation?