Antidepressants and weight-loss, and how to make dieting and exercise work better for you if you have issues with depression

Posted on April 9, 2012

0


From the lecture I reference below: “Depression is the most damaging disease you can experience.” Notice the word DISEASE. If you are one of those people who hears “depression” and thinks “wuss” you are woefully misinformed.

This is going to be three parts.

1) I’m going to talk about whether or not antidepressants affect weight-loss (short answer: yes) in 2) and 3) I’ll give some helpful modifications to dieting and exercise for those who are either prone to depression or currently depressed.

This is going to start with a story exhibiting the idiocy of some doctors. First, a joke:

“A doctor is at the pearly gates, he cuts in line and tries to walk through. St. Peter tells the doctor he has to wait in line with everyone else.

The doctor responds, “But I did so much good in my lifetime, I saved so many lives, and was such a great man. Why do I have to wait with these people?”

St. Peter “That’s wonderful, but everyone has to wait lin line.”

A few minutes later a man in a white jacket walks up to St. Peter, exchanges a few words, and walks right on through the gates. The doctor is not happy.

“St. Peter! Why does that guy get to go through and I don’t?!?”

St. Peter “Oh, that was just God. He likes to play doctor sometimes.”

Back to my story.

I have this client Montana, she’s pretty new; only been training with me for a few months. She started getting serious with her weight-loss after her most recent baby. She did this on her own for about 4 months, and then like I said, has been working with me for 3 months.

For nearly 7 months straight she was losing weight. If not every week, then just about every week.

Of course, a stall is almost inevitable. Weight-loss is pretty much always a step function, not a linear one.

So Montana stalls for a week, begins freaking out, then stalls for another week, and now she’s really freaking out.

Montana is, self-admittedly, OCD and very much a Type A person. (This will be important later on.) The kind who measures every single thing she consumes and has to resist getting on the scale three times a day. To stall for a couple weeks was a BIG deal to her. And only added to her naturally stressed self.

After nearly a month of my pleading, she finally gave in to the idea of a “cheat” day. The primary purpose of such to give her a break from the very low calorie dieting she had been doing for 6 months. She was consistently eating 1000-1200 calories a day. Often times going down to 700-800. Considering she was working out twice a day (!) and was about 175lbs at the time, that’s a pretty damn low amount of calories.

So she has her cheat days. A Friday and Saturday. Despite my advice she stepped on the scale Monday and found herself 5 pounds heavier. (Always give yourself a few days after a cheat day before you step on the scale.) Pretty common after a cheat weekend, and really no big deal. That should come off within a day or two of getting back to the diet. It’s primarily just water weight, which is associated with a higher carb intake.

Here’s where the problem starts. After talking to Montana and looking at her food log, her “cheat” days consisted of one day going up to 1500 calories and another going up to about 2000. These barely qualify as cheat days.

Considering she was 175lbs and working out twice a day, with two young children to take care of all day, her maintenance caloric intake was probably around 3000. 1500 calories is still well below her maintenance as is the 2000 calorie day. So I was very surprised she gained 5 pounds off of this.

Further adding to the issue, after ten days the 5 pounds was still there.

This just isn’t right. First off, adding only about 1000 extra calories over the course of two days hardly qualifies as something that should add 5 pounds. Secondly, it should definitely not still be there after ten days of being back on a diet. Something is going on.

After a ton of prodding I was nearly clueless. Montana was just about on her period, which can cause bloating and water retention, but I still felt like that couldn’t explain a whopping 5 pounds for ten days. Montana was stressed to the nines over this as well. Finally, after seeing the stress on her face, I took a long shot and asked, “You’re not taking any new medications are you?”

Montana “Yeah, I started taking my anti-anxiety pills with everything going on lately.” (Note: Montana was stressed over some big financial purchases her and her husband were about to make.)

Me “AHH! What are you taking??? That could definitely be a factor.”

Montana “Really?? I’ll get you the names.”

She was on paroxetine, aka Paxil (an antidepressant), and alprazolam, aka Xanax.

This HAD to be the issue. This was the only thing that changed. I ran a quick google search and found paroxetine has “weight gain” as a side effect and told Montana so. She said she’d go to her doctor, talk things over, and see if she could get a different prescription. Great.

Apparently this doctor wanted to revel in idiocy.

Doctor to Montana, “The meds aren’t the reason you gained weight. I even researched before you came in to double check.”

My email back to Montana:

“I’m not sure how much of a conversation you got to have with your doctor, but I think she is being rather dismissive and or naive. (Note: This is how I politely refer to people as lazy morons.)

This is just from a quick google search: 

Unlike two other popular SSRI antidepressants, fluoxetine and sertralineparoxetine is associated with clinically significant weight gain.”

http://en.wikipedia.org/wiki/Paroxetine

“(One note on paroxetine: This fine antidepressant appears more likely to cause weight gain than the other SSRIs. Whether the weight gain is due to an increased appetite, carbohydrate craving or recovery from depression is unclear.)”

http://health.msn.com/health-topics/depression/antidepressants-and-weight-gain

“Common tolerability-related side effects of modern antidepressants include nausea, insomnia, somnolence, fatigue, sexual dysfunction, and weight gain

http://www.ncbi.nlm.nih.gov/pubmed/18494538

“Weight gain is a relatively common problem during both acute and long-term treatment with antidepressants, and it is an important contributing factor to noncompliance…Paroxetine may be more likely to cause weight gain than the other SSRIs during long-term treatment.”

http://www.ncbi.nlm.nih.gov/pubmed/10926053

One of the meds you are on is the med MOST likely to cause weight gain out of the possible choices! And I haven’t even looked into the other one yet.

Personally, I think once things calm down a bit for you stress wise, you take a break from the meds, and your period passes, your weight will drop right back down. You simply do not gain fat that quickly, only water. I don’t think your doctor’s recommendations are bad, but for her to disregard the possibility of the meds is surprising to me. You inadvertently just took her advice this past weekend of eat more and take time off and you STILL gained weight. Which is fine, but you haven’t lost it. 

A pound of fat has 3500 calories in it. Over the course of two days you ate an extra 700 calories or so. That’s not even close to a pound yet you gained 5 pounds! There is just no way, save for breaking the laws of physics, that day or two caused you to gain 5 pounds, AND keep it on.

-Brian”

Seriously, what in the world did this woman “research” before she saw Montana? I sent that email to Montana after 5 minutes on google and I found two informal references and two formal references (from the NATIONAL INSTITUTE OF HEALTH) contradicting her doctor.

As I mentioned in the email, one of the meds Montana was taking (Paxil), is one of the antidepressants most likely to cause weight gain as a side effect.  Short of this woman making profits off of prescribing paroxetine, I have no idea what her thought process was.

The ironic thing is this: The doctor’s recommendation to Montana was to raise her calories to 1500 and exercise less. Montana did that EXACT thing for a few days (her cheat days) and that’s roughly when her weight went UP. And STAYED up. Thus, Montana inadvertently already took the doctor’s advice (before it was given to her) and, contrary to the doctor’s advice (and mine coincidentally), her weight went up and stayed up. Basically Montana already proved the doctor’s advice did not work and was not the cause of her issue. Yet the doctor still dismissed the notion the meds had ANYTHING to do with her weight gain. And proceeded to give her the same advice, again. What’s that definition of insanity?

Montana got rid of that doctor rather quickly.

Of course, she weened off the meds, went to another one, from another doctor, and lost the five pounds within a week. And has lost more since.

The purpose of this is 1) Antidepressants unequivocally can (this doesn’t mean they always do) affect weight-loss and I suppose 2) Hey doctors and really anyone involved in some type of health care, your every day client / patient has access to just about much information as you. Don’t be a lazy moron.

Why did this happen? Why did Montana’s weight stall? And why did it go up?

Now for the complicated, mumbo jumbo shit. This must be prefaced with the fact that depression is incredibly complicated. Even the best antidepressants only work a whopping 30-40% of the time. Thus, the brightest people in the world working on treating this issue are still having a lot of trouble.

First, how do antidepressants affect the most pertinent factors to weight-loss, i.e. how much you move and how much you eat?

I’m only going to give this a cursory look by examining what Montana was taking. I’m not going to go over every single antidepressant and its effects. I’m simply going to use Montana’s experience as an example of what can happen with some meds.

Not talked about above is the fact Montana was on two medications during this time. I discussed paroxetine some; the other medication was alprazolam, aka Xanax.

An obvious side-effect of Xanax, and many anti-anxiety pills, is lethargy. The point of the pill is to calm you down. Thus, it has the potential to make people move less. Moving less can obviously make you gain weight.

The not so obvious:

Food intake on days when alprazolam (0.75 mg) was administered (days 2,11) was compared to days when no capsule (days 1,9) or placebo (days 3,10) was administered. Alprazolam increased total caloric intake by approximately 975 kcal from a baseline of 2800 kcal.

From this study: Alprazolam increases food intake in humans.

Primarily because I don’t hate myself, I’m not going to go into a ton of detail on examining why Xanax might do this, all the hormonal influences, etc. The point I want to make is that Xanax does seem to make people move less and eat more, at least in some people.

Alright, but here’s the issue when it comes to Montana specifically. She was religious about tracking her food intake and adhering to her exercise program. I train her when her husband is nearby, and he fully corroborates this. Always doing so with a glare to me suggesting, “Dude, she can be insane.” Often times followed by her saying, “He thinks I’m insane.” Followed by him nodding. Ah, young love.

So this is a tough spot here. I’ve had clients swear up and down to me they are tracking their calories properly, only to find out later (in various ways) they are flat out lying to me. You’d be amazed at the ways people attempt to pull this off. However, I’m a fairly, and I say that cautiously, good judge of who may be doing this.

Montana just did not strike me as so. She was losing weight for way too long to all of a sudden just blatantly lie to me about falling off the wagon. And more importantly, she really cared about what was going on. Often times the people who are lying just shrug it off as, “Yeah, you know, I just can’t do it, I’m tracking, but blah blah blah.” Montana was a little different. A laid back response just isn’t her nor is it typical of Type A people. I’d say her response was something akin to, “WHAT THE FUCK IS GOING ON WITH MY BODY?!?!?”

Because of this; coupled with the fact Xanax doesn’t seem to impact hormones as much as paroxetine, I felt like if there was something going on the paroxetine was probably causing it.

So what does paroxetine do? (Please remember this is an overly simplistic view of things.)

The primary purpose of paroxetine is to increase the reuptake of serotonin. It’s been noted people with depression have issues with getting enough of either serotonin or norepinephrine to their brain. Paroxetine attempts to help the serotonin aspect but not the norepiphrine. Increase the amount of serotonin; hopefully decrease the depression.

The problem here is increased levels of serotonin in the brain tend to increase fat burning. Dieting actually lowers levels of serotonin in the brain, and who loses fat the slowest? Really lean, extensively dieted people (aka those with low serotonin). So it appears, if anything, increasing serotonin uptake in a person with likely low levels (due to extensive dieting) would be beneficial for weight-loss. However, Montana was not experiencing this.

This is a good place to remind everyone that Montana gained 5 pounds, over the course of two days, and did not lose it after 10 days. See above again if you need to, but remember there is no way Montana gained 5 pounds of fat this quickly. So we’re primarily looking for some kind of affect from these drugs resulting in increased water retention ala the type of weight that can fluctuate the quickest.

After scouring the internet, there is one other side effect of Paxil I thought could be the culprit. It appears to increase the levels prolactin (See here: http://jop.sagepub.com/content/11/4/345.short) . Prolactin increases milk production in females, thus causing things like increased breast size. It’s most commonly increased in new moms. As any immediately post-partum mom will attest to, there is a significant increase in breast size during lactation.

As I mentioned, Montana is a new mom. However, at this point she was no longer breast feeding. Perhaps though because she is a new mom she is someone more sensitive to having increased levels of prolactin? I’m not sure.

Because a lot of people really aren’t quite sure what’s responsible for antidepressants sometimes causing weight gain, here’s my best guess as to what happened with Montana: Because she was on her period she gained 1-2 lbs of water weight, she maybe gained 1-2 lbs of water weight from her cheat day, and then another 1-2lbs from her antidepressant causing increased levels of prolactin. Add this all up and you get roughly 5lbs of weight gain.

Also, with the increased levels of prolactin, her body was given signs of possibly just having a baby, therefore her body was holding on to weight with everything it could. (The female body is notoriously stubborn when losing weight. It is much more concerned with reproductive success, not how flabby your thighs are.)

Again, this is speculation. I could be completely way off base, but I think I’m at least in the ballpark.

For most people, aka the non-nerds, the above is just mental masturbation. The important thing to remember is if you’re on antidepressants they CAN affect your weight-loss efforts. Some are going to affect things more than others. And some might not matter. After all, your diet is still the most important thing. Just keep in mind your antidepressant COULD be making life harder. It’s just hard to know in what way it’s making things harder.

Dieting mistakes to avoid if you’re prone to depression or are depressed

I want to go back to Montana’s personality traits. I made a point of mentioning her OCD and the level to which she gets stressed. This is not uncommon amongst those prone to depression and or anxiety. Robert Sapolsky, the author of Why Zebras Don’t Get Ulcers, has a great lecture on this:

For fear of picking on Montana I want to mention this is not uncommon in the clients I see either. (Hi Bonnie 🙂 .)

As Sapolsky mentions, people often think of the depressed as something akin to the walking dead. That is, they move slowly, they’re always down, lethargic, etc. In actuality, often times those prone to depression (and the overly anxious) are extremely high strung. They are the opposite of the walking dead. They come in for their training session and they are fucking wired.

(If you get enough experience training others or yourself, you’ll likely notice a weird phenomenon at some point. When you or your client comes in and they are all pumped up and ready to go, there’s a good chance they are not going to have a great workout. However, when they come in and they’re tired, lethargic, just really relaxed, there’s a good chance they are going to set some PRs and do some good things.)

Because of this their stress hormones are on overdrive constantly. The biggest, most well known stress hormone is cortisol. Cortisol is through the roof in this population. In most people, cortisol elevates sporadically. See stressor, kick in cortisol, overcome stressor, decrease cortisol; go back to your day. But in the depressed, it just stays elevated.

Back to Montana, here’s a person prone to depression / anxiety to the point where she feels medication is beneficial for her. Nothing wrong with that. But, look at some other aspects of what she was doing. Remember how she was measuring everything she consumed? Or how she was working out twice a day, every day? She was doing this with two young children too! Does this sound like someone with a down energy level? No. It sounds like someone tripping off a night of cocaine.

So we have a person who is constantly stressed with a sympathetic (fight or flight) nervous system in 100th gear. When it comes to dieting then, we want to accommodate this as best possible. We do this by trying to mitigate the stressors of dieting as much as we can. Now this is true for anyone, but in someone prone to clinical depression it is even more important.

One thing we can’t change, and the one thing everyone has to adhere to if they want to lose weight, is we have to burn more calories than we consume. (PLEASE no responses from the Paleo tards or Gary Taube’s circle jerkers on this. Save it for another post.) Depressed people are no different. This is one thing we do not have control over.

What we do have control over is where those calories come from. Ideally, when on a fat-loss diet a person is consuming at least 1 gram per pound of body weight in grams of protein. Using Montana: 175lbs = 175 grams of protein per day. 175 lbs * 4 calories per gram of protein = 700 calories from protein each day.

Remember, Montana was, on her best days, getting 1000-1200 calories. Considering an ideal fat-loss environment would cause 700 of those calories to be protein, that doesn’t leave much left over for carbs or fat.

This is important because carbohydrates have beneficial affects on serotonin. That is, they tend to increase the amount of serotonin in the brain.

Furthermore, in these people the high levels of cortisol can cause decreased levels of dopamine, which is a pleasure causing chemical. Another symptom of the depressed is anhedonia, the inability to derive pleasure from typically pleasurable things. (See the Sapolsky lecture linked above for more on this as well.) Many a carb foods have been found to increase levels of dopamine and give pleasure, at least temporarily.

In other words, the people who should definitely not be doing intensely low-carb diets are the depressed or those prone to depression. They simply are not giving themselves any benefit by doing so. Clinical depression is not worth losing weight a bit faster. And it’s no guarantee you will lose weight faster by merely lowering your calories to absurd levels.

So just eat more, right? Well, yeah, but this is where we come back to the psychology of someone depressed and or on anti-anxiety pills…

They tend to be extremists.

If they’re losing weight on 1500 calories a day, they think, why not eat only 700 a day? And some people can get away with that.

However, there are two distinct categories of people who often cannot: Women, and the depressed. Who is more prone to depression? Women. In essence, depressed women are the people least likely to get away with extreme dieting. And who is most likely to indulge in it? At least in my experience and others I know…it’s depressed women.

In a nutshell, women tend to be more emotional, more prone to stress, and thus more prone to having high cortisol levels. (For all you idiots out there claiming I’m being sexist, this is scientifically verified. While I am biased in the sense I still don’t get why my ex-girlfriend freaked out when I put the comforter upside down, that doesn’t disqualify the above statement.) As mentioned already, depressed people often have high cortisol levels too.

Dieting is a stress, and so is exercise. The more intensely you do of either, the more you are stressing yourself.

Back to Montana, remember how intensely she was dieting and exercising? This is the norm with her situation, not the exception.

This is the long way of saying those who are depressed are often likely to engage in extreme diet and exercise protocols, causing intense stress on themselves. And this is all done while they are already more stressed than most. They are burning the candle at both ends. And when this is done, things do not go well from a weight-loss perspective. Often times the person stalls, and they stall hard.

When the body is this stressed its survival instincts kick in. Think of a starving caveman roaming the wilderness. This person’s body is going to be holding on to every ounce of fat, water, muscle, bone, etc. it can. Its primary goal is to live, not to impress your friends with how good you look after having a baby.

(For a more in depth look at this, with some specifics on the various hormones at play, read this from Lyle McDonald Why Big Deficits and Lots of Activity Can Hurt Fat Loss.)

So, yes, eating more helps. Unfortunately, it’s not that simple. It’s like telling the person, “So yeah, like, uh, just don’t be depressed. Ok, cool.” Also unfortunately, I’m not sure there is an easy answer for this.

With that said, here are some things I have found to help at least somewhat:

-I’m not as strict with these sorts of people on their protein intake. I realize they are likely going to be having huge caloric deficits on many days, contrary to my advice. The primary reason for a certain level of protein intake is to preserve muscle and promote satiety. I’d rather the person have a little less muscle on their frame and not be clinically depressed. Therefore, I’m more lax with these people with regard to their carb intake, and likely suggest they eat more carbs than I would a regular person. (For another great article from Lyle McDonald related to this, check out Carbohydrate Intake and Depression .)

-I plead and plead for cheat days. Trying to argue from a scientific standpoint that they can benefit fat-loss. I’ve found arguing from a psychological standpoint is futile. These types of people often consider the psychological angle as being mentally weak, and it just goes no where. However, make a case a cheat day will increase fat-loss due to physiology, and they’ll at least listen. Cheat days will also usually get them to eat more carbs.

-Don’t be as strict about calorie counting with this group. Not counting makes most people more likely to overeat as opposed to undereat. It’s counterintuivtive at first, but we want these people to overeat on occasion. If nothing else it makes up for the insane undereating they normally partake in.

Important note here: We are talking about true, long-term, often reoccurring, possibly clinical depression here. This is not “I had a rough day so I’m going to drop 30$ at McDonald’s…on the dollar menu. (Don’t judge my hungover self.) We call having a rough day being human. Don’t put yourself into a psychological category you don’t belong in.

-Finally, and unfortunately this is often the case, wait for the stall. Because it is going to come. And once it does, once the person is at their wits end, they are more likely to listen to a different philosophy. If for nothing else they see the actual scale not moving for weeks on end. It’s not even like the person actually believes what you’re telling them, it’s just they are so frustrated they figure they might as well try something else. Many times this won’t even work and you’ll see the person continue their same behavior over and over. They simply cannot wrap their head around the idea of eating more to lose weight. What’s that saying about camels and water?

Mitigating depression with exercise

This is not going to be a diatribe making a case for exercise benefitting depression. That’s already been done ad nauseam everywhere. Suffice to say, exercise unequivocally benefits depression; often times more so than medication. This is going to focus more on a few specifics to apply to your exercise program to further help depression.

Anhedonia

Anhedonia is a symptom of depression. It is the inability to derive pleasure from typically pleasurable things.

Now exercise can be not enjoyable for perfectly healthy people, never mind those who are clinically depressed. However, I’ve found this is variable based on different exercises and different types of exercise.

I’m going to only talk about the most common person I see in this regard, a prone to depression woman. In my experience, I’ve found the addition of a solidly structured weight program is much, much better than other conventional forms of exercise. These people seem to respond much better to an exercise program that gets them strong and keeps them healthy much more than your “go run a few miles” program.

I think this is because weight training gives a different type of feedback. It can be enjoyable to see yourself lifting more weight than you have before, to see yourself do a push-up for the first time ever, to have some muscle definition you never had, etc. I think people respond to this much better than “I felt like I was going to puke at mile 3 last week; now I only feel like intensely vomiting at 3.5 miles.”

Of course this isn’t everyone. There are sadists everywhere. The important thing here is I’m more lax with exercise selection with this group. I’m more concerned with them enjoying themselves and or not hating their sessions than I am with my average client. While I want all my clients to enjoy their sessions, sometimes people need to do things they don’t enjoy. (We often avoid what we most need.) I’m willing to negotiate more here than I normally am.

Posture

As I discussed in Negative People Make Us Fat, Your Posture Can Make You Depressed, I Hate The Biggest Loser, it’s becoming increasingly clear poor posture can be a cause of depression as opposed to only a result. As aforementioned, antidepressants only work 30-40% of the time. In other words, trying to correct things at the brain doesn’t work the majority of the time. It surely cannot hurt to try and correct things at the body, hoping changes then occur at the brain as a result.

There are a bunch of posts about posture on this site. Check out things like 3 Common Weak Muscles, 3 Common Tight Muscles along with others.

Soft-tissue work / Massage

Referenced in Sapolsky’s lecture is the fact depressed people are more likely to have high amounts of muscle tone. Their muscles are often very tight and just not relaxed. This is similar to their personality, wound tight and not able to relax.

This is something I have definitely noticed in my clients with these psychological traits. When I put my hands on them to do some soft-tissue / massage work their muscles feel like metal rods. Things like foam rolling are immensely painful for them.

Because of this, these are the clients I typically give extra amounts of soft-tissue / massage / foam rolling work to. Hopefully helping to relax their extra tense muscles. It’s painful for them at first, but it’s often highly relieving in the long run. This helps to…

Get them out of pain

Along with the above, at least in my experience, these types of people are much more likely to be beat up. It’s pretty easy to see why. Combine a person with high muscle tone, who is prone to extreme dieting and exercise, a person who is likely not sleeping well, who has a lack of desire to take time off, and you have a recipe for consistent injuries.

Therefore, I try to hold these people back more often. They are going to have deload weeks more often, easy days (especially when they are really stressed), and extra amounts of corrective exercise combined with less volume of intense exercise.

This will (hopefully) alleviate the amount of pain the person is in which will (hopefully) alleviate the amount of stress they’re in. In other words, we’re trying to reverse the cycle that can typically occur in this population, which is: depressed / stressed / anxious -> high muscle tone -> insane exercise programs -> insane dieting -> injury -> more stress -> more muscle tone -> more insanity -> more injuries.

Intensity

Going with the above, exercise is a stress to the body. In this population we have people who are chronically over stressed. Thus, these people need to be concerned with the intensity at which they exercise. Greater intensity = greater stress = greater likelihood to have issues with weight-loss and make less progress exercise wise.

The ironic thing here is that this population is one which should not be exercising very intensely, very often (unlike most people), yet they are the most likely (in my experience) to want to exercise very intensely, very often.

As a tangential aside, keep in mind these people often have sleep issues as well. So while they may be wired and appear ready to go, their body is not well rested.

Subscribe to Blog via Email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Advertisements