Anti-anxiety meds & weight gain

Hello All!

I have a generalized anxiety disorder (GAD) with panic episodes and have been on Lexapro for 2.5 years. Throughout that time, I've gained about 20-25 pounds after struggling to put on weight my entire life (pre-meds: 116 lbs, current 140 lbs). I tried switching meds to combat this but 1. They made me so nauseous I couldn't function for the first half of every day the two weeks I tried to switch and 2. My insurance decided to not approve them so it wasn't even worth continuing. Lexapro (combined with therapy and coping mechanisms) does a decent job at keeping the anxiety at bay so I don't really want to mess with that.

So back to the weight gain. I climb 2-3 times a week for 1.5-2 hours. Mainly bouldering, occasionally top roping/leading (home gym is a little short for me to lead comfortably). I prefer climbing focused exercises because they get me out of my head unlike yoga. I occasionally pick up running (I hate it but its good for my head space) but summers in Oklahoma are brutal so I usually quit. Pre-meds, this was also my routine so nothing has really changed. Diet wise, I eat healthy-ish but try not to obsess over calories. I try to balance veggies, protein, carbs, etc. and not to over-indulge same as pre-med life (I actually think I eat healthier now). Other notes: I broke my ankle in January but continued to auto-belay on one foot/in a boot until the gym closed for covid. When covid restrictions started, I hired a trainer to focus on at-home exercises I could do (and ankle recovery so I could avoid PT) but $$$ prevented me from continuing with a trainer past July. Even with the ankle injury, I didn't lose/gain weight. I've been pretty much hovering at the same weight. Our gyms in Okie-land opened back up in May so I've been back to the climbing routine since then.

While I still climb well, I'm definitely in a plateau and I feel like the extra weight is holding me back.  So the question is, is for people who have also had the anti-anxiety/anti-depressive med weight gain, what are the best ways to combat this? What should I add to my routine? Should I be focusing on more high intensity cardio or weight training? Is there hope for me to be able to lose any weight while on meds? Should I start obsessing over calorie counting? I don't want to get back down to my pre-med weight by losing 10-15 pounds would be my goal. 

Any advice appreciated!

Thanks in advance! 

- Skylar 

Isn't Lexapro generally considered relatively weight neutral?

Maybe it's that the treatment worked and you just feel better and have a different appetite?

PWZ wrote:

Isn't Lexapro generally considered relatively weight neutral?

Maybe it's that the treatment worked and you just feel better and have a different appetite?

Weight gain is listed as a side-effect for Lexapro and adding it to my life is when my weight gain started. My doctor believed it could be lexapro or the fact that I'm just getting older (currently 27) but I'm stubborn and don't want to think its age.
It is true though that I may have a different appetite now. Either way, I'd like to lose a few pounds and know that it is much harder to do when on meds that can cause weight gain.  

How is it causing weight gain? Is it because you have more appetite and are eating more?

I think it's useful to use a food and exercise logging tool like myfitnesspal.com just to give yourself a reality check on how much you're eating vs. how much your body needs. It will also give you a really good nutritional breakdown so you can see, for example, if you're not eating enough fat or protein, or if you're eating too many nutrient-sparse foods, which can make you hungrier. I'm 44 and have been logging food for years as well as maintaining my weight where I want it. It becomes a habit and pretty easy to do once the foods you normally eat are in your database. 

How tall are you? 140 isn't exactly heavy, unless 116 was a reasonable weight. Be careful, and maybe aim for just being fit, and not gaining more weight? 

Hi Skylar,

So! I have been in a very similar situation at a similar age/sex/weight. This will not sound like the best news, but I found it impossible to lose weight while on anxiety meds + birth control pills.

Caveat time: I am not a doctor, this is not medical advice...also not a therapist...really I have no credentials in this area other than having had this exact experience. I tried lexapro and zoloft. I don't climb very hard but I've been doing it consistently for like 6 years now.

I am confident that at least one of the meds I was on caused ~20 lbs weight gain over 3 years, which is a lot at my height (Why do I say that? Because with no change in diet or exercise, I magically starting putting on weight when I started all the meds, and magically started losing it when I tapered off. Soooo big coincidence).

But when you need anti-anxiety meds, well, you need them. And it can be demoralising to work so hard at the gym and not see progress. As to what to do now, here are some of my tips:

• It's not your imagination! These medications have a powerful effect on body chemistry. If you don't think it's diet or age causing the weight gain, don't let people gaslight you. I swear some of these meds make you gain weight from breathing.
• Don't count calories. Eat a diet that makes you feel good, lets you climb, and is healthy, whatever that means for you.
• Weight training is great! I had trouble putting on muscle on the meds, but I still got stronger - it just took time. Based on your post it doesn't sound like you do any dedicated strength training now. If it's possible for you to add some to your routine (you don't have to go wild, just a few exercises) it'll help you climb better despite the weight gain.
• Cardio is also great! It's also where I had the easiest time seeing gains, so I was a lot more motivated to work on it. Didn't help me lose any weight, but hiking to the crag is easier now.
• Get clothes and a harness that fit, if you've changed sizes. You'll feel more comfortable and confident.

Most importantly, prioritize your mental health. Even if climbing doesn't look the way you expected right now, you're working on your long term health, and that's going to pay dividends.

If you're interested in hearing another perspective about strength, weight and climbing, I highly recommend this interview with Natasha Barnes: https://thenuggetclimbing.com/episodes/natasha-barnes.

Feel free to message me directly if you want to talk more.

With the above post, I will add that I was one of those for whom Zoloft was an appetite suppressant. I took it for about a year for depression. That's not usual, weight gain is the norm, and I put the weight right back on later. But? It might be worth seeing what meds may work for you, on both the mental health end and for weight. Your pharmacist would likely know equivalent meds, and have real life feed back from customers.

A few notes:

1. Bodybuilders have a saying, "Abs are made in the kitchen, not in the gym." If you look at the number of calories in common foods, and the number of calories burned by common exercises, you'll quickly notice that even a small increase in food intake can easily outweigh even massive amounts of exercise. Add in the fact that exercise can increase appetite, and it's not at all a given that exercise will help you lose fat--it may actually cause you to eat more and gain weight.
2. There are a lot of mental health issues around weight, and we can't advise you to lose weight. Your current weight might actually be a healthy one. Be sure that's not the case before you embark on a weight loss journey, because it may in fact not be the right path for you.
3. However, IF weight loss is the right path for you, then the upthread advice to not count calories is bad and misinformed. Calories in < calories out = weight loss. That's an immutable fact without scientifically-founded exceptions as far as I know. The medications you're on can affect your metabolism (that is, they can decrease your calories out), but they can't make you consume more calories. If you refuse to count calories, then you're giving up the only means you have of measuring whether your diet will help you reach and maintain a weight that's right for you.