I have traded the weight of depression for the weight of flesh — or, to put it bluntly, for a tire around my torso that makes me appear as if I'm walking with a flotation device beneath my clothes. This rim of flab never fails to shock me when I glimpse myself in a store window. I stare and stare as my fumbling brain does its double take: Is that belly-heavy self really me?
Affirmative. Alas.
When it comes to weight, the devil is in the details. I'll spare you most of them, but I'll at least mention that my midsection is not all that has expanded now that I'm in my supposedly expansive middle 40s. My face has also gained girth, broadening in the weirdest of ways, a thickening of my features that causes people who haven't seen me in a while to pause, stuttering, as they struggle to reconcile the face they recall with the face they see before them. What typically follows is that the long-lost friend will step back in surprise, silently wrestling with etiquette. Eventually, she'll give me a strained smile, painful for me to observe, and I'll feel my face get hot. Shame, apparently, weighs even more than the collective flesh of our obese nation, a land where people grow fat on cheeseburgers and also, it turns out, on certain calorie-free capsules known as antidepressants. By some counts, nearly 30 million Americans — among whom I number — are currently taking these medications.
"It's so nice to see you," the long-lost friend might finally manage to utter, or "God, your hair has really grown!"
In an attempt to spare these friends (and myself) from these awkward reunions, I now give advance warnings about my state. "Listen," I'll say over the phone before we meet. "It has been a while, so I need to tell you that I've gained a bit of weight."
The devil is in the details, right? A "bit" of weight means more than 80 pounds. I almost enjoy the fact that shame or no, my fatness has bestowed upon me a newfound ability to be as blunt as my new shape. Maybe, once the scale has slid up beyond a certain point, you lose your sense of propriety, throwing all caution to the wind. It can be fun, this almost Dionysian sense of abandonment. On my end of the line, I smile. "Beware," I say. "I look like a cheeseburger."
Before I became a cheeseburger, I was a woman composed of 105 pounds of muscular matter known as the biochemical phenomenon Lauren. Yet despite my balanced body-mass index, my mind has always had a wayward metabolism of its own, circling up into great excitements, then, just as precipitously, diving down into deep waters where everything is dank and dark.
Up or down, I've relied on an ever-changing parade of pills for more than 30 years: pills oblong, spherical, in plastic casings or scored so you can crack them in half like a cookie. Some people give thanks to God. My deepest thanks have always been reserved for the psychopharmacological factories that pop out these synthetic cocktails designed for the millions of folks who, like me, are in desperate need of an anchor. When everything works well, these drugs prevent us from sinking or spinning, allowing us to stand like a normal homo sapien.
I am a person who reacts robustly to antidepressant drugs. When one medication ceases to work, as it always does, I am able to switch to another and regain my stride. Before I took these drugs, I had spent weeks and sometimes months of my childhood and early adulthood in institutions. Afterward, I became a grown-up: a wife, mother, psychologist, writer — successful beyond my dreams. Given that the payout has been so much greater than anything I ever dared ask for, I have had little patience for people who complain about antidepressants' side effects. I mean, side effects?! My own most prominent, overpowering side effect has been regaining the ability to live my life, thank you very much. If I suffered from dry mouth or a low sex drive in the meantime, well, who the hell cared?
I had no empathy for the pill-popping complainers of the world, those who took these incredible lifesavers, felt measurably better, then whined about constipation or jittery sleep or — and this really bugged me — not being able to cry as easily. Good God! I'd think. You took this drug because you cried too much. So what if you sometimes feel a little numb? Let's toast to a little numbness after a lifetime of excessive emotion!
When people I knew went off their antidepressants because of the side effects, I'd shake my head, thinking, Obviously, you weren't really depressed to begin with. Indeed, I thought these folks were worse than depressed. Because if a drug restores you to your mind — the hallmark of humanity — and you reject that for better orgasms or more copious tears, clearly, you're so crazy that no drug in the world can set you straight.
I walked and talked this attitude for a good 23 years, having my robust responses and thus maintaining my sanity, stumbling now and then, even occasionally falling, but always finding my way back, thanks to a new drug combination, perhaps a bit bruised but extremely happy to be safe and sane at home.
Then, one day, despite taking an antidepressant known as Effexor, my dark mood returned and did not abate for days, then weeks, then months. I sank into a sea so deep that no one could locate me. I was utterly alone, unable to make out anything but the occasional distant flecks of phosphorescent fish swimming by in the murky ocean, their light too dim to see by.
Until my psychopharmacologist reached into his bag and came up with a new concoction. Take two, he said, and let me know how it goes. The new drug was called Zyprexa. I'd never heard of it. Zyprexa. It sounded like xylophone. I imagined someone playing a scale, the notes arcing down and then back up.
I took two. By that point, I'd been taking two new pills every six or seven years, whenever the old ones got too old and didn't do their job anymore. For me, Zyprexa was manna from heaven. I took the pills during a time of despair that seemed deeper than any I'd ever known, and soon, after months of no appetite, I woke up hungry. Toast tasted dark and delicious, the butter melting into a pool of yellow like the summer sun through the window. I plunged my finger into that yellow pool, then sucked on it, enjoying the flavor. The tangy acid of orange juice cut through the lipids and made my mouth taste fruity.
I didn't know that morning that Zyprexa could cause massive weight gain, swift and severe. In a widely reported 2009 study in "The Journal of the American Medical Association," children and teenagers who took the drug for 12 weeks gained an average of one and a half pounds per week. Had I known of this possible side effect before my doctor handed me the pills, would I have refused them? All I can say is that I should have refused them, but it's difficult to predict what one will do in times of desperation. Then again, if I had refused them, I might not be here today, alive and sane, sitting on the big berth of my bottom.
Of course, many antidepressants and other mood-mending drugs have the potential to cause some weight gain. I had put on a modest 5 pounds or so on my prior medications, but, due to the treadmill and salads, I'd kept the poundage from creeping up much beyond that. At my best, I was a petite 110, at worst, 117, which, at 5 foot 3, was still fairly svelte, with a few curves.
On Zyprexa, my weight skyrocketed, despite my efforts to diet. My bottom became like a separate being, with a will and waddle of its own. My 9-year-old called it Mama's Patootie, then just Patootie. My 4-year-old liked to dash at me from behind, diving into my patootie as if it were a snowbank. "Maaammma!" he'd say, though whether to me or to my patootie, I wasn't sure.
When it comes to weight gain, Zyprexa is in a class by itself. One theory holds that the drug impairs the satiation center in the brain, making it hard to feel full, however much food one consumes. Based on my experience, I agree with this hypothesis. Add to this the fact that most Zyprexa users have spent a great deal of time in a foul mood, a state in which food tends to taste like gritty prison gruel. If you combine a malfunctioning satiation center and the exhilaration that comes from realizing that the big banquet called life is once again yours for the taking, you take and take and take. At least that's what I did. At first, all this taking felt really good. Enchiladas tasted really good. Mole sauce was really, really good. The only problem is that people start to notice if you go up to the buffet six times, so, to avoid embarrassment, you pile your plate really high. Yet afterward, you're still hungry! How odd.
All those years, I'd confidently assumed that as long as I had my sanity, nothing else mattered. I had never deeply considered that, like it or not, my mind happened to be packaged in a body, a body I couldn't jettison. And yet, I had my set-in-stone credo: Whether tearless or now obese, my body (and my side effects) would always play second fiddle to my mental well-being. But what is sanity? How to define it? Is it scoring high on a standard exam of mental status? Holding down a well-paying day job? I'd say it is both of those things, along with the ability to enjoy life's pleasures, big and small, like appreciating the soft breeze on a warm spring day, having nice soaps in the guest bathroom, loving your children and husband, and being able to treat yourself to regular shopping trips to Target.
Except I didn't want to go to Target. The only garments I fit into there were from the plus-sized department, all gauzy and draped, their purpose to conceal rather than reveal. Indeed, I started to fear going out at all, on the off chance I'd meet someone I hadn't seen in a while. Mental health is largely defined by the ability to engage in social interactions. Yet increasingly, I felt isolated because of my mental health regime. At first, I pretended not to notice, but soon I couldn't ignore that as my body grew, my social circle shrank in nearly direct proportion.
I was also worried about my physical health. Zyprexa, I discovered, while incredibly effective when taken in combination with more standard antidepressants, may also put patients at risk of developing metabolic syndrome, a combination of conditions, including high blood pressure and cholesterol, that can increase the chances of developing heart disease, stroke and diabetes. At the time, staying true to my beliefs, I told myself that diabetes was nothing compared with the deep despair that is depression, which feels as if the mind is being held hostage in a cage of nails. Wasn't it better to be mentally well now and eventually need an extra-large coffin, albeit a bit earlier than anticipated, than suffer through a series of slow, sad days?
The answer seemed obvious, and yet, it wasn't. After all, I had two children and a husband to consider. My husband is a good man. He wanted to love me regardless of my weight. He did love me regardless of my weight. But though he would never admit this, I didn't feel as if he wanted me regardless of my weight. I sensed a tension in his touch. As with my social circle, my sex life got skinnier, filled with more awkward silences than kisses.
I didn't blame him, not one bit. After all, he didn't sign up to marry Patootie. He signed up to marry me — Lauren. But Lauren was hidden, the extra pounds like curtains on a window I couldn't see through, feel through, get through. I was trapped, the jiggle and roll of my extra flesh causing me not only shame but also discomfort. Summer heat felt searing. Stairs seemed to double, then triple, topping off in the clouds, impossible to scale. I gasped and sucked for air. I could not reach certain places on my body when they itched, my arms too short to span my own girth. My daughter, on the cusp of adolescence, stared at this new body called Mom with wide-eyed alarm. "You have to start jogging," she'd say, "or you'll have a heart attack and die!"
My daughter's fear is what finally enabled me to feel some fear of my own. If I was fearful, then how could I be happy? And so my cherished assumptions about the mind being separate from the body, about physical side effects being of little or no importance, began to crumble. I realized that I couldn't be happy if my body wasn't happy. Even more destabilizing to my theory, I learned that my happiness was not a private affair — it was inextricably tied to the people I loved. It was impossible to separate my daughter's panic, my friends' shock, from whatever misgivings were brewing in my own increasingly taxed heart. And so I was left, again, with a seemingly untenable decision: Would I rather be fat and happy or thin and miserable?
I'd always prided myself on being someone who valued intellect over appearance, but the truth is that it's difficult to be fat and happy. Besides the conundrum of being made both well and ill at the same time, there was also a reality issue: As a very fat — OK, an obese — person, I felt unreal. Sane yet unreal. My essential identity had nothing to do with being a fat person, because I'd never been a fat person, and so the inner me was at odds with the very meaty outer me. This helped me see a mere "side effect" for what it could be, in the extreme: a symptom that separates you from your normal self. This, ultimately, is why taking the drug became intolerable to me.
I wanted to stay on Zyprexa to maintain my happiness and sanity, of course, but I also wanted to prove a point, to hold on to my safe assumptions that my mind and body were easily divisible. I wanted to stay on Zyprexa so that I could claim my happiness as mine alone, unrelated to the feelings of my family and friends. But my daughter had fear in her eyes, my husband had hesitation in his eyes. I was trapped by love.
In the end, I went off Zyprexa as one leaps off a cliff while being chased by wild animals: Leap and you'll crash on the jagged rocks below. Stay put and you'll be eaten alive. I was afraid that I was giving up the last medication that would kick me into the land of the sane, and the living. But I was also less judgmental about the choices all of us must make about our life and our health, the trade-offs we discover we can and cannot live with.
Within a few months of going off the drug, I shed 40 of my excess pounds. I also struggled with my mood, although I tried hard to hang on to the belief that there were other concoctions that might help me, as there had been in the past. And I did eventually find them, though the search has never been easy. But it was necessary, because for me, fat and happy do not go together. In some ways, I wish this wasn't the case. I believe that it is possible to be both fat and happy — surely, some men and women are — and I feel somewhat shallow now that I know my physical size has such emotional heft, that it casts such a looming shadow on the very self it contains. Yet, like it or not, I think of myself as a petite person. I've discovered that who I am and how I feel cannot be considered apart from my body, especially if that body, my body, is clogged with fat and sugar. In this condition, it becomes difficult to ignore death loitering at your doorstep.
I have also come to see that my body is not really mine. Its atoms existed before me and will continue to exist long after I am gone. My body belongs not only to me but also to those I love. It is merely on loan to me, temporarily assembled, and if it becomes ill, the people who rely on it, who rely on me, suffer, too. In this sense, we are all bridges to one another, stretched out tip to toe, sometimes colliding but undoubtedly joined, each one of us a possible point of communion, in happiness, in sadness, in sickness and, hopefully, in health.
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