Atypical Antipsychotics & Weight Gain: My Experience
Trigger Warning: Discussion of Weight, Eating Disorders, Suicidal/Self-Harm Ideation, and Abuse
“Whose body even is this?” I remember the horror dripping through me as I looked at the angry purple stretch marks lining my protruding stomach. My mother had referred to my arms as “ham-hocks” and I could no longer get comfortable easily from the way my skin folded.
I had gained weight— lot of it, and very quickly
Second Generation Antipsychotics, or Atypical Antipsychotics, were welcomed readily when they first came on the medical scene in the late 20th Century due to being less likely to induce the Extrapyamidal, or Neurological, side effects of the First Generation. However, it was quickly revealed that these drugs came with their own troubles, major metabolic disruptions. Insulin Resistance/Type II Diabetes, major weight gain, and Metabolic Syndrome are common side effects of these medications, Clozapine and Olanzapine most intensely. While Schizophrenia itself is thought to have an endocrine aspect, and possibly have an endogenous aspect of Insulin Resistance, these drugs worsen the problem for many people. There might be a genetic aspect in who experiences the side effects and who does not. The drugs affect the liver and brain to create Insulin Resistance, and affect appetite as well as fat metabolism. (Grajales et al, 2019).
I was on an Antipsychotic specifically with lower risk of metabolic side effects—still an Atypical, but one of the less metabolically active ones. Unfortunately, I had some sort of drug interaction after taking Depo-Provera, and began experiencing metabolic side effects as a result of the interaction. I gained over 100 pounds in 6 months without changing my veggies-mostly plant-based diet and actually increasing my exercise habits to near-daily exercise from being fairly sedentary. It was horrific for me, as I was recovering from an acute Eating Disorder as well as 10 years of general disordered eating as part of my Dissociative Identity Disorder (DID). My mother was highly critical, commenting on everything I ate and telling me to eat less when I was in fact recovering from restrictive behaviors. She would mock my weight and comment about how much prettier I had been at lower weights (including active Anorexia), how manly and inhuman I looked at my heaviest. She didn’t care that is was triggering me or that I was recovering from Bulimia—she saw the Eating Disorder as a moral failing, as well as the weight gain. She just wanted me to be pretty; my weight was embarrassing to her.
My Eating Disorder recovery is a bit unique, because it wasn’t a true Eating Disorder, it was caused by an Alter in my Dissociative Identity Disorder. All of my suicidal and self-harming ideation was stored in this one fragment of my self, cast away so I wouldn't have to face it. When I Integrated and accepted these feelings, they disappeared. Integrating the self-harm Alter was powerful and healing, what felt like a radical-act of self-acceptance. I tried to carry the self-love and acceptance from my Integration forward and love and accept the other, less hidden parts of myself, including my body.
Part of that body acceptance has included Schizophrenia acceptance. Understanding Schizophrenia as a brain condition, and the brain as a part of the body, is very important to me. I am grateful for and to my body, and my brain is a part of my body. My body has fought for me my entire life, and she’s had to work hard. My body is different, but it’s mine and I choose to cherish it.
Did I try to loose the weight? While I have been able to tone my legs some and reduce my waist and upper arm circumference, my weight has not dropped by much. I was very excited when I dropped dress sizes only to find my weight unchanged. I developed Insulin Resistance and was diagnosed as Pre-Diabetic in 2020, it was caught early in a stroke of grace after a skin infection triggered a doctor to run some blood tests. Some good came from this, as I was finally able to get to Dietician and get treated for my Gastroparesis. I was put on the medication Metformin, and between the dietary improvements and medication my blood sugar has stabilized. I am focusing on healthy diet and regular exercise; my Primary Care Physician has mentioned I may be a candidate for gastric bypass surgery, which can aid the endocrine system, but I am not looking for anything that drastic right now.
Citation
Grajales, D., Ferreira, V., & Valverde, Á. M. (2019). Second-Generation Antipsychotics and Dysregulation of Glucose Metabolism: Beyond Weight Gain. Cells, 8(11), 1336. https://doi.org/10.3390/cells8111336
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