Two weeks ago I went for my overdue annual physical. I only went because I needed a new referral for my chiropractor and my primary said they wouldn’t process it unless I got a physical. No big deal, I thought. I never imagined I’d end up sitting through a lengthy sales pitch for what amounts to diet pills. And I definitely didn’t think I’d actually leave with weight loss drug prescriptions in hand.

Obesity Prescribed with Weight Loss Drugs

I had never met with the physician before, but I cared more about convenient scheduling than who examined me. “How’s your diet and exercise,” the Dr. asked.

“I exercise more than it looks and I eat far healthier than it looks.” I then told her briefly about all the amazing work I have been doing with my psychotherapist to curb my emotional overeating and get my eating disorders in check. “Losing weight continues to be a struggle, though.”

“Okay, well,” she started… and then began a lengthy sales pitch for prescription appetite suppressants.

“So, diet pills?” I clarified.

“No,” she said, clearly annoyed, not appreciating the generalization. “Prescription weight loss drugs.”

She explained how different drugs work together and what the myriad of side-effects are. She stressed how rare the negative effects are and how beneficial the good ones are, FDA-approved, life-changing results, blah blah blah. I wondered if she’s on the pharmaceutical company’s payroll.

“So although one of the medications treats epilepsy, it’s side effect is loss of appetite. The other one does something similar but also increases energy. But since it’s a controlled substance it may not be covered by your healthcare provider.”

Words, red flags and confusion flooded my mind.

“And if you’re interested in these pills, which again, are truly life-changing, we would gradually increase your dosage over several weeks to morning and night—”

“Why would I take it at night?” I asked, interrupting her.

“So you’re not hungry in the morning.”

“Aren’t you supposed to be hungry in the morning? It’s called breakfast for a reason. Break. Fast. Are you suggesting I not eat breakfast?” Then an entirely new thought occurred to me. “You do want me to eat, right?”

She shifted in her chair, and sat a bit straighter, annoyed. Time was almost up, I could tell.

“Yes, of course,” she said. “But I don’t know you, or how or what you eat.”

I thought I detected a tinge of disgust in her voice. I realized I was just another obese person who she probably figured got artificial breakfast every day from whatever chain with a doughnut to go for a 10:00 am snack. As much as I wanted to shove off from the table and say, “No, thanks, I’m good,” I couldn’t help being curious. Could these pills give me the boost I needed to take my efforts to the next level like the Prozac had done?

“Fine,” I conceded. “I’ll give them a try.”

My First 7 Days on Prescription “Diet Pills”

By the time I picked up the pills, I was downright excited. Less than twelve hours earlier, the possibility of a shortcut to weight loss never even occurred to me. I am impervious to fad diets and whatever supplement Dr. Oz happens to be pushing that week. I know that it all boils down to diet and exercise. But here I was, looking forward to trying them out. As much as I was turned off by the words “controlled substance,” I had to admit I was intrigued. This could be good…

The following morning I took the pills for the first time. The effects were practically immediate. I went into taking them with a promise to myself to stay aware, but also an understanding not to judge them by the first days. I had spoken to Mike about them and we agreed to keep an eye on things. That very first day my energy levels were similar to those after several shots of espresso, but I was also intensely focused. My heart beat a little too quickly, which I didn’t like, but I will not sit here and deny that I didn’t love my energy and focus. I have never taken Adderall before, but I imagine this wasn’t too unlike that feeling. Productivity was my middle name!

That night Mike and I met my parents for dinner at a restaurant. Already, declining a second piece of bread was easy. Making a better menu decision was easy. I only ate half my meal. I was completely satisfied. My God, I thought, Is my fuel gauge finally fixed!? There were times in the past when I planned to take home left-overs only to eat the remainder by the time the waiter returned with a container. This time, I allowed my food to sit, a gold badge on a plate, having no power over me whatsoever. It was glorious.

After one day I was elated.

That night, I had insomnia. I was wide awake from 2:00 am – 5:00 am. I figured it was a small price to pay and dealt with it.

The next several days went similarly. It took far less food to satiate me. I had no cravings, so I made all my food choices based on what the best fuel was. Food no longer spoke to me, whispering my name every waking moment. I didn’t experience the hunger pains that previously burned holes in my belly. Food had ruled my existence for so long that I often said I could set an alarm to my stomach. Suddenly, I was working straight past noon, blissfully unaware of the time.

But I still wasn’t sleeping. I read or watched TV and just dealt with it. Things were still moving quickly, and my heart beat quicker. The best way to describe it is I felt like I was on a ride that was going a little too fast.

That Friday night, four days into taking the pills, I woke up at 2:00 am. Since it was the weekend I figured I’d do some work. I worked until 5:00 am and then slept until 8:00 am. Then I cleaned. I cleaned like it was the first day of spring and I was hosting royalty. I had the energy and I had the focus. By that evening I finally felt tired and I thought perhaps I had finally succeeded in exhausting myself.

That night I slept straight through the night for the first time since I started the pills. I had less energy and motivation the following day, though. I accomplished a few small things between naps, but I figured I deserved a day off, so I also watched a lot of television. I never changed out of my pajamas. It was like I had been a speeding freight train that ran straight into a brick wall. Nevertheless, after the first five days I increased one of the dosages as instructed.

I didn’t experience insomnia again. I lost that amazing focus and energy. Things slowed down – I felt sluggish and my mind was foggy. I hit the message boards I found earlier when I wanted to compare my experiences. It was reassuring to know so many women (and men) were on the exact same prescriptions for the exact same reason and dealing with the exact same side effects. The general consensus after one week was “what happened?” The increased energy and focus was apparently not long for this world. Bummer.

But I was grateful to be sleeping again. I still didn’t experience hunger and I also still had a working fuel gauge. But I did notice that in addition to the general sluggishness, I experienced shortness of breath and my thoughts seemed to be darkening, the way they do as they start their slow march toward depression. After 7 days I was already down 5.1 lbs. I took the good with the bad…

Things Take a Turn

Eight days after starting the pills I went out for a few drinks with a girlfriend. I want to clarify that I did recall reading that I shouldn’t drink while on these pills, but felt like every medication says that and I never had a problem before, so I ignored it. We had a great time talking and catching up, as always. I had 3.5 drinks over the course of four hours. On the train home it became clear that something was horribly wrong.

I’m going to spare you all the details about what happened later that night. It wasn’t pretty. I had trouble breathing, couldn’t cool down, faded in and out of some sort of weird blacked out state. I was scared, angry and irrational. To put it in the simplest terms, it felt like I had been drugged. It was entirely my fault and I learned my lesson the hard way.

But alas, the next morning I took my pills. It was a long, tough day. I had trouble focusing and was exhausted. I felt dizzy, fuzzy and generally hungover, but also emotional. This was more than a hangover.

I started thinking about my mood even before this incident. It had shifted as I grew increasingly irritable and less patient. It was evident the pills had affected my mood. I felt as if I were backsliding. I had gone off my Prozac mid-July because I finally felt so good I wanted to give life a go on my own. Here I was, a little over a month later feeling surrounded by darkness again, losing all motivation that only one week earlier radiated from me. This wasn’t natural. This was too extreme. I had worked too hard to have stability in my life and I was once again an emotional mess. It occurred to me that this might not work after all…

Desperate to Make it Work

I thought maybe I could stay on the pills if I went back on my Prozac to help me with my mood. The idea was a glimmer of hope. So I checked to see how they would all interact together and it was no good. This was a toxic cocktail that could lead to possible serotonin overdose, among other things. When reading how the diet pills interacted with other drugs, I noticed that the two I was on in the first place didn’t exactly play nicely together, either. I read about what was happening chemically in my body, while tears streamed down my face – so many emotions colliding, exacerbated by the drugs currently in my system.

I cried because I realized I couldn’t go long term without my Prozac and that made me sad. I cried because these diet pills were hurting me; I wasn’t loving my body – I was poisoning it. And I had actually allowed myself to hope, and I cried as that hope faded away. I daydreamed, literally, when the weight started coming off and I was no longer ruled by food. I daydreamed about getting rid of all my clothes and shopping for a capsule wardrobe. I cried at the realization this would not happen sooner than expected. I also cried for myself and everyone else who is so desperate to lose weight that they resort to these measures of hurting themselves in order to try to help themselves. These were some of the many things that collided in my mind as I cried.

The choice was obvious. I had to go off the pills and get back on my Prozac. There was only one way to lose weight and it had to be the hard way. Dedication, patience, and hard work.

Those last two days on the pills coupled with the incident with the alcohol had knocked me on my ass. On Friday morning I decided to go off the pills. I called out from work to rest and do what I could to expedite flushing them from my system. My hunger returned immediately and I was once again faced with craving the wrong things and an intense desire to comfort all I was feeling with food. Despite my physical and mental state, I found the willpower to make all the right choices. It took a few days, but I feel much better… physically, emotionally, mentally. I even managed to maintain the weight I lost so far, even over the course of the weekend, which is pretty impressive for me.

All in all, I was on prescription weight loss drugs exactly ten days.

What I Learned

My body is sensitive – it always has been. I have to take great care to keep my hormones and chemicals balanced and can’t be screwing around with anything that messes with it. These pills work well for some people, and hey, good for them. But I can’t afford to subject my mental and emotional well-being, as well as my mental clarity, to give me an edge to lose weight. I tried the pills against my better judgement. They worked, but there was a cost involved that I decided was too steep for me.

I now know what it’s like to not be ruled by food and I am extremely grateful for that experience. I know it’s possible, which means I can recreate it. It won’t be easy, but I tried easy, and easy didn’t work for me. As for the energy and motivation, I have a lot of that naturally. It’s what happens when I am inspired and happy. I have the tools to do this right. I just have to use them.

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When losing weight is your number one goal, there isn’t much room for other priorities. The only time in recent years when this wasn’t my number one priority was when I was in school, and guess what, I gained a lot of weight during that time. Other than that, it’s been my focus. That’s a whole lot of energy, time and work that has gone into one thing with far too few results, other than preventing me from gaining even more weight.

Imagine if I had devoted all that space and energy to something else, something I was good at.  Who knows what I could have achieved by now!

When I finally figured out I couldn’t lose weight because I was focusing on the wrong things (diet and exercise instead of cognitive thinking), I redoubled my commitment to losing weight with a new approach. My counselor recommended The Beck Diet Solution: Train Your Brain to THINK Like a Thin Person, by Dr. Judith Beck. Her father, Aaron Beck is regarded as the Father of Cognitive Therapy, so I figured she knew a thing or two on the subject.

The book claimed it would help me change the way I think about diet, eating and weight loss “FOREVER.” I’d learn how to abolish my cravings, resist temptations, deal with emotional triggers, end emotional eating, and conquer excuses to overeat, according to the book’s description. I believe that if something sounds too good to be true, it probably is, so I was skeptical. I’ve been trying to do these things for twenty years; no way was one book going to get the job done. But with an open mind and trust in my counselor, I loaded it onto my Kindle.

The book is broken into 42 lessons. My first task was to write an Automatic Response Card (ARC) listing all the reasons I want to be thin. The idea is that when you’re staring down chocolate cake or want nothing but to eat your weight in french fries after a hard day, you have something to whip out and read to remind yourself what’s more important and why the food isn’t really what you want.

I had never really thought before about why I want to be thin. We all want to be rich, right, but seldom think of the specific reasons why. We usually just have some broad sense of increased happiness and quality of life. That’s what I thought when it came to being thin. So I had been dedicating the bulk of my time and energy to a goal that I didn’t even know specifically why I wanted! How ridiculous is that!?

So I thought about why I want to be thin and twenty specific, damn good reasons tumbled out of my brain and onto a piece of paper as fast as my hand could write them.

#1 on my list; the very FIRST thing I thought:

Being thin will free up space in my life for other goals.

I didn’t think much of that being the first thing I thought until this month, when the space showed up.

Let me back up.

I dedicated the entire month of January to cooking and eating right, exercising daily, and practicing my newly learned cognitive thinking skills. I read The Beck Diet Solution and beyond these things and work, I had little time for anything else. I was excited and enthusiastic; happy to devote so much time and energy to my goal. But January turned into February and I began to lose steam. I got sick, too. On February 10, I wrote “The Part When We Quit” to process all that I was feeling, and ultimately acknowledged it was normal and to keep my eye on the prize.

But then everything got even harder… and darker.

Here’s the thing – there is no instant gratification in weight loss. It is a slow, grueling process. I am a spinning wheel, something my friend, Kathy affectionately called me recently, and detest being stagnant. My husband has accused me of having shark syndrome. “When you stop swimming, you die,” he’s said. For me to work so hard on something, and make such slow progress, is downright depressing.

By the second half of February I was in a dark place. There was something else at work, too. When you eat to process and/or mask your emotions and then you stop, you need to replace it with something. We as people love to tell people to stop doing things; stop drinking, stop smoking, but we don’t tell people what to do instead. We drink, smoke, and eat for a reason! Take those things away and we have no choice but to feel really uncomfortable emotions we’ve tried so hard to hide from.

That’s what happened to me. I didn’t replace my eating with a healthy alternative and I was left feeling rundown, raw, and really fucking sad. I desperately needed something else to work on, but was too depressed and tired from working so hard. I was also afraid that if I shifted my focus, I’d lose any progress I made.

“What you’re doing is really, really hard,” my counselor said sympathetically as I sat across from her quiet and crying.

We agreed I could use some help from my Prozac, so I decided to take it every day, at least for a little while, instead of only the two weeks before my period to ease my PMDD.

Within a week, I felt better. And then March was upon us and the urge to create this new website overcame me like a virus. I was sick with excitement and desire and motivation. And so for two solid weeks I spent every spare moment working on this site. I was overjoyed. My need to NOT be stagnant was being met. I was moving forward, making progress, and it was happening quickly.

Once I finished the site, I realized that after two solid months, weight loss was no longer my primary focus. I had shifted my priority to the website and the most incredible thing happened. I didn’t gain weight. The weight loss efforts went on auto pilot and ran in the background. I had created space for something else.

I was able to do this because I spent two months creating habits and for once, they took! I cooked, I meal planned, I exercised. But since those things were habit, they didn’t require so much thought and energy anymore! I almost gave up that second month, but I stuck with it. Now, I am beginning to reap the benefits, and it’s glorious.

Following is the continuation of a 2 part story. Please click this link to read Part 1.

The day after I was diagnosed with PMDD and prescribed Sarafem, an anti-depressant specifically geared toward treating the symptoms of PMDD and that can be taken for two week stints leading up to menstruation, I had an appointment with my wellness counselor. I explained to her that I didn’t want to take the pills and that maybe I should work harder on a more holistic approach. “I could give it a month. Really mark out the calendar so I know when to do what. Inversions, more vitamin B, more carbs and protein, more naps, more meditation, more avoidance of emotional triggers.” We agreed I should give it a shot. She also pointed out that sometimes having a diagnosis makes a big difference in and of itself because there is a better understanding of what’s happening.

A few days later, I confided this latest development and my plan with my friend Kathy, who immediately whipped out a piece of paper and started drawing a calendar.

“Here,” she said, enthusiastically circling a square on the impromptu calendar, “is when you need to start increasing your magnesium. Pumpkin seeds and Epsom salt baths. Here,” drawing an arrow, “is when you need to start putting legs up the wall. It is so good for your body. Make sure you have plenty of healthy junk food in the house. And here,” voraciously circling a square repeatedly, “is when you need to be extra gentle with yourself. Dr. Christiane Northrup says that in a perfect world, women would stay home and rest their first day of menstruation.”

I had my plan and shared it with the most important people in my life, the ones directly affected by my behavior, and had their support. I would insulate myself against PMDD with sleep, the right food, vitamin B, meditation, yoga, and magnesium. It would be great. I would defeat the beast with graceful shoulder stands, indulge in healthy junk food and meditate whenever destructive emotions arose within me. I would be poised against the storm.

Things were going okay. Until they weren’t anymore. After a particularly hellish morning, another one in which getting to work was a victory in and of itself, I was distracted and emotional. I could hardly wait to get home to start my medication, desperate for some relief from myself. The holistic approach clearly wasn’t enough. I was going crazy. But like my counselor had suggested, knowing what was wrong was a little comforting. Countless times I had wondered, what is happening to me!? Not this time. This time I knew. And even though I didn’t think there was any room in my toolbox for medication, I started to think that I had been wrong. Maybe needing a little extra help wasn’t the worst thing in the world. Maybe it didn’t mean I was a failure and a fake. Maybe I had been denying myself a very useful tool that had its place amongst the other tools. I am no stranger to depression and anxiety. I had exhibited great strength at times overcoming those emotions. One of my past yoga teachers once said that going into child’s pose, a resting pose, takes great strength because it requires you to admit that you need rest. I decided when I got home that evening and took my first antidepressant in over a decade that it wasn’t a sign of weakness, but one of strength. Here I was admitting I couldn’t do it alone and I needed help.

I was only on the pills for three days the first go around. I am a big fan of the placebo effect, and even though the pills were no placebo, they had an instant calming effect on me.

I recently finished my second go around taking the pills (this time for 2 weeks) and I noticed a difference. I spoke to my Mom briefly once my period had started. We agreed after my diagnosis that since our relationship is on the mend, it may be best if we didn’t speak leading up to my period. “You sound good!” she said. “I feel good. I slept a lot, which is unfortunate, but I don’t think forcing productivity would have been very successful. I prefer to sleep when my body needs it rather than be awake and emotional. The pills help me think clearer. Everything doesn’t seem so hopeless.”

I decided that I’m okay with needing a little help. I only feel better – emotionally and about myself – because with the help of this mild antidepressant, I have more control and can see a little more clearly and not be so reactive or destructive. I can still feel. Before going to see my doctor, I was downright scared of what was happening inside of me. I had a therapist who said, “That’s the thing about preventatives. You never know what you may have prevented.” She’s right. I consider my pills a preventative that have earned their place alongside my vitamin B.

Please keep in mind that in no way am I undermining the holistic approach that I had tried. I still continue to do these things every month and I do believe that they are beneficial. But right now at this point in my life, while I am cracking my nut open and wounded, it unfortunately just isn’t enough.

I am fortunate that I only feel this way a couple weeks at a time. For countless people, this is their daily life and there is no escape from their black pit of despair. If you have no idea what I am talking about, then I am happy for you, but I ask that you please have some compassion for those who have depression, mood and anxiety disorders, because the struggle is real.

I was torn as to whether or not to tell this story and admit all this to the world. I am worried what you all will think of me. But I went a long time without any help and seeking it out is now part of my journey to becoming a gentler, happier woman, and I am dedicated to sharing that journey. Also, I think it is important that we keep the dialogue open about mental and hormonal health and prescriptions and work on breaking down the stigma that medication is bad or for the weak-minded. Also, if you or someone you know, like your spouse or girlfriend, appears to be a different person before her period, maybe this story will encourage you to talk about PMDD.

I don’t plan to need these pills forever. I do believe that as I continue to crack the nut on my suffering and work toward a life more reflective of the one I want that I will be happier. Right now, I am rubbed raw, so the lemon juice hurts. Maybe in the not so distant future, new skin will have formed and things won’t be so painful.

But for now, this is where I’m at and I am meeting myself in the present.

This journey thus far has been an exercise in cracking the nut on my suffering; letting the light in to allow me to see better. I don’t always like what I find. But I’d much rather see, than continue to live my life with blurred vision, never really being able to make things out for exactly what they are. Through mindfulness and self-awareness I am finally seeing more clearly, and have detected some patterns in my emotions and behavior.

I have always been an emotional person, but at times those emotions are volatile. As a teenager my mood swings were chalked up to a chemical imbalance and I was diagnosed as bi-polar and prescribed medication that I rarely took because I thought it made me inauthentic. Over time, I just seemed to grow out of it, except for the one to two weeks leading up to my period, and then it was chalked up to PMS. I wonder now if my problem had always been hormonal…

Some months are better than others, depending on my life at the moment. PMS is an intensifier, like lemon on a wound. If life is going okay and stress is under control, it’s like a scratch, and a little lemon juice isn’t so bad. But if life is painful, an open wound, then PMS can make it downright unbearable. Nothing experienced during this time is disingenuous, just exacerbated. For women who are already emotional on a good day, this monthly roller coaster ride of hormones can be debilitating and destructive, disrupting work and damaging relationships.

Back in February, I experienced one of my lowest points so far this year. My mood changed directions like a weather vane in a tornado and a sense of sadness permeated my soul. On a regular day, I wake with energy and a mission before me, maintaining a fairly positive attitude as I work out, enjoy a healthy breakfast, prepare for work, fix my lunch and walk my dog, Cooper. I am focused and productive at work and my energy stays up through the evening as I continue to be productive. But some days, like back in February, getting out of bed requires monumental effort. I am exhausted, filled with dread and hopelessness. Nothing has meaning. I lay in bed as my tears soak my pillowcase and conjure possible call out excuses. Only maturity and the reality that work is a valuable distraction and that not going will only increase my anxiety gets me to slowly swing my legs out of bed. Working out doesn’t even cross my mind. By now, I will most likely be late for work anyway. I have no appetite so I skip breakfast and figure I’ll just buy lunch, something I don’t like to do, but I don’t care about money or routine. Cooper gets walked because he has to, but I don’t enjoy it, and I feel fatigued after 20 minutes. Driving to the train station, I daydream about car accidents and Cooper being left without his Mommy, and wonder if anyone would miss me…

This particular day back in February, no tool I had learned – meditation, yoga, nor positive thinking combatted the intense hopelessness and frustration that was interfering in my life. Everything was wrong. Desperate, I did something I hadn’t done in a very long time. I called my Mom and sobbed into the phone and explained every ugly emotion I was feeling. I needed sympathy, understanding, and advice. Out of my desperation came a phone call that would single handedly bring our relationship back from the brink of destruction, because she was everything I needed.

“I am so, so sorry you’re just like me,” she said. Together, we identified what might be going on. It was the same thing she had dealt with since she was in her early thirties: Premenstrual Dysphoric Disorder (PMDD), PMS’ larger, uglier, angrier sister. Since underlying depression and anxiety are common in both PMS and PMDD, it’s possible that the hormonal changes that trigger a menstrual period worsen the symptoms of mood disorders, hence why emotions are so intensified. It made sense. I exhibited every symptom.

My mom listened and consoled, and urged me to see a doctor. “You have to call tomorrow,” she said. “If you don’t, in a few days you’ll feel better and then you won’t think it’s a big deal anymore. You need to see him while you’re feeling this way. You can’t go through this every month.”

“Can I ask for a hysterectomy?” I cried, dead serious. “You can ask, but menopause is no picnic, either.” We talked until exhaustion set in.

With some reinforcement from a friend (because the next day I felt better and the matter lost its sense of urgency), I did call the doctor. The morning of my appointment I was a mess. I sat in the chair, holding back tears. When the doctor arrived and asked what brought me in, I choked on my words. “You have no control of your emotions.” I don’t know if it was a question or an accusation, so I just nodded and let the tears stream down my face. “We can fix this,” he said.

Within minutes I was given a diagnosis of PMDD and a prescription that burned in my purse. I was back on the elevator heading down to Walnut Street, my mind reeling.

My feelings have been medicated. There wasn’t even any discussion of alternatives. Sure, what I’m feeling is extreme, but these are my feelings, and I want to FEEL them. I don’t want to be numbed! Pills kill creativity and passion – they will change me. How can he prescribe me so quickly? This isn’t just a prescription, but a stigma. What will people think? I have endured for a long time through emotional turmoil and I have done it without medication. There is no room in my toolbox for medication. Healthy, happy people don’t take medication. This isn’t who I want to be…

Already as vulnerable as a seedling during a frost, I struggled greatly with this development and all my preconceptions against medication that would never even cross my mind had anyone but myself been prescribed. But despite the struggle, I still felt a desperation. A desperation that pulled me to the pharmacy to pick up my prescription. The bottle would sit in my purse for a few days, and then the medicine cabinet for weeks… unopened.

To be continued…

Please click here to read Part 2.