Symptoms, Side Effects, & the Reality of Recovery

Dear Amy,

Your pregnancy week-by-week calendar was one of the highlights of my pregnancy and I’ve been following you ever since.

I was diagnosed with a panic disorder and low-level depression three years ago. After much tinkering with the Lexapro dose and LOTS of talk therapy, the panic and anxiety have subsided – words cannot express how grateful I am to this incredible medical team BUT the side effects of the medicine leave me tired, lethargic and a good 20 pounds heavier.

I spoke with my doctor and he insists that exercise and a healthy diet will fix this. Sounds great, but I have so much trouble getting motivated that his “just do it” advice seems impossible some days.

Do you have any thoughts on mitigating the side effects of medicines like this?

Gratefully yours,
My House Is A Mess

I personally leaned heavily into therapy when navigating the grey area between symptoms and side effects. While it’s very true that many antidepressants cause the exact side effects you’re describing…so does depression! So it can actually be helpful to shift your thinking from “my medication causes this” (because that puts you in a passive place where it’s easy to feel like there’s nothing you can do about it) to “this is still a symptom (or result) of my illness that I can take active steps to correct.”

And then you Cognitive Behavior Therapy (CBT) the hellllllllll out of those symptoms. Set doable, easily achievable goals for yourself — like you will exercise for 15 minutes once or twice a week vs. I WILL WORK OUT EVERY DAY FOR AN HOUR AND EAT SALADS AND LOSE ALL 20 POUNDS IMMEDIATELY. You will make your bed every morning vs. I WILL CHANGE THE SHEETS, SCRUBS THE TOILETS, CONQUER MT. LAUNDRY AND THAT’S JUST THE PLAN FOR MONDAY. Keep yourself accountable with to-do lists or accomplishment lists or daily self-assessments or whatever CBT tools you found worked best for you in talk therapy.

And if that talk therapy wasn’t technically CBT or CBT-adjacent, or you are currently not in therapy, I highly, HIGHLY recommend getting yourself back in front of someone who can help you tackle these specific issues. “I want to get my old energy levels back and take better care of myself physically.” These are good goals! Doable goals! And it’s okay to need help mapping out your action plan given everything you’ve been through.

I know a lot of people think of therapy and picture someone prone on a couch talking endlessly about their childhood and how their mother is the root of All Their Problems, but it’s also about helping you cope with the present vs. simply unpacking your past. (My current top therapy goal is to stop avoiding and procrastinating on phone calls. I’ve already unearthed where my phone anxiety comes from! Great! But that didn’t fix it and I still need to FIX IT.)

Alllllll that said, since I am not a therapist or psychologist, but as someone who’s battling the same side effects as you…

I’ll also include some practical tips that I’ve found helpful:

1. Think green, as in tea.
If caffeine is still an option (since a lot of panic/anxiety sufferers are advised to cut it out completely), I’ve found a cup or two of green tea after lunchtime helps mitigate the afternoon crash out, without the jittery or sleep-interrupting effects of coffee. (Plus, it’s supposedly good for your metabolism, so you can congratulate yourself on meeting one of your fitness/weight loss goals at the same time.) If you’re like me and find most green teas tastes like hot hay water, try Genmai tea (also called Genmaicha) which adds toasted brown rice and actually tastes like something, and is (to me) legit yummy and enjoyable.

2. A big water bottle full of ice-cold water.
Fill it up first thing in the morning and carry it with you all day, adding more ice cubes as needed. There’s something about REALLY REALLY cold water that wakes my brain up more than anything and keeps me naturally alert. Plus, healthy! If you hate plain water go for carbonated, but just keep it always super chilled and always within arms’ reach.

3. When the urge to nap strikes, go outside.
I’m not even saying “go for a run/walk” or anything that requires real commitment over inertia. That’s too much, too soon for many people. Literally, just open a door and go stand outside. Go get the mail, take out the trash, retrieve something from your car (even if it’s just an old to-go cup you’ve been meaning to throw away). Take a few deep breaths while you’re out there. Maybe stretch and touch your toes if no one’s watching.

4. Get your bloodwork done.
Check for vitamin deficiencies like D or B or Iron…these are super common for women in general AND for depression sufferers, and they can 100% make the symptoms you’re describing worse. Get your thyroid checked while you’re at it.

5. At the end of the day, record everything you DID get done in a small journal.
I’ve always been a big to-do lister, but my illnesses managed to turn those into my daily enemy, as I would optimistically overload my list in the morning and then get discouraged when I couldn’t get to all of it. (Especially if the reason was depression/anxiety related. That opened up a nice mental head space for the depression bully.) Now, I focus on an “I Did” list, where I record every email I sent or phone call I made, the work deadlines I completed and every single little thing I got done around the house. After a few days of this, I started seeking MORE little things to do for that list. A set of squats while brushing my teeth. Baking my kids a treat. An extra load of laundry or washing out the pot I left to “soak” in the sink two days before. An email or text message I’d been procrastinating on, etc. Knowing I’d get the pleasure of writing the task down at the end of the day was satisfying, and a weirdly powerful motivator over the lethargy and daytime blahs.

You’ll notice none of these things are “get on the treadmill for 30 minutes” or “go to the gym for a spin class” or “diet diet diet.” Not that there’s anything wrong with those things! I would genuinely like to do those things! But I’m not there yet. Right now I’m course-correcting my days to feel like successes rather than a string of failures and old bad habits. It’s okay for your successes to be small and short-term for awhile. Then you re-build your habits and routines from there. That’s the reality of recovery.

At the same time, don’t fall into the passive thinking trap that medication side effects are something you simply have to accept and sink into. Yes, they are real and they suck, but remember that you’ve already conquered something much, much worse that was ALSO every bit as real and physical: Panic and anxiety! Lady, you are a goddamn warrior princess.

Remember how hard it was to convince your brain that you weren’t literally about to die and every worst-case scenario wasn’t lurking around every corner, 24/7/365? But you did it! Now your brain is telling you that you’re too sleepy/lethargic to do X or Y or Z. It feels every bit as physically real as those panic attacks, right? You can beat this too. With a big stick. Right back into mental and physical health submission.

Photo source: Depositphotos/PetarPaunchev