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Symptoms, Side Effects, & the Reality of Recovery

By Amalah

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

Amalah
About the Author

Amy Corbett Storch

Amalah

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to [email protected].

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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jrg
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jrg

i dig this so much, thank you.

Caroline Bowman
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Caroline Bowman

I love this advice. Basically start small, like really small. When you’re accomplishing several little things most days and the good days start outweighing the not-so-wonderful ones, then for sure, step it up just a bit. Maybe then instead of ”I will walk my dog for 10 mins every day”, you can see if 15 mins might be doable on at least a couple of days. Stuff like that. Small things done incrementally (much like saving money!) add up surprisingly fast and snowball. No need for fancy, overwhelming ”special” diets or complicated gym timetables, no requirement to run a marathon… Read more »

IrishCream
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IrishCream

I’ve successfully added more activity into my daily routine by turning my lunchtime walk into a treat via trashy podcasts. I don’t have a substantial commute and I am not going to listen to my favorite snarky podcast about the Real Housewives on the house speakers while my kids are around, so if I want to listen, I’ve got to be walking! It’s helped me reframe it as “I get to go for a walk!” versus “I have to go for a walk.” It’s created another good positive feedback loop too, because it helps my mood (I also have a… Read more »

Rachel
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Rachel

Thanks for writing this. It inspired me to make some phone calls I needed to make. I can feel my sanity slowly returning! 🙂

alana
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alana

Really great advice, especially the small but steady goal-setting. It’s so easy to get overwhelmed with all the to-do lists, but breaking them down incrementally seems so much more manageable.

Also, for years I’ve been searching for how to describe green tea, and “hot hay water” is officially the correct way.