Today I got on the scale and was officially down 20lbs (from 213.8 at Thanksgiving to 193.4). Since I always wanted to see posts like these of people successfully losing weight while taking mirtazapine, I wanted to share how I did it for those who also experienced significant weight gain.
Disclaimer: This took me a lot of effort and I have a situation that makes it easy to follow through on these steps. I'm lower-middle/middle class with a solid job and sufficient disposable income, older kids who can take care of and entertain themselves, and am a decent home cook. I am in no way saying that what worked for me will work for you and I completely respect anyone who reads is and says "nah, that ain't for me."
Background
I've been on mirtazapine for nearly 6 years for depression and anxiety and it's been life changing for my mental health. I've taken a lot of other meds before, but nothing worked as well as this, so I was committed to sticking with it. My psychiatrist was supportive and responsive the whole way and was ready to switch me off if I ever decided to quit to try a different drug.
However, over that 6 years, I slowly but steadily gained what I estimate to be around 55lbs (160 to 214lbs?)! I have a super supportive partner and family so I was never shamed for my weight gain. I decided to lean heavily into fitness, doing 5ks, 10ks, and half marathons. I also quit drinking and ate super healthy, keeping fatty foods to a minimum and mostly cooking at home.
But it doesn't matter how healthy you eat, or how much you exercise, if you still eat too much.
The weight gain started to really bother me in the last two years and i hit a breaking point this past Thanksgiving when I tried on an XL shirt and it looked like it fit properly. AND, everyone around me starting to look super thin from GLP-1s. I was ready to change.
How I Did It
I had lost weight before at least two times using calorie counting, so I figured that I could do it again. The main trick was to figure out how to stay within a calorie budget despite the mirtazapine and running causing me to feel hungry all the time.
1. Calculating My TDEE
I got a solid digital scale to get my current weight and used https://www.calculator.net/calorie-calculator.html to calculate my total daily energy expenditure. Based on my age, weight, height, and activity level (which I'll touch on later), it estimated my maintenance calories to be a whopping 2,800+ per day. That's actually a lot of food, which means I was eating a lot more than that causing my weight gain.
At loss rate of 1lb per week, my starting calorie deficit budget was just over 2,300 calories per day. Which, again, if I play my cards right, is actually still a lot of food.
2. Calorie Tracking
I use MyFitnessPal as my calorie counter. I paid for premium. There's a big stink right now about the UI update, so if you don't like it, other apps will work just fine.
I got a nice digital food scale and upgraded measuring cups. I started by measuring literally everything I ate as precisely as possible. I'm a bit neurotic, so this was actually easy for me. YMMV.
I think a lot in half cup measurements. Half a cup of stuff, especially for side dishes, is a great starting place for me.
3. Diet
Since a big driver of weight gain with mirtazapine is hunger, my strategy was to focus on foods that I could eat the most of or would make me feel the most full, for the least amount of calories. I also focused on increasing my fiber and protein intake. If I was gonna snack, it was gonna be productive snacks: more fiber or more protein.
To help minimizing moralizing my eating, I think of food in terms of "cost". Fried foods and desserts are "expensive" foods while steamed vegetables are "cheap" foods. And my calories are how much money I can spend. I still permit myself to have ice cream or fries, but I gotta make their costs fit in my budget.
Some easy foods for me:
-All Bran cereal
-Fiber one bars
-Reduced fat cheese sticks
-Almond milk
-Protein power
-Bags of steamed mixed vegetables
Quick note on the bags of steamed mixed vegetables. I started off eating 1 whole bag at dinner along with whatever the main I cooked. I used Maggie All Purpose Seasoning to flavor them. Depending on the brand, that was often a whole pound of food for less than 300 calories. It really helped me feel full and curb hunger at dinner.
4. Exercise
This one took a lot to dial in, but I've got a good routine now. The reason why my TDEE is so high is because I exercise enough to be at the "active" level. Most people are at sedentary, which would have put my calorie deficit at 1,700 calories (eep!).
I walk for at least 1hour each day after work at high zone 1 / low zone 2, which for me is around 3mph or 20-minute miles. And I do 1 hour of strength training 3 days per week before work.
I have a fitness watch that I use to track all this.
Again, that is a lot of exercise and I totally respect folks who read that and say "nope".
Also note, running is your enemy. Sure I was able to do half marathons, but the hunger it caused led me to eat significantly more food. It doesn't matter how "healthy" the food is. If you're eating over your maintenance calories, you're gonna gain weight.
DO NOT EAT BACK YOUR CALORIES
The calorie counter apps and fitness trackers will lie to you, telling you that you've burned XXX calories during your work out. Not only is this an overestimation, but the calories burned during exercise was already factored in at step 1 when you calculate your TDEE.
If you set your TDEE at anything above sedentary, but then eat back your calories burned from exercise, you're gonna gain weight.
What's Next for Me
I'm gonna go for about 1 more month and try to lose about 4 more lbs to end up around 189-190 and then take a break. They say you shouldn't be in a calorie deficit for more than 16 weeks. So this is a good opportunity to practice maintenance calories. Because of my exercise and the mirtazapine, I don't quite trust myself to do intuitive eating. So there's a good chance I'll need to count calories forever.
Again, this is what worked for me, and as you can see, it's a ton of effort. But for folks who have been discouraged by how much weight you gained, I wanted to let you know that it is possible. There's a way for it to work, but you have to figure out if that way is workable for you.
Stay safe friends.