When My Medication Made Me Unable to Eat

I’m a foodie. I love eating. I love cooking. I love going to new restaurants and meeting up with friends for any meal of the day, midnight snacks included. Despite this, I didn’t realize just how much food meant to me until it was taken away.

My relationship with food is complicated at best. In middle school and high school when my self-hatred was at an all-time high, I would often weaponize food against myself. I worked hard to repair my relationship with eating and accepting my own body but after college when I first went on an antipsychotic medication I gained about 30 pounds as a side effect, which brought a lot of those feelings right back up to the surface.

At one point my problem with food wasn’t even with the calories. There were periods where I was experiencing psychosis-related sensory issues and could not stand the sensation or the idea of food being in my body. I also have a gluten allergy that I did not find out about until a couple of years ago and so eating often made me sick no matter if I was over or under eating.  

Despite all of those problems, I still considered food one of my most favorite things about life. My mother was an excellent cook and made a point to teach me as much as she could before she passed. Hardly anything was ever from a box and she taught me the value in crafting a nourishing meal from scratch, and sometimes, seemingly out of thin air with our shoestring budget. My grandparents are passionate cooks, even in their old age. I have always valued the way food brings people together and I recognize it as one of the most bonding experiences you can share. And at the end of the day, treating myself with a snack was a surefire way to give my brain a little dopamine rush when everything else was going to shit.

Enter Naltrexone. Naltrexone is a medication often prescribed to recovering opiate addicts because it blocks the same brain receptors that those substances bind to, filling them up like parking spaces before opiates have a chance to, making you unable to experience a high. Naltrexone also disrupts the brain's rewards system and makes engaging in compulsive behaviors like drinking or skin picking much less appealing and offers relief for those with addictions or obsessive compulsions. We are finding that a byproduct of this is a reduced feeling of dissociative symptoms like depersonalization and derealization, the feeling that someone or their surroundings do not exist. In one study, "the majority of patients who felt positive effects reported a clearer perception of both their surroundings and their inner life. Assessment of reality and dealing with it improved as did the perception of their own body and affects as well as self-regulation."

When I was prescribed 25mg per day to ease the chronic dissociation / derealization that I experience 24/7, it obliterated my appetite entirely. What I didn't know was that another popular purpose is as a weight loss medication, prescribed around only 1-5mg to quell appetites.

If you have ever overeaten then you are probably familiar with the feeling of being so full that you feel like you can’t swallow another bite. No matter how long it had been since I had eaten, that is what I felt like every time I even smelled a meal. Food felt like sand in my mouth. I could hardly choke it down. I have a distinct memory of sitting in my office, crying with a mouthful of protein bar, wondering if I should run to the bathroom to spit it out instead of having to force it down.

I went from a mostly healthy eating routine to eating one small meal at dinner time. I was woozy all the time. I felt flat-out fatigued and my vision would go fuzzy when I stood up. It was hard to focus and motivate myself to get through the day. My stomach could be cramping and rumbling and begging for food but I could hardly get a few bites in before my body would tell me it wasn’t having it.

Needless to say, this was incredibly frustrating. I had finally found a medication that made a dent in the cloud of dissociation that I was so desperate to escape, but now I was feeling miserable. My go-to way to ease my dissociation before was to eat crunchy or cold food like potato chips or ice cream. The sensory experience would bring me back into my body. I essentially traded a coping mechanism that I was familiar with for a more direct solution. That technically helped the problem but losing a coping mechanism ultimately just causes distress until you manage to adjust.

The hunger made me irritable. I was crying out of frustration and getting snappy with people that got on my nerves. I decided that reaching out to friends would be a healthier way to cope than isolating myself but I came to the sickening realization that most of our interactions revolved around food. We used to meet for brunch or have each other over for wine and dinner. I was honestly just too embarrassed to partake. In high school, my boyfriend’s friends decided they liked me because I was able to eat an entire pizza by myself and I wasn’t too concerned with being prim and proper. It’s a weird thing to pride yourself on, but when you’re socialized as a female to punish yourself with food until your body conforms, being able to fulfill and indulge yourself that way is kind of like a badge of honor. Now I just pushed food around my plate and hoped no one noticed that I wasn’t actually eating any of it. I piled it into to-go boxes that I would throw away, untouched, a few days later. I felt awful for wasting food. The number of ways that this impacted me kept on surprising me and didn’t get any easier to deal with.

It was hard to avoid discussing it at times (how else do you tell someone you can’t eat the food they cooked especially for you?) but the response I almost always got was: wow, I wish I had that problem. Everyone wants to be skinny but I don’t think they realize the gravity of what they’re saying and what it takes to get there. I’d tell them about how I couldn’t stand the feeling of food in my mouth and how I’d give anything (but my newly granted sanity) to be able to enjoy a meal again. That usually shut them up but some people still didn’t get it.

Eventually, it got easier. My body adjusted and I started being able to tolerate more and more food. I was usually able to get a snack in before I took my meds in the morning and then a full-sized meal in the evening. At that point, I had lost all of the weight that I was hoping to lose but the pounds kept shedding until I didn’t like how skinny I was looking anymore. It’s strange how narrow the window of self-acceptance is. Still, I pushed through and developed a new eating routine while my body became more and more tolerant of food.

Because Naltrexone mimics opiates it can be a tricky substance to pair with. If I were to take opiates or other heavy substances I could easily overdose and die. Because of that, it has to be completely out of one’s system before going under anesthesia. That means I had to go off it for 2 weeks before I could get the minor surgery I needed at the time. I knew that I felt better on Naltrexone but I didn’t realize how much of a hell I had escaped by starting it. That all came flooding back when I tapered off of it, and on top of it all, I was STARVING. I enjoyed the hell out of being able to eat again but it wasn’t worth feeling like I was trapped in a bad dream every waking moment of my life.

When my surgery was done I skipped out on taking my prescribed pain killers so I could immediately resume my medication regimen. I was devastated to find out that I was starting from square one again when my inability to eat came back full-force. Three months of building a tolerance were completely gone. I had already grieved my loss of food so it wasn’t nearly as debilitating this time but it still wasn't easy by any means, especially when it makes you so tired you can hardly function.

It’s been a few years and I manage. I typically have a small breakfast or snack, an average dinner, and another meal sometime between 10 pm and 2 am when the meds start to wear off. I’m preparing to get another surgery in about a month and I’m dreading starting over yet again after years of building a healthier eating routine.

If you’ve read this far, I’d like to remind you that it’s usually not appropriate to comment on how much (or little) someone is eating. About 9% of the world (and US) population lives with an eating disorder. Less than 6% of people with eating disorders are medically considered underweight, so there is no way you can tell what someone is struggling with, no matter their size. There was a time in my life that I was underweight, before the Naltrexone, and I received glowing comments about it constantly. It’s a big part of what led me to believe I was doing the right thing by restricting my diet, and more dangerously, that I was in complete control. While I do not have an eating disorder, I did display strong patterns of “disordered eating” (thought patterns and behaviors of an eating disorder but not to an extreme). I can only imagine how much more those comments would have fueled those behaviors if my circumstances were different. Many more people seemed concerned about my health when I gained 30 pounds.

If you spend a significant amount of your time and energy worrying over food and your body image, I urge you to educate yourself on the types of eating disorders and how your behaviors might mirror them.

Stay safe, and try to treat yourself when you’re able. You deserve it.

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