Mix Paxil with Orlistat (Alli)? How can I get my doctor to prescribe Orlistat?

I suffer from anxiety and mild-depression. I'm male, 20, BMI in the morbidly obese range. I've tried Paxil but I RAPIDLY gained weight on that. I've tried Zoloft but it made me so lethargic that I couldn't even get up and take a shower, but it did help with hunger. My nurse practioner isn't the most knowledgeable about this stuff but she's all I can afford. Paxil helped tremendously but I couldn't stop gaining. Anyone know how hard it is to get Orlistat prescribed? It's the prescription version of Alli weight loss pill (which I have used before). If I could have my pick I really want to try Paxil and Orlistat together but I don't know if that's something she could prescribe. Any advice?

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Many doctors prefer not to prescribe Orlistat due to an unfavorable risk-benefit ratio. Orlistat works by inhibiting pancreatic enzymes thereby altering fat metabolism. While initial judgement of this drug is positive, one must also consider the side effects as well as the efficacy of the drug itself. Orlistat has been proven to only increase weight loss by 2-4% in a given year, which is hardly something to boast considering the side effects. By inhibiting pancreatic enzymes, a variety of gastrointestinal issues can arise. Besides simple stomach aches and headaches, Orlistat decreases the body's ability to absorb fat soluble vitamins (Vitamins A, D, E, K). Long term use of this drug can cause vitamin deficiencies which can present in many ways.