Contraception Depression: Can the Pill Affect Your Mood?
Think About Contraception
What if I told you that a product is available that can interfere with your hormones to the extent that your daily and monthly rhythms are no longer operational? And because you will no longer have functional brain to ovary signaling, you will likely avoid conceiving if you have sex during what would otherwise have been your 6 fertile days a month. Of course this product’s hormonal effects also leave you with the sense that everything is stable and predictable which is something like turning the white noise up so loud that you don’t hear your own baby crying.
For this, you will risk migraines, weight gain, hypertension, gallstones, cancer, and yes, sudden death without warning. Would you believe that millions of women the world over, line up to take it every day? In fact, they even fight for their right to take it.
After 4 months of post-pill amenorrhea (no return of my natural cycle after stopping 12 years of birth control), I decided to see what the research showed about lesser-known side effects of the pill. I was astounded to find evidence supporting its inflammatory, nutrient-depleting, metabolic, and microbiota-impairing effects. I’ve found recent research linking the pill to cancer, autism, and even brain-based changes. But because so many critical questions have not been asked about what happens when we manipulate the hormonal pathways and feedback loops in the body, we rely on post-marketing research including girls and women dying in the name of contraceptives used for acne or so they can avoid having an inconvenient period.
Then I began paying attention to my patients’ stories. Over and over again, I would learn about their onset of anxiety, depression, and even mania after beginning synthetic hormones.
The Pill and Your Mood
Since the 1960s, there has been controversy around the potential mood-altering effects of oral contraceptives. Over 50 years of public use has not settled the question.
There is acknowledgement; however, that depression is the most common reason for discontinuation of use with pilot studies demonstrating that women using the combined oral contraceptive pill were significantly more depressed than a matched group who were not. The existing research is of fairly compromised quality – mostly reflecting the fact that this topic has not been a research focus over the past several decades. What does exist in the annals of science suggests that there is likely a subset of women for whom oral contraceptives represent a major risk factor for depression and/or related mood disturbance.
Who might these at-risk women be?
From 13 prospective trials, it appears that they have a personal or family psychiatric history (though doesn’t that include the entire population at this point?), one that has been exacerbated by pregnancy/postpartum, and premenstrual periods, and young age. More specifically, women with premenstrual mood symptoms prior to use experience more adverse effects with lower progestin dosages or triphasic OCs, unlike women without this history who experience more psychiatric side effects with higher progestin preparations.
The Pill & Antidepressants: Perfect Together?
Now we have the largest epidemiologic study of its kind, published in JAMA, out of Denmark, entitled Association of Hormonal Contraception with Depression. One million women ages 15-34 were followed for 13 years.
Here’s what they found:
- Women who were prescribed the combined pill were 23% more likely to be treated with antidepressants
- Progestin-only treated women (sometimes called the “mini pill”) were 34% more likely
- Teens were 80% more likely if prescribed the combined pill and two-fold more likely with the progestin only pill
Epidemiologic data is rife with potential confounders and certainly doesn’t demonstrate a clear causal signal, so this is merely food for thought. But what thought? What should we be thinking about as prescribers, as mothers, as women?
I believe in informed consent and free choice.
Because oral contraceptives are poorly studied drugs given to healthy women, prescribers are morally obligated to thoroughly explore the known risks. If you still want to take a pill daily knowing you could develop everything from weight gain to migraines to an unhealthy relationship with your moods all the way to your very life, then that is your choice.
What we are trading to control our cycle
I have come to the perspective that you can never truly own your primal femininity, never answer the question that what your symptoms are asking – from irregular periods to PMS – without deep contact with your hormonal self. Your symptoms are telling you that you need to change – your diet, your sleep schedule, your stress level, or maybe just that plastic you’ve been microwaving.
I’m not sure it’s truly possible to live the life you are here to live, while your vitality-supportive sex hormones are hijacked by Pharma.
It’s not hard, and the side effects are incredible – from clear skin to weight loss to a healthy sex drive. When you balance your hormones, you learn that a woman’s experience is cyclical. Energies shift to particular rhythms and you can watch yourself to know exactly when in your life you’re supposed to be doing what. It’s called getting in touch with yourself and it’s what true empowerment is all about.
If you’re taking birth control for contraception, own your right to keep Pharma out of your bedroom, to bring your full vital self to your sexuality, and work with your body, not against it. This is my favorite gadget for learning how to do that…and it’s 99.3% effective.
This is the new feminism. Spread the word!
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