If you’ve never heard of the relationship between hormonal birth control and antidepressants, you’re not alone.
Read on to find out how they interact with each other and how you might be affected.
What contraceptive methods are we talking about?
Numerous hormonal methods of contraception may interact with some antidepressants. This includes:
- pill
- implant
- patch
- vaginal ring
On the other hand, using an intrauterine device (IUD) or contraceptive injection doesn’t seem to have any effect.
Can one reduce the effectiveness of the other?
The good news is that there are no recognized interactions between various forms of contraception and commonly prescribed antidepressants, according to Dr. Deborah Lee, a specialist in sexual and reproductive health at Dr. Fox Online Doctor and Pharmacy.
“These antidepressants include serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine and duloxetine, and serotonin reuptake inhibitors (SSRIs), such as fluoxetine, citalopram, escitalopram, and sertraline.”
This means that any of the above antidepressants should not affect the effectiveness of birth control.
According to Lee, “the hormones used in contraception are broken down and excreted from the body by liver enzymes on a daily basis.”
“Medications that increase the activity of liver enzymes, like St. John’s wort, lower the blood levels of contraceptive hormones by doing this.
“These low levels of estrogen and progesterone may be inadequate to stop ovulation, and this therefore increases the risk of an unplanned pregnancy.”
The only types of contraceptives that are not affected are IUDs and the injection.
If you take St. John’s wort, be aware that you will need to use a non-hormonal form of contraception, such as condoms, for up to 28 days after stopping the remedy.
However, there isn’t much research on whether birth control can affect the effectiveness of antidepressants. As Lee states, “the effect of taking reproductive hormones on SSRIs is complex and not well understood.”
According to the Centers for Disease Control and Prevention (CDC), there is no evidence to suggest that hormonal contraceptive use is associated with changes in the effectiveness of SSRIs. However, the CDC notes that current evidence is limited.
Can they exacerbate each other’s side effects?
For antidepressants that do not appear to interact with birth control – SSRIs and SNRIs – there should be no difference in side effects.
But TCAs and MAOIs used together with hormonal contraceptives can lead to antidepressant side effects.
Taking St. John’s wort and a birth control pill can also cause side effects, such as menstrual irregularities and bleeding between periods.
Again, more research is needed into why this may happen.
Are there positive effects: can one improve the other?
Oddly enough, there may also be positive effects. But there is conflicting evidence.
A 2007 study found that people with major depressive disorder who took combined hormonal contraceptives were significantly less depressed than those who took no hormonal treatment.
And, Lee says, “research studies on the Depo Provera injectable contraceptive, the patch, the vaginal ring, the implant, the IUD, and the IUS have shown no negative association between the use of these methods and low mood”.
But a 2019 review said it is likely that hormonal contraception may have adverse mood-related side effects in people with a history of depressive episodes.
This is yet another area that requires further study.
Why have I never heard of the relationship between the two?
There are two main reasons: There isn’t much research on it and it is rarely discussed in healthcare appointments.
Lee draws attention to a review that appeared in the American Journal of Obstetrics and Gynecology in 2015 regarding mental health and contraception.
The researchers “point out that, to date, mental health has not been given sufficient priority in the context of the field of contraception, and there are many gaps in the research,” according to her.
One of the largest studies on the link between birth control and depression appeared in 2016. It discovered a link between a diagnosis of depression and all forms of hormonal contraception.
So why aren’t there many more studies?
“There are particular problems associated with doing mental health studies,” Lee says. “Recruiting participants for research is typically challenging, partly because receiving a mental health diagnosis is still stigmatized.”
“Research on women’s health has long been understudied and underfunded,” the speaker continues.
This isn’t helped by the fact that depression “can be overlooked or even unrecognized in a busy sexual health clinic.”
How do you know if it will have a positive or negative effect?
Each person has different hormone levels and body reactions, so it’s hard to say for sure.
“There’s no way to predict how you’ll feel about either,” Lee says. “The only way to know is to try.”
However, there are some guidelines to follow.
According to Lee, “it’s always important to carefully check whether it’s safe to take regular medications at the same time as using hormonal contraception.”
Thus, it is best to roll out one new medication at a time. “On the other hand, it may be challenging to identify which medication is causing side effects if you take two or more at once.”
Common side effects of contraceptives include:
- heachache
- nausea
- tenderness in the chest
With antidepressants, side effects can vary. Some side effects include:
- heachache
- dizziness
- drowsiness
The majority of the oral contraceptive pill’s side effects, according to Lee, “are mild and disappear within a few months of starting.”
Side effects of antidepressants are also “likely to improve with time.”
What can you do to help regulate this situation?
The best thing to do is talk to a doctor or other healthcare provider before taking either birth control or antidepressants.
Be open with them about any medications you are taking, any history of mental health conditions, and how you are currently feeling.
They can then recommend a form of birth control or antidepressant that is best for you.
Once you begin either form of treatment, Lee recommends keeping a diary and noting how you feel each day, including any new symptoms.
“This means you have written proof as proof to show the doctor” in the event that side effects manifest.
They can adjust dosages, discuss changing methods, and see if nondrug therapies can help.
Are there any other mental or emotional side effects to consider?
Both birth control and antidepressants can have emotional side effects other than depression. Try keeping a diary about how you feel, and if you’re worried, see a doctor.
They may recommend changing your dosage or switching to a new medication or contraceptive that is less likely to cause emotional effects.
Users of hormonal contraceptives experienced higher rates of the following emotional effects, according to a 2004 review of multiple studies:
- depression
- anxiety
- neurosis
- constraint
- anger
The review authors noted that it was impossible to say whether these effects were directly caused by hormonal birth control due to a lack of research.
On the other hand, a 2016 review discovered that the majority of users of combined methods—like the combined pill or patch—experienced little to no improvement in their mood.
However, you will find mood changes listed as possible side effects by manufacturers of contraceptive pills and rings.
Some antidepressant users have complained of feeling emotionally numb and having suicidal thoughts.
A 2014 study of more than 1,800 people taking antidepressants found that more than half of young people between the ages of 18 and 25 had suicidal feelings.
And over half of participants said they didn’t feel like themselves, with 42% reporting a “reduction in positive feelings.”
Suicidal thoughts are most commonly linked to SSRI antidepressants, but can be a side effect of any form.
As suggested by the study above, the risk is greater with younger people. Additionally, side effects are more likely when you start taking antidepressants or change your dosage.
Would changing contraceptive methods or antidepressants make a difference?
Switching to a combination known to have zero interactions can help if, for example, you are prescribed TCAs, MAOIs or take St. John’s Wort.
“I would suggest switching the antidepressant if you’re really happy with your contraception, have used it a few times, and really don’t want to change it,” advises Lee. “However, it depends on each person’s situation and the specific side effects they are experiencing.”
If you are interested in seeing whether your side effects are due to the birth control or the antidepressant, you can try switching to the non-hormonal copper IUD and continuing with your regular antidepressant to see if your symptoms improve.
“Time is a tool,” Lee observes. “Always wait approximately three months after the switch before determining whether things are better or worse, as it typically takes four to six weeks for the drugs and hormones to completely clear from your system.”
She reminds you: If you want to prevent pregnancy, talk to a healthcare professional before stopping any contraception.
What if I want to stop hormonal birth control completely?
Some forms of birth control, such as the pill, can be stopped immediately, although it may be best to wait until the end of the pack or period to avoid irregular bleeding and predict your next period.
Others, such as the implant and IUD, require removal by a doctor or other healthcare provider.
In most cases, the hormones leave the body within a few days. This means you will need to immediately use a form of non-hormonal contraception or a barrier method, such as condoms, if you want to prevent pregnancy.
In the case of the injection, the contraceptive effects can last much longer – about 3 months.
Unfortunately, some people experience side effects as a result of stopping birth control. Menstrual changes are common and can present themselves in the form of irregular periods, spotting, and lighter or heavier bleeding.
Conditions experienced before starting birth control, such as acne breakouts, may also reappear. On the other hand, any negative side effects of the hormonal contraceptive should disappear.
If you find the changes are difficult to cope with or you have not had a regular menstrual cycle 3 months after stopping, contact a healthcare professional for advice.
The bottom line:
There is still a lot to learn about the relationship between birth control and antidepressants.
For now, you can safely take more modern types of antidepressants, such as SSRIs and SNRIs, with any form of contraception.
But regardless of which combination you choose, always seek advice from a healthcare professional before starting, replacing or stopping any medication.