Birth Control & Poly Pharmacy- The Series: Part I Antidepressants and Anti Anxiety Pills
I’ll start by saying I am all for the use of Birth Control, it is empowering. I am also all for the use of adequate Informed consent about the use of the birth control and I love empowering women through education surrounding the use of the birth control. This week I will be sharing a series about the reality of the Pill and PolyPharm(; the use of multiple medications to address side effects of previously prescribed medications.)
Women on the birth control are SIGNIFICANTLY more likely to be prescribed multiple drugs after starting Hormonal Birth Control:
PART I:
Anti-Depressants and Anti Anxiety Medications
Used to manage
depression, suicidal thoughts, mood swings, pain attacks, anxiety.
The Facts
Use of hormonal contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of hormonal contraceptive use.
Women on the birth control pill were found to have 3 times the risk of becoming suicidal.
Women taking combination pills were 23% more likely to be prescribed anti-depressants.
Teens were 80% more likely to develop depression when prescribed the combined pill.
progestin-only pill increased teens risk of depression by 2 times.
The connection:
Our hormones, neurotransmitter’s, nutrients, immune system, inflammation and the gut microbiome all play a role in mood regulation. All of which the hormonal birth control affects.
For example, progesterone is our “chill and relax hormone.” In a cycling female who is showing mood swings prior to their period can be a sign that they are making too little progesterone. ProgestIN which is the synthetic hormone found in many hormonal birth controls actually has the opposite effect leading to us feeling depressed and anxious.
Hormonal birth Control also suppresses B6 and B12 which play many critical roles in our body, one being a role in the regulation of serotonin and GABA leading to Mood issues.
Women on hormonal birth control also have higher CRP levels, a marker of inflammation, that can effect our cellular functioning that can potentially affect mood.
A note on Birth control, Anti Depressants, and Libido:
Hormonal Birth Control can affect libido because they increase something called Sex Hormone Binding Globulin (SHBG). Which decreases hormones like testosterone which leads to lower libido. A 9 week trial of 3 forms of hormonal birth control found they all increased SHBG and a follow up study suggests that this increase in SHBG stayed elevated long after discontinuation of the pill.
The journal of clinical psychiatry estimates that 59% of people reported the onset of sexual dysfunction with the use of antidepressants. While the literature on Antidepressants suggest that only 30%-40% of patients see improvement with the use of antidepressants.
Thus, the percentage of antidepressant users who suffer from sexual dysfunction is higher than the percentage of people who gain relief from depression. Which can lead to yet more medications to treat sexual dysfunction.
Does this mean you need to come off the birth control if you are experiencing mood swings and or being offered additional medications to manage them?
Probably not, but maybe! Always your choice. Replenishing your nutrient depletions, supporting your gut health, inflammation, insulin signaling, etc can work wonders to help you find stability with your mood on or off the birth control. But unfortunately, for some we see minimal improvement. Keep in mind the symptoms you’re experiencing are real and don’t let anyone tell you differently. Women are much too strong to be broken by birth control, but it does give our physiology a run for its money!
Final thoughts:
A 2016 Interview with Jeffery Jensen, a professor of reproductive & developmental sciences and director of the Women's Health Research Unit at Oregon Health & Science University in Portland stated “Women are more skeptical of using hormonal therapy than ever before, It's a tragedy of the riches. If you really want to be depressed, have an unintended pregnancy."
Things like this personally make my blood BOIL. Men in these influential positions who have never experienced the effects of hormones are the ones making these decisions surrounding women’s health. Personally, I feel capable of deciding which is a greater risk for myself and my individual situation. You cannot assume unintended pregnancies are a greater risk than all of the side effects that women experience on the pill and after coming off the pill. The cost/benefit of using hormonal birth control in the presence of side effects is an individual decision for women to make and as health care providers we need to do a better job of helping provide our patients with the facts, validating their experiences. and providing adequate informed consent which has been withheld from us for too long.
some resources
https://www-ncbi-nlm-nih-gov.ccnm.idm.oclc.org/pubmed/27680324
https://www-ncbi-nlm-nih-gov.ccnm.idm.oclc.org/pubmed/31395237
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021918/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048656/
https://psychscenehub.com/psychinsights/the-impact-of-oral-contraceptive-pills-on-mood-depression/
https://drbrighten.com/articles/ (The Queen of all things birth control, PBCS, and more. Much of my information in my brain used to write about topics surrounding hormonal birth control comes from podcasts, books, and article Ive read and basically memorized by Dr. Jolene Brighten so check her out)