Women of reproductive age (15-44 years) using birth control pills for contraception while also taking antidepressants might be concerned about taking these medicines together. Some may have questions about the effectiveness or safety of birth control pills taken with antidepressants, or vice versa. Others might also question of the effect of the pill on depression. The good news is that these medications can generally be taken together without problems.
Interactions
Medicines are broken down by liver enzymes before excretion. There is data available on the interaction between the metabolism of birth control pills and medicines such as antibiotics and anticonvulsants, but little on their interactions with antidepressants.
Antidepressants and birth control steroids (estrogens and progestins) compete for the same liver enzyme systems for metabolism. When taken together they can affect each other's metabolism by suppressing or inhibiting these enzymes. However, in practice, neither appear to significantly affect the other's safety or effectiveness.
Effect of Antidepressants on Birth Control Pills Activity
There is no evidence that antidepressants decrease the contraceptive effectiveness of the birth control pill because they do not lead to lower levels of hormones.
Some antidepressants could lead to increased blood levels of estrogen. They do this by inhibiting or suppressing the liver metabolism of the pill. There might be an increased chance of breakthrough bleeding and other hormonal side effects such as nausea and headaches due to the increased hormones. The metabolism of progestins does not appear to be affected.
Effect of Birth Control Pills on Antidepressants Activity
Birth control pills can potentially increase your blood level of antidepressants. They modify the activity of some antidepressants by inhibiting the enzymes involved in the metabolism of the antidepressant. Ask your doctor if he needs to check your blood level of your antidepressant if you are on the pill.
Side Effects of Antidepressants and Birth Control Pills
Side effects that are common to both birth control pills and antidepressants may increase. These include:
- Nausea
- Headaches
- Bloating
- Weight gain
- Changes in appetite
- Sexual dysfunction
If you are starting both medicines together it might be difficult to pinpoint the culprit. To sort this out better it might help to explore some options:
- Don't start each new medicine at the same time. Wait until you adjust to one new drug and then start on the other.
- Don't take both medicines at the same time each day.
This all depends on your individual needs, so it is important to follow the advice of your own doctor about the timing and spacing of your medicines.
Contraception and Birth Control Pills
It is important if you have ongoing depression - and at the same time want to avoid pregnancy - that you have an effective form of birth control. This will reduce your anxiety about an unplanned pregnancy acting as a factor in managing your depression.
The birth control pill is the number one (28%) method of contraception used by women in the United States and is an effective method of birth control (9% failure rate). Birth control pills are available in two forms in the U.S.:
- Combined estrogen plus progestin hormone pills
- Progestin-only pills
Both forms have the same level of contraceptive effectiveness and there are many brands of each available, including generic brands.
Some women may experience depression on the progestin-only pill. On the other hand the pill is sometimes used to treat the depression that can occur with premenstrual syndrome (PMS).
If you are concerned about taking antidepressants while on the pill, or your combined side effects are bothersome, there are several other birth control options available to you, some of which are even more effective and convenient than the pill.
Depression and Antidepressants
Treatment of depression, a mood disorder more common in women, may include psychotherapy, or antidepressants, or both. Antidepressants alone can effectively improve the mood disorder in many affected people depending on the degree and cause of the depression.
There are several classes of antidepressants and each affect a specific brain neurotransmitter (dopamine, serotonin, or norepinephrine) that are thought to be involved in regulating mood and a feeling of well-being. They include:
- Selective serotonin reuptake inhibitors (SSRIs): These are usually the first line in modern treatment of depression.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs): These work similarly to SSRIs.
- Tricyclic and tetracyclic antidepressants: An older class of antidepressants which usually are no longer prescribed as first line treatment but may be added in small doses to improve the effectiveness of others
- Monoamine oxidase inhibitors (MAOIs): An older class used as a last resort because of side effects and interactions with other antidepressants and with aged foods.
- Other antidepressants called atypical antidepressants because they don't fit into the main classes
Finding an antidepressant that works for you with few side effects can sometimes take weeks as your doctor adjusts the drug or dose.
St John's Wort
St John's Wort is a nonprescription, herbal supplement used by some for depression but it is not regulated by the U.S. Food and Drug Administration (FDA). Batches may be contaminated with unknown substances.
St John's Wort induces enzymes in the liver which metabolizes the birth control pill and can therefore lower the levels of the hormones and increase the risk of pregnancy. St John's Wort is also dangerous when mixed with other antidepressants. Be certain to tell your doctor if you are taking it or any other nonprescription supplement.
Consult Your Doctor
Birth control pills and antidepressants are safe and effective and do not have significant adverse effects when used together. However, despite what is known about them, unknown or rare side effects may occur in you while taking them.
If you are concerned about any symptoms or changes in your body or have questions when you start a new medicine, or when you are taking a combination of medicines, don't hesitate to speak with your doctor.
