Feeling down? You're not alone. Depression affects about 7 percent of U.S. adults, according to The National Institute of Mental Health. And women are more likely to suffer from depression than our testosterone-ridden counterparts are. Our many, many hormones directly affect brain chemistry, often controlling our emotions and mood, according to the Institute. Biological, lifestyle, relationship, and psychosocial factors unique to women are thought to influence women's higher rates of depression.
If you're taking the Pill, you're also not alone. Four out of five women use oral contraceptives at some point in their lives, according to some estimates. They're quick, easy, safe and effective -- as long as you don't mix them with certain meds.
Depression vs. PMDD
Before you start popping antidepressants, make sure you're actually suffering from depression, not PMDD (premenstrual dysphonic disorder), a condition resulting from the hormonal changes that typically occur around ovulation and before menstruation begins, says Toni Stern, M.D., Chair of Obstetrics and Gynecology at Coney Island Hospital. About 30 percent of menstruating women have PMS. Up to 8 percent of women with PMS have symptoms that meet the diagnostic criteria for PMDD, according to Mayo Foundation for Medical Education and Research.
PMDD can easily be confused with depression, as both can be debilitating. Common symptoms of both include feelings of deep sadness or despair, suicidal thoughts, anxiety, increased sensitivity to rejection or criticism, panic attacks, severe mood swings, irritability or anger, apathy or disinterest in daily activities and relationships, difficulty concentrating, fatigue, food cravings or binge eating, and insomnia or excessive sleeping.
The difference between depression and PMDD is that symptoms of PMDD occur in the last week of the menstrual cycle and usually improve within a few days after menstruation begins. To help determine if you are suffering from PMDD, Dr. Stern suggests keeping a log to determine if your feelings of depression depend on the stage in your menstrual cycle.
If your doctor determines that you suffer from symptoms of PMDD, she may prescribe certain oral contraceptives or antidepressants. The Food and Drug Administration has approved the YAZ birth control pill to treat the emotional and physical symptoms of PMDD in women, while selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft have been shown to reduce symptoms such as fatigue, food cravings and sleep problems.
Antidepressants and the Pill: An Effective Combo?
If your doctor decides to prescribe an antidepressant medication, make sure that she is aware of any medications you are taking and any current health conditions you may have, to avoid possible drug interactions or side effects, Dr. Stern says.
Risk of unintended pregnancy associated with combining antidepressants and birth control pills is "more theoretical than realistic," says Kent Holtorf, M.D., Medical Director of Holtorf Medical Group, which studies women's health and endocrinology.
Antidepressants such as SSRIs can affect levels of estrogen and progesterone in women, Dr. Stern says. If the bioavailability, or amount of circulating hormone in the body, of these hormones change, the effectiveness of oral contraceptives can be compromised in some women, possibly leading to an unintended pregnancy.
"There's a large difference in the amount of hormones from woman to woman, so the decrease for one woman could mean a bigger drop in oral contraceptive effectiveness in some women than in others," says Lisa M. Keder, M.D., Director of General Division of Obstetrics and Gynecology at Ohio State University.
Some women experience irritability as a side effect of hormonal medication. "If you do find depression exacerbated with the use of oral contraceptives, make sure to tell your physician," Keder says. These symptoms can often be alleviated with a different pill formulation.
Natural Supplements Are Drugs, Too
The majority of birth control pills are combination pills, containing both estrogen and progesterone to prevent ovulation. St. John's wort, an herbal supplement used to treat symptoms of depression, changes the way your body breaks down the estrogen, decreasing the amount of circulating hormone in the body, Dr. Keder says. If you take St. John's wort as well as birth control pills, you should use a backup method of birth control, according to the National Institutes of Health.
Because natural (or herbal) supplements aren't regulated, companies don't have to list possible drug interactions on their labels as other medications do, says Dr. Keder. Plus, no studies are conducted on herbal supplements unless and until there's a problem with them.
What about anti-seizure medications?
Before you say "I don't have seizures," and stop reading, consider this: Many psychiatric conditions are treated with anti-seizure medications, which are known to decrease the effectiveness of birth control pills, Stern says. For example, Lamotragene, Tegretol and Topomax, common anticonvulsant medications, can all be used to stabilize bipolar disorder and treat symptoms of depression.
If you're taking any of these medications, you should use an alternate or backup method of birth control.
The Bottom Line
Antidepressants and birth control pills have a complicated relationship. The type of antidepressant used, oral contraceptive prescribed, body composition, and stage in the menstrual cycle all factor in, Dr. Stern says.
Before you start any medication, discuss with your healthcare provider all drugs you are currently taking to prevent potential interactions. Many women don't look at contraceptives as medications, Dr. Keder says, so they forget to tell all of their physicians when they are taking them. But if you want to avoid drug interactions and keep your baby blockers working, you best start talking!
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