Do antidepressants decrease the effectiveness of birth control? We spoke with experts to learn more about potential interactions.

By K. Aleisha Fetters
Updated February 20, 2020
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According to the Guttmacher Institute, four out of five women with sexual experience have used birth control pills. This method of contraception is about 99.7% effective with perfect use. What some women don’t know, however, is that certain drugs may influence the effectiveness of birth control. Does that include antidepressants? We talked with experts to find out. 

Why Women Take Antidepressants

Symptoms of depression affect one in 10 adult women in America, according to the Centers for Disease Control and Prevention (CDC). Common signs include feelings of deep sadness or despair, anxiety, mood swings, irritability, disinterest in daily activities and relationships, difficulty concentrating, fatigue, food cravings, and insomnia. 

Doctors may treat the mental health condition with talk therapy or antidepressant medication—usually in the form of selective serotonin reuptake inhibitors (SSRIs) such as Zoloft, Prozac, Lexapro, and Celexa. These drugs increase the levels of serotonin (the “feel good hormone”) in the brain to regulate mood. Other types of antidepressants include serotonin and norepinephrine reuptake inhibitors (SNRIs) and bupropion (Wellbutrin).

Do Antidepressants Affect Birth Control?

The majority of birth control pills rely on estrogen and progesterone to prevent ovulation. But antidepressants such as SSRIs can affect levels of these hormones in women, says Toni Stern, M.D., Chair of Obstetrics and Gynecology at Coney Island Hospital. If the bioavailability (circulating amount) of estrogen and progesterone changes, 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.

In other words, antidepressants and birth control combinations affect each woman differently.  The type of antidepressant used, oral contraceptive prescribed, body composition, and stage in the menstrual cycle all factor in, Dr. Stern says.

How Can I Guarantee Birth Control Effectiveness?

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. 

Rest assured that the 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. But it’s always better to be safe than sorry when it comes to your reproductive health.

And you’re taking both antidepressants and birth control pills, be mindful of how you’re feeling. Sometimes birth control can trigger feelings of depression in women. "If you do find depression exacerbated with the use of oral contraceptives, make sure to tell your physician," Dr. Keder says. These symptoms can often be alleviated with a different pill formulation.

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