How do I know whether I'm depressed, or if it's birth control?

October 21, 2009 2:16 PM

I've started hormonal birth control (Ortho Tri Cyclen Lo) for the first time, and am currently on my third day. I've heard/read of the accompanying depression and mood swings. When can I expect side effects, so that I can assess myself and decide whether or not to continue with the pill? What sort of red flags should I look out for, in case I don't realize I'm being depressive, mood-swingy, or sans sex drive?

A year's supply of birth control was free, and I consider this much more economical than a $400 abortion. I'm trying to be careful and responsible, by using both condoms and birth control.

The women in my family are either bipolar or depressed (and I'm fairly sure that none of them are on the pill, or ever have been) So far, I'm the only one who hasn't shown any signs of it. I am determined not to become like them.

I intend to quit the pill the moment I find out it's turning me into a depressive. How can I keep an eye out for this, and know whether it's just me having a bad day, or if it's birth control-related? I don't have the option of asking someone else to monitor and assess my moods, because I don't see any one person on a daily basis.

Also: there are three different kinds of active pills in each pack. Could I test out one kind per day, and see how each different kind affects my moods? Seems risky - is it? Or do I have to wait out a month or three, or just wait and see if my moods start to turn?

posted by Xere to health & fitness (21 comments total)

I intend to quit the pill the moment I find out it's turning me into a depressive.
My doctors always told me to give it six weeks for your body to adjust before making any sort of decision. Trying to test different pill "activities" is a bad idea, there's a reason they are in the order they are in. Just chill out.
posted by june made him a gemini at 2:20 PM on October 21

Could I test out one kind per day, and see how each different kind affects my moods?

Well, you could, but... it's not really going to be an accurate gauge of anything, because it's not reflective of how you'd actually take your birth control pills. Also, just taking different doses every day to see how they affect you will likely screw up the ability for the pills to actually function as, well, birth control.

Just... wait it out. Some women get hammered by side effects early, some feel them only gradually, and some don't feel them at all. Some women's side effects taper off quickly, some taper off gradually, some never do. There's not a one-size-fits-all answer, unfortunately. Try not to be too nervous about the horror stories you may have heard, or about your medical history. Give yourself some time -- a month or two at the least -- and reassure yourself that whatever happens, you'll handle it.
posted by scody at 2:22 PM on October 21

Keep a journal of how you feel. Pay special attention to emotions - "Today I cried at a commercial" (this was me) and at the end of month 2, read over it and ask yourself, 'Does this sound like me?"

Birth control made me crazy, but I was much less crazy on Ortho Lo.
Also, remember that just because you get the nasties from one pill doesn't mean you'll get them from every pill. If this one sucks, I encourage you to try another.

DON'T test out one pill a day. No, no, no. Those pills are regular hormone, less than regular and sugar. It will seriously compromise the effectiveness of the BC.

It will take a few months for your body to chill out. Don't get to worried if you go through some strange things the first month.
posted by caveat at 2:25 PM on October 21

That's my pill, and I haven't had any side effects other than maybe softer skin. I like it a lot.

I intend to quit the pill the moment I find out it's turning me into a depressive.

it really might not. There's depression in my family too, but I've had 0 mood effects from this pill.

How can I keep an eye out for this, and know whether it's just me having a bad day, or if it's birth control-related?

How do you know whether you're depressed or not now? Your awareness about that isn't likely to change. Just do it the way you're doing now (as I'm sure you do, given the family history). Use a depression questionnaire if you have difficulty noticing your own moods. For me, if I'm getting depressed, there is a bit of a delay in noticing. But there's still quite a big difference between a single bad day and depression. A single bad day evaporates the next day or so, and you feel back to normal. In depression, there's a lengthier time over which you more consistently feel down.

Could I test out one kind per day, and see how each different kind affects my moods?

Absolutely not - they're controlled doses of hormones that affect the activities of your reproductive system in specific ways. They are not interchangeable.

It sounds like you haven't read the folded paper instructions that come in every packet of OTC-Lo (because they go into great detail on how you can't interchange the different colored pills). Before you do anything else on this issue, sit down and read through the entire packet. It explains how the pills work. It does go into detail on side effects, but don't let that freak you out - the vast majority of people never experience severe side effects.

And there are many benefits to a low-dose pill. The hormone treatment is more subtle, but it does afford you protections against some kinds of particularly deadly cancers for women. it regulates your cycle and, as I noted, may soften your skin (and inflate your boobs) just a little bit. I really prefer being on this pill to not being on it. Don't expect the worst - for most people who have been prescribed this medication, it works excellently.
posted by Miko at 2:26 PM on October 21

If you have three different pills in each pack, I would take them in sequence, the way you're supposed to, rather than playing around and testing to see which does what. That could mess your system up even more.

I took Ortho Tri Cyclen for a year back in the 90's, when it was a bit stronger; in my case, the "moodiness" was more like a perpetual case of PMS. No single incident stood out, it was more a matter of me noticing after a couple months that "you know, I seem to be a lot more sensitive about things these days." I had good days and bad days, just like normal, but it's more like the different moods were a little more....intense. I understand your concerns about depression, though -- but it took a few months for me to even notice that I was having some moodiness, and that's as bad as it got. I will grant you that that was just my individual experience, but the majority of cases of pill-related moodiness are more like PMS than like depression.

Good luck.
posted by EmpressCallipygos at 2:32 PM on October 21

It's very important to remember that most women are not made depressed by the pill, and a lot of the alleged side effects of the pill you hear about in common tales are not really always from the pill. People have physiological or emotional changes occur and since in many cases the pill is the only medication they take, they assume that is the cause and not just their own body or external factors.

For example, they found that a lot of women who reported weight gain from starting the pill were actually just gaining weight because they were of the age when young women commonly start gaining weight anyway (18-20 yrs). In many cases, they would start the pill, go to the doctor complaining of weight gain, but they would keep gaining weight after stopping the pill.
posted by ishotjr at 2:34 PM on October 21 [1 favorite has favorites]

Just chiming back in to mention: some women who react badly to one brand (or form) of hormonal birth control can do just fine on another brand (or form). I never did well on any of the Ortho versions I used (even the low dose), but was fine on Loestrin for several years. Other women never do well on any pill but are fine with the Nuvaring or the patch.

The convenience and effectiveness of hormonal birth control make it a great match for many women, but it's not unusual to take a bit of trial-and-error to get it right. So I would advise against this sort of all-or-nothing position straight out of the gate. Because even if Ortho Tri Cyclen Lo doesn't work for you, it may be that another brand will be just fine. Just follow the instructions you were given and give it some time.
posted by scody at 2:35 PM on October 21

Even after you wait for initial symptoms to settle (and you should, june's response above is spot on), you will have to continue staying aware of your mental state. I was on Ortho (tri-cyclen, not the lo version) for several years before I started to show mood swings.

Additionally even if you do find untenable mental side effects from this particular formulation (whether in a couple months or a couple years) there are umpteen versions of hormonal birth control out there, and a different one might work better for you. I switched to Nordette and my mental issues disappeared; now I'm on NuvaRing and again no problems.

I like the idea of keeping a journal or using a depression questionnaire regularly; you might also ask someone you're close with for help monitoring your moods if you're particularly concerned.
posted by nat at 2:38 PM on October 21

Depression runs in my family, and I'm on the same medicine. I have no problems with it. Just my experience.

I was concerned though - my doctor told me to wait about 3 months to try it out before quitting if I thought I was experiencing side effects.
posted by quodlibet at 2:42 PM on October 21

The mood swings I've experienced from various types of oral contraceptive have never been apparent until after the 3 month mark. It's very hard to spot something like this, as it has to become a chronic problem before you notice. Just keep an eye on your mood, look out for excessive weepiness, and wait it out until you notice a strong trend.
posted by sunshinesky at 2:47 PM on October 21

I intend to quit the pill the moment I find out it's turning me into a depressive.

Good idea, just remember that quitting in the middle of a pack can potentially really mess with your cycle for the next few weeks or months.

Could I test out one kind per day, and see how each different kind affects my moods?

No. This will render it useless. Also, the changes you will experience on the pill (if any!) are incredibly subtle, hard to notice, and often happen over the long-term, not immediately. It's not like a side effect you'd get from taking any other medication, where you might react right away and feel very ill or break out in a rash or whatever. One brand of pill gave me near constant dull headaches, but not until I'd been taking it over two years, and I attributed them to everything under the sun before realizing that my birth control might be the culprit.

Keeping a journal is a fantastic idea, and I wish I had known to do that.
posted by anderjen at 2:55 PM on October 21

Nthing that symptoms can take a long time to show up. My unbearable OTC Lo mood swings didn't show up for a year. After a lot of online research and a chat with my doctor, I started taking a B complex vitamin to help with my moods -- and it did the trick! I still can't believe how well they've stabilized my mood and kept me out of the teary-for-no-reason state I was in before. So if you start feeling down, don't give up on the pill until you try vitamins (B6 is specifically what my doctor recommended, but the complex is working great for me).
posted by phatkitten at 3:36 PM on October 21

I've been on and off of various brands of the pill for about 14 years. I have problems with depression, but it's never been tied to my BC use. Just piping up as a person who's never had anything but positive side effects from the pill.

That said, I know a couple of girls who've totally lost their minds on Ortho Tri Cyclen but that was 10 years ago, and I've been told a good dose of B vitamins can mitigate some of the potential mood effects of the pill.
posted by lunalaguna at 3:39 PM on October 21

When I started on the pill, I wasn't particularly depressed, just cranky. Like when you're PMS'ing and every little thing makes you annoyed. It went away after a few months.
posted by radioamy at 4:24 PM on October 21

As a counter point, the pill actually helps me with my moods. I had wild mood swings throughout the month before I started the pill. I've been on the pill most of my adult life, though there have been times for various reasons I haven't. Inevitably, those are the times I want to cry for no particular reason and I just generally feel weepy. On the pill and everything is level and normal and the little things don't send me into a sobbing fit.

My point being that it affects everyone differently.
posted by [insert clever name here] at 4:48 PM on October 21

Good advice given above already. But just make sure you don't over worry yourself into wondering about every little emotional reaction - whether it means depression has set in or if it's abnormal. That's a good way to make a self-fulfilling prophecy. Keeping a journal, looking for constant signs, might do a bit more harm than good.

Ortho Tricyclen Lo is triphasic, so each week's worth of pills contains a different amount of hormones. Take it in sequence.

My first experience with hormonal birth control wasn't good. I used the patch and it made me weepy and overemotional and a bit crazy, but I gave it several months before going back to the doctor and asking to change to something lower-dose.

I've been on two other types since (including Ortho Tricyclen Lo currently) and neither had any mood effects. In fact, I don't notice any bad side effects at all. But it will depend on your body chemistry.

Give it three months' time to let your body fully adjust to the medication. Unless it becomes truly unbearable before then.
posted by cmgonzalez at 5:41 PM on October 21

Just chiming in to agree with everyone else that it really takes some time before symptoms show up and you should absolutely only take the pills in order as described. Otherwise not only will it render the birth control protection useless, it will render the effects on your mood useless--the whole reasons that birth control causes mental issues in some women is the build up of hormones within their bodies. It's not like any one of these pills causes these issues, so you could just skip that color and be fine--it's the extended use over time of hormones.

Did you talk to your doctor about any of your concerns? It sounds like you don't have a very good understanding of a) how birth control pills work in terms of dosage and b) what kinds of side effects are not just possible but likely, how long they take to appear and what you can do to mitigate them. These are definitely discussions to have with the person prescribing hormonal birth control and handling your health care.

My anecdotal experience has included mostly physical side effects (constant bleeding and then amenorrhea on Depo, nausea and vomiting for two days when starting any new oral contraceptive, slight weight gain with Depo and one of the pills I've been on, severe decrease in libido and lubrication with another type of pill) with actually GOOD mental health benefits, in that since my cycle is regular, my mood swings become regular as well--easy to predict, easy to handle. WHY AM I SO CRANKY becomes Oh, right, it's That Tuesday and I can ignore the feelings because I know they're hormonal. I've also been diagnosed and medicated for depression, and no hormonal birth control has ever messed with that--it's a whole different can o' worms for me.
posted by peanut_mcgillicuty at 7:11 PM on October 21

Oh, and specifically regarding the loss of sex drive, it was a very gradual thing. I just wasn't into sex as I'd been before and we were having to use more lube than before, but nothing in the relationship or anything else had changed. One day after about six or eight months I went HEY! I BET IT'S MY PILL! I'd been on the same birth control for over a year. (And for what it's worth, it's not the worst thing that could happen. I'm still on that pill for other reasons, and it's not affecting my relationship. It's not like I never want sex ever--I just don't get superhorny like I used to. So I pay attention to it, and we keep lube on hand. No biggie.)
posted by peanut_mcgillicuty at 7:22 PM on October 21

Nthing what everyone else said about taking your pills according to the directions.

The mood swings I've experienced from various types of oral contraceptive have never been apparent until after the 3 month mark.

And seconding this. I just recently went off birth control after being on several different brands for seven years. There was one (yasmin) on which I had marked moodiness even after about six months on the pill--I remember, vividly, bursting into tears at a diner for no apparent reason. Though that went away when I switched brands, I've come to believe that over the past who-knows-how-long, I've had low-level depression due to oral contraceptives. I felt slightly numb, and, weirdly, no longer enjoyed listening to music, but I figured this was just a side effect of getting older. Well, turns out it wasn't--I went off the pill a month and a half ago and I've been surprised by how intangibly good I feel. Oh, and music affects me again, in a way that it hasn't since high school--before I was on hormones.

That being said, these mood changes were slight enough that I didn't notice (though, on yasmin, Mr. WanKenobi sure did! We were fighting a ton) and weren't the reason I stopped the pill. Instead, one of the more dangerous side effects of oral contraceptives is what spurred me to quit--at my last yearly, my blood pressure was through the roof. I tried switching brands, which got me into the "prehypertensive" range, but also made me an emotional mess and caused me to gain ten pounds in two months. Since I've stopped, my blood pressure is back to normal, and my weight is, slowly but surely, getting back to where it was.

To be honest, since I don't smoke, I'd never worried about things like high blood pressure and the pill, but it's something you should be aware of, along with the risk of blood clots. Be aware of the warning signs of blood clots, and if your blood pressure starts to climb, remember that the pill can be a contributor.

Oh, and I never had a libido decrease on the pill, but instead consistently had significant problems with vaginal dryness during sex. It's the first time I've ever been sexually active without being on hormones, and the difference is immense.

It's very important to remember that most women are not made depressed by the pill, and a lot of the alleged side effects of the pill you hear about in common tales are not really always from the pill. People have physiological or emotional changes occur and since in many cases the pill is the only medication they take, they assume that is the cause and not just their own body or external factors.

You know, I used to say that kind of thing, too. And I was very happy about the lack of babies for years. But as I've gotten older, I've met more and more women whose stories don't sound that different from mine--women who felt intangibly crappy on the pill, women who gained weight on the pill and whose weight dropped off immediately after stopping, women who had panic attacks or crying jags on the pill, and even one friend who had a blood clot in her arm while on the pill. Now, I'm not saying that this is true for everyone; there are, of course, some women who use birth control without a problem. But I think it's really, really important that women trust their bodies and trust their instincts regarding changes with their bodies. No one should be made to feel ignorant or ill-informed because something isn't working for them.

OP, if you're concerned about mood fluctuations, it might be a good idea to track your moods using mymonthlycycles.com. And if the Ortho Tri Lo doesn't work well for you, consider a low dose monophasic pill. And if that doesn't work, remember there are still other options, including non-hormonal IUDs.
posted by PhoBWanKenobi at 7:25 PM on October 21

In my experience, hormonal birth control makes me angrier and more prone to crying. Kinda like super-PMS.
posted by Jacqueline at 8:54 PM on October 21

I'm not sure if its been mentioned above but all pills are different. If you want to be on the pill and the one you're on is causing you problems (after using it for a few months) you can always try a different brand/dosage. I've asked gynos to recommend one based on the last one I took and was told that its basically a crapshoot determining how you'll react because everyone reacts differently.

I'll nth the fact that things creep on you slowly. I was on different bcp for 13 years straight and didn't even realize some of the side effects that I've had for years were caused by them. It usually took me 6 months - 2 years to realize that a certain pill was making me crazy/emotional/bloated/etc. because its not a sudden change so you don't correlate it to the pill.
posted by Bunglegirl at 4:14 PM on October 22