Not pregnant, just crazy

July 19, 2005 2:07 PM

Best birth control pill for depression?

So, I was starting to wonder why I went a little crazy after I started on the pill (Orto Tri-Cyclen). Things were going well in my life, but my tendencies towards depression and OCD got suddenly much worse. I only found out fairly recently, after 4 or 5 months on the pill that it can exacerbate depression. Mental illness seems to run in my family and since my mother committed suicide, I'm pretty concerned about keeping up good mental health.

I'm going to talk to my doctor about this on Thursday, and I know that the pill surely isn't the only relevant variable that I should be looking into, but I'm interested in other people's experiences with this sort of problem.

I'm 18, if that's relevant.

posted by ITheCosmos to health (24 comments total)

Oh god, I had the worst, worst, WORST mood swings on every version of the Ortho pills I ever took (late teens through early 20s) -- so much so that I swore off being on birth control pills forever. But then about 5 years ago (in my early 30s) I asked my doc out of curiosity, and she put me on Lo-Estrin (generic version is called Microgestin) -- it's one of the newer low-dose pills, and it was great: no mood swings, much lighter periods, etc. Good luck!
posted by scody at 2:16 PM on July 19, 2005 [1 favorite]

My advice would be to try out any of the low-dose formulas... they're generally lower on side effects in general, of which depression is one.
posted by salad spork at 2:20 PM on July 19, 2005

My girfriend was having the same problems so she switched to the Nuvaring, which is a low dose little plastic ring you insert and leave in 3 weeks a month. She's much happier with it, and it's basically impossible to forget.
posted by Edible Energy at 2:47 PM on July 19, 2005

My two cents: Depression runs in my family already, but I also had terrible mood swings while on the pill. And after I year I stopped taking them. Never will again.
posted by Specklet at 3:02 PM on July 19, 2005

If you are prone to depression, do not use Depo-Provera. (See related discussion, a few threads over.)
posted by Asparagirl at 3:10 PM on July 19, 2005

My girlfriend uses the birth-control patch and doesn't have any particularly irrational mood swings (no more that I do, anyway). Since the examples of the Nuvaring use as well as the patch don't seem to be victims of mood swings, I'd guess that mood swings might be the result of taking a big dose of hormones every day in a pill form, rather than having a slow, controlled release.
Ask your doctor to put you on the patch. See how it goes.
posted by Jon-o at 3:31 PM on July 19, 2005

Just echoing various other posters: I have genetic predisposition for depression. My six months on the birth control pill saw me hospitalized once with a godalmighty migraine, quite apart from the insane mood swings.

I used the Nuvaring all last year, and it was excellent. Completely reversible, too - I got pregnant again in February as planned.

Looking into the Mirena IUS as a post-baby option.
posted by rdc at 3:35 PM on July 19, 2005

Yasmin has been good to me - the depression hasn't gotten better, but it certainly did not get any worse. Ortho Try-Cyclen was very much the opposite.
posted by schnee at 3:44 PM on July 19, 2005

I had the same experience on triphasic BCP, along with a 60lb weight gain in 5 months that nobody, even my doctor, considered linking to the pill. I spent a number of years kinda crazy until I stopped taking the pill.
posted by Lyn Never at 3:56 PM on July 19, 2005

I have a history of being very picky when it comes to birth control. I have found this website to be immensely helpful because of these two tables (scroll down on the page):

"Progestin Potency of Different Oral Contraceptive Progestins"

"Current Pill Problems and Choice of Pill to Switch To"

I have come back to that little summary of the different types of progestins and their potencies many times. It's much easier to weave your way through the maze of options out there if you have some background information. However, I guess you should take the advice with a grain of salt, as the second table does list Ortho Tri-Cyclen as one of the pills that is generally better for depression. It does note that pill side effects vary from woman to woman. Perhaps a different type of progestin or an even lower dose of it would be helpful? At the very least, you will be able to see what other pills your doctor might suggest and the reasoning behind it.
posted by Nice Donkey at 4:16 PM on July 19, 2005

It will, of course, be different for everyone. When I switched from brand-name Ortho Tri-cyclen to the generic (Tri-sprintec, I believe), I was irrationally PISSED OFF for three months. And that was supposedly the same drug! My doctor said often the supposedly inactive ingredients that make the generic different can have effects that they don't understand and can't predict, and that's what happened, I guess. So it's possible that even a switch to the generic (which is also cheaper!) may make the difference for you.

That said, I have known or heard of more than a few people who had trouble with Depo Provera, including depression and also, strangely, really bad B.O. Another friend was trying Seasonale, I think, for endometriosis, and it made her supremely bitchy. She knew it, even at the time, but couldn't do anything about it. But I've not heard that about Seasonale from anyone else, and have actually considered it for myself. So.

Basically, it's try different things until you find a good one, which is awful since for some women it takes the full three months of adjustment to a new drug to see how you're going to deal.

(Lyn Never mentions the weight gain thing -- I know that the Pill is tied to weight for me and I think that is also a factor in my depression, so you might think about the link not being exactly causal, not pill -> depression, but possibly pill -> something else unpleasant -> depression?)
posted by librarina at 4:34 PM on July 19, 2005

I tried the patch and I was a wreck for a week straight. That's all I could handle. I had similar problems, but less intense on Orthocyclen.
posted by slimslowslider at 4:37 PM on July 19, 2005

Glad I'm not the only one made mental by BCPs. I've found that anything that affects my hormones affects my moods.

Are you using the pill for medical reasons or just for birth control? If you're just using it to prevent pregnancy, I'd suggest switching to some other method all together(condoms, diaphragm, etc.). May be less convenient than the Pill, but you'll feel a lot better.
posted by jrossi4r at 5:05 PM on July 19, 2005

I must be the only person in the world that has had the opposite problem. On the pill I am a much more stable girl. My old roomie on the other hand, went through 4 different types of birth control before she found one that didn't make her go nuts. She is pretty happy with the nuvo ring mentioned above.

All in all, only you and your gyno can figure out what is good for you.
posted by idiotfactory at 5:25 PM on July 19, 2005

I use Seasonale and I'm much, much better now than when I was on Alesse. Of course, I'd been on Alesse for nearly the entire time I was on the pill previous to Seasonale, and I think my body just developed an irrational hatred of it or something. I'm on a more even keel, the period suppression rocks, and I don't have crampy icky backpain of the same variety. So. I like the Seasonale.
posted by Medieval Maven at 5:29 PM on July 19, 2005

Not to hijack, but anyone else (besides me and, apparently Medieval Maven) take the same pill for a long time (years) before finding that it starts exacerbates depression and mood swings? This thread made me think I should ask the gyn about this nuvathing.
posted by desuetude at 6:04 PM on July 19, 2005

Ortho Cyclen made my depression really awful- even while taking antidepressants.

I tried NuvaRing too, thinking that switching to a lower hormone level wouldn't bother me, but unfortunately, it was just as bad as taking oral contraceptives.

There are a lot of reasons why women take oral contraceptives- not just birth control- but if you find it's more trouble than it's worth, maybe it's a good idea to look into other options. If you're taking the pill for cramps, for example, you might want to think about other remedies, like yoga, proper nutrition, and exercise.
posted by elisabeth r at 8:32 PM on July 19, 2005

The pill made me crazy. I swore it off forever and am much happier. This isn't the case for everyone, yet a lot of folks I know who tried different pills spent months of their lives going nutty only to reject it in the end, so I chose to just pull the plug without going through the trial and error. I don't regret it, but then again, my boy isn't one of those guys who has an issue with condoms.

Good luck, in any case.

On preview: Like elisabeth r says, cramps can be dealt with in many ways, and you may be happier considering those. Exercise and sex have worked well for me.
posted by dame at 8:45 PM on July 19, 2005

Nuvaring= constant yeast infections for me.
The patch kept falling off.
I started Ov-Con and love it. No mood issues, no anxiety.
posted by oflinkey at 8:53 PM on July 19, 2005

I took Mircette (low dose) for about six months before finally connecting it to the absurd mood swings I would have before my period each month. I would literally cry over nothing.

It got to the point where I stayed depressed throughout the month (of course, winter didn't help).

Obviously YMMV.
posted by mai at 10:29 PM on July 19, 2005

I tried Ortho TriCyclen and Yasmin. They were both awful, and I can't imagine ever going on another bcp. Both exacerbated my depression and completely eliminated my sex drive. Yasmin also made my hair fall out AFTER I stopped taking it. It took a year for it to get back to normal. My dermatologist told me that that is common with any sort of hormone change--it usually happens when women or pregnant or just after. Regardless, it was awful. While I was on it, my hair was gorgeous, though.

Like a few others here, using condoms is much easier and more enjoyable. Of course I was taking it for contraceptive purposes and I know it can be hard to find other options when you're taking it for other reasons (heavy periods, etc.)
posted by fabesfaves at 10:42 PM on July 19, 2005

desuetude, regarding you question about being on the pill for an number of years - I was on Ortho for 3 years, until I realized that it was making me crazy. (Mood swings, depression, inability to handle emotional stress, panic attacks) Since then I've had great luck with the low-dose pills, was on Loestrin for about 3 years, and am now on Levlite.
My very excellent gyn explained to me that after a couple of years your body can react differently to a brand of pills - something having to do with tolerances I think? She suggested that I change brands every 2-3 years or so, to keep any odd reactions (depression, acne, weight gain) from happening. It was the first I'd heard of it, but she was extremely helpful to me on other issues, so I toke her word for it.
posted by sarahmelah at 8:23 AM on July 20, 2005

I've been told that taking vitamin B6 keeps many women from getting depressed on the pill. I have been on Estro-Step for a month now and I take B6 daily and I havent had any major mood problems (which I am prone to).
posted by radioamy at 5:43 PM on July 20, 2005

Progesterone's normal action on the brain is depressive, and progestins are synthetic (less metabolizable) versions of this hormone. But it's necessary to take it with bcps in order to prevent the endometrial proliferation that can lead to cancer. A woman who responds to progestin use with depression will probably be more comfortable using a method that simply does not include systemic progestins or at least uses the lowest possible dose. Each progestin is different, too, so the reaction to one is not necessarily predictive for another.

Those who find that they have agressive effects from bcps are probably running a bit high on testosterone because their progesterone needs are being met by the bcps, leaving enough of their own progesterone available to be converted to testosterone. Sometimes switching progestins can help this; sometimes using a lower proportion of progestin and higher estrogen can help.

Those who appreciate the stability of mood from bcps are probably those whose own hormone outputs fluctuate considerably. Since bcps override ovarian output, a steady dose provides for steadier hormone levels more of the time. Our brains tend to like steady.

For those who find mood instability to be problematic, however, the case may be the reverse: their own levels are pretty good but the cycling of hormones, with its ups and downs, are not well-received by their brains. These women may find that the more stable protocols, with less cycling, are more comfortable for them.

Unfortunately, there are no rules for this stuff: all we can do is experiment, find out what happens, then try to reason from what we saw to why to what might present that same problem. Understanding the relative hormone actions and the role stability plays (particulary with respect to brain chemistry) are the tools for unraveling it all. Helpful book on brains and hormones: Women's Moods
posted by salt at 10:22 PM on July 20, 2005