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Depression vs. IUD
December 15, 2013 1:41 PM   Subscribe

I've been dealing with depression for years. I can't tell if it's worse because of my birth control. Help?

Some backstory:

I've been dealing with some level of depression since I was 12 or 13 (I'm 25 now.) About two years ago, I went on oral bc and noticed the symptoms were much worse (particularly the week before my period - it was pretty awful.) Around that time, I began seeing a psychiatrist for the very first time, and he prescribed me lamictal, thinking I was bipolar II - but I was still on the oral BC.

A few months ago, I got off the BC and got a Mirena IUD inserted. I was told that, since the hormones are localized, I wouldn't experience the crazy imbalance and resulting symptoms that haunted me while on the pill. I preferred it because I liked the idea of having lighter periods and less cramping. But here I am, after a week of dizzying crying spells, angry tantrums, and feelings of sluggishness and exhaustion. I'm also off the lamictal because I'm not sure it ever worked for me.

Sigh. I guess I'm just not sure what to do. The week to week-and-a-half before my period, like clockwork, I'm a mess. Every month. Even now, on the IUD! I work a very high-energy creative job and I'm barely keeping it together right now. I can't go on like this, but I'm not quite sure of the best way to go about figuring this out. I honestly can't tell if I'm depressed because of the birth control, or if it's just me.

Should I stay on the Mirena until my symptoms even out, since it's only been a few months? Should I go to the doctor and try to get a prescription for an anti-depressant instead of the mood stabilizer I was on, until I can get my birth control switched out? Should I get on the paraguard first, and then try an antidepressant? There's too many factors involved for me to know what steps I should take in which order. I'm sure some of you lady mefites have dealt with a situation like this before - did you get off the birth control, change your medication, or do a combination of both until you figured out what the real culprit was?
posted by themaskedwonder to Health & Fitness (11 answers total) 3 users marked this as a favorite
 
You need to see a doctor (or rather, probably two: a psychiatrist and a gynecologist). You will probably get a lot of anecdotal evidence here on AskMefi, but it can't be a stand-in for a medical opinion for a licensed doctor who is familiar with your case. I hate taking a lot of medicine, so my inclination would be to go off the Mirena, but again, your psychiatrist and your GYN need to find a solution that works for you.
posted by schroedingersgirl at 1:50 PM on December 15, 2013 [1 favorite]


Did you come off your medication by yourself? It's generally not a great idea to take yourself suddenly off something prescribed, even if you feel it's not working. It sounds like your body has had a lot to deal with over the last few months - withdrawal from meds plus a new lot of hormones being introduced into your system. It might be worth staying off the hormonal bc while you try and work out if your symptoms are due to that. If they settle down while you're off the hormones but on the medication, you could then talk to your health care provider about coming off the medication too. If your symptoms flare up again, you'll know that's the cause.

Are you able to use non-hormonal bc in the meantime, condoms or a non-hormonal IUD? fwiw I made the decision about five years ago to stop using hormones for my own reasons. I had the copper coil inserted. I've never had any trouble with cramping or bleeding, it didn't affect my periods at all, it's really effective and I know that my moods etc are my own and not due to my bc. I think you should definitely go back to both your family planning doctor and your psychiatrist and discuss all your concerns. Good luck.
posted by billiebee at 1:57 PM on December 15, 2013 [1 favorite]


I experienced mood swings and depression in the first couple of months of getting the Mirena but it coincided with some major stress in my life, so I wasn't sure if it was the IUD. I spoke to my gyn about it and she said the Mirena can exacerbate the symptoms but doesn't usually bring them on outright.

I do have two friends who had a similar depressive spell on getting the Mirena and got it removed within a few months to good effect.

I personally am sticking with it because I like the lack of periods (I was anaemic before), and a recent vacation has done my stress levels a world of good.
posted by Dragonness at 2:01 PM on December 15, 2013


ANECDATA: I experienced intense, unprecedented mood swings when I got the Mirena inserted. My doctor said it was impossible that the Mirena was affecting my mood, because the hormones were so localized. So I kept it for a year. I cried about once a week that year (as opposed to my more average perhaps-twice-a-year crying). Then I came across a huge internet forum full of people with similar reactions to the Mirena, I got it removed, and the mood swings and the weeping stopped right away.

Your story is less clear, because if I understand you right these symptoms have been going on a long time, preceding the Mirena's insertion, so it's hard to know if the culprit is birth control hormones, a mal-treated psych condition that doesn't respond to Lamictal, or what. I would talk to a psychiatrist and ask them what order they'd do things in.
posted by feets at 2:20 PM on December 15, 2013 [1 favorite]


If bipolar is the right dx for you, then some antidepressants could badly worsen your symptoms, rather than improve them. I would strongly recommend that you only tweak your psych meds under the care of a psychiatrist who specializes in bipolar. It is, unfortunately, common to have to try a few combinations of meds before finding what works for a given person with bipolar disorder.

It's hard to say what's going on with you. If you could tolerate nonhormonal bc for a while, I'd say get the Mirena out, use something else while you get the psychiatric dx and treatment figured out, and then maybe experiment with hormonal bc when you can do so from a stable place.

I say this as someone who loves my Mirena, but also someone who's watched a loved one try to sort out the bipolar medication merry go round. It's a delicate and time consuming thing to figure out, why add more variables if there's a reasonable alternative?
posted by Stacey at 2:56 PM on December 15, 2013


The only way to find out if the Mirena is the culprit is to take it out and be hormone-free for awhile. I'm doing that right now, and it's a big relief. It's possible you're depressed and that an antidepressant might help but that doesn't mean the depression is causing all that crying etc. Like Stacey said you have to remove the variables.

Your psychiatrist may not be aware that birth control can cause these mental symptoms. Many doctors aren't, even GYNs. I don't know how you could diagnose Bipolar while someone was on taking these hormones. They can really mess you up.
posted by bleep at 3:21 PM on December 15, 2013 [1 favorite]


MORE ANECDATA:

BPII here, took +30 years to get the diagnosis (and it's working OK now). Hormonal BC was the pits; PMS was the pits; I'm happy about menopause. Most common symptom in bipolar is depression.

You're juggling several variables while your variable juggler is most impaired. +1 on Stacey: you may want a different mood stabilizer, while a different antidepressant could be dangerous. +1 on bleep: your psychiatrist needs to be fluent in all your issues -- is it depression or BP (a careful history can supply answers); what impact are the hormones having; is your thyroid working OK (one engine of long term depression).

Unless you feel you cannot maintain reproduction control with condoms + contraceptive foam/gel, I'd remove that element from the soup.

Best wishes!
posted by Jesse the K at 5:30 PM on December 15, 2013


I'm sorry you don't feel well. If this is your first period with Mirena, I'd be inclined to give it a longer shot. I've had mine for more than two years and my periods now are pretty light. My PMS symptoms aren't non-existent - I usually have a few days where I feel exhausted and at least onr day where I am unbelievably angry and suicidal depressed and have all of the feelings at once. But I used to have more days like that so YMMV.
posted by kat518 at 5:56 PM on December 15, 2013


Is there a reason you chose/your doctors pushed the Mirena over the Paragard copper-T? Birth control pills made me suicidally depressed, to the point that I refused to even consider a Mirena. I've had a Paragard for 6 years or so now and LOVE it. My depression is significantly improved, too.
posted by Lexica at 7:24 PM on December 15, 2013


Talk to your gynecologist and psychiatrist and come up with a plan to investigate this in an orderly way. They might want to try you on a different medication first, just because removing the IUD is a more invasive change and if it's not the culprit, it's more complicated and expensive to reverse.

However, if you really can't stand the idea of it being in there, then get it removed. It's worth it for the peace of mind.

If you like the idea of an IUD, consider switching to Paragard. I have a Paragard and really like it. Periods were definitely rougher for the first six months-year but it stabilized.
posted by elizeh at 8:01 PM on December 15, 2013


Okay. To be clear, you made a series of decisions to alter several factors near-simultaneously, and now would like to have an orderly and quick way to sort the whole thing out. Did you just.....quit the lamotrigine? I mean combined OCPs lower blood levels of Lamictal, but you do not just take yourself off anticonvulsants--even prescribed as mood stabilizers--without medical supervision. You can trigger seizures, even if you do not have epilepsy. It takes a while for your brain to recalibrate its seizure threshold.

If this is a correct understanding of events, the IUD seems to be a secondary concern (not that it should be dismissed or not dealt with, as everyone reacts differently to pharmaceuticals, only that your post describes one potentially life-threatening decision) except that depending on when you stopped Lamictal and had the IUD inserted, Mirena may have temporarily increased serum levels of lamotrigine, since you were no longer on the combined pill, thereby making the decision to stop lamotrigine unsupervised even riskier.

Please see a physician. Start with a psychiatrist--not because the Mirena may not be a part of this, but because you may be experiencing rebound psychiatric (not just neurologic--i.e., seizures as described above) effects from coming off lamotrigine. Then look into seeing your gynecologist. Please also consider talk therapy and mood charting. Not by memory--chart every day on that day.
posted by Uniformitarianism Now! at 8:21 AM on December 16, 2013 [2 favorites]


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