Depressed on birth control

[Jay27]

I know I’ve already complained about my pill a lot on here. But I’ve realized for the past couple months, I never really feel happy. I used to have bad mood swings during my period and the week before but feel pretty good the other two weeks of the month. Now I’m just always kind of sad. If 1 is the worst mood and 10 is the best, I only experience 3-5 most of the time but sometimes it goes lower. I don’t wanna quit the pill though because it’s reduced my cramps so much. Is there anything I can do? Do I just have to put up with being kinda sad forever so I can be pain free?

[Ellie]

Hi Jay27,

I'm so sorry that you're having that experience. I can relate, my birth control pills affected my mood in a big way. It sucks! You are still on the same progestin-only pill as before, correct? There are plenty of other forms of birth control you could try that reduce PMS symptoms like cramps. The ring and the patch can make periods lighter, more predictable, and less painful. You can also use them to safely skip your periods altogether. Hormonal IUDs, the implant, and the shot can also ease cramps and make periods lighter and shorter, but they’re a little less predictable - some people have more irregular periods while on these methods. Have you reached out to your doctor and reported your symptoms? They can help you explore your other options if you want to stop taking the pill to see if your mood improves.

[Jay27]

Yep I’m on the same pill since last August! I can’t use the ring or the patch because I have a high blood clot risk. If I got the IUD, I’d have to be under sedation because my obgyn couldn't even open the speculum all the way during my Pap smear because it was so uncomfortable. I have anxiety and I’d constantly be worried that it would perforate my uterus or fall out (which actually happened to my friend!) The only options I can see are the implant, the shot, or a different pill, but you can only use the shot for 2 years because of bone density issues. I plan to be on birth control until menopause and I’m only 21.

I’m just scared to change because what if this is the best it’s going to get? I can’t overstate how bad my cramps used to be. I used to take ibuprofen and use a heating pad and still not be able to get out of bed. Even my legs and feet would hurt really badly.

This month, I only had back pain for 2 days, and even without ibuprofen, I was able to go swimming and walk 5 miles. The pill that I tried before this barely did anything for my cramps. I just don’t wanna be in pain

[Sam W]

Hi Jay27,

It really does suck to feel like you're stuck with the choice of "deal with the horrible cramps" or "deal with the crummy side effects." Since it sounds like you've been communicating with your healthcare provider (I assume that's how you learned that the shot was not a great fit for you based on bone density concerns, but please correct me if I'm wrong), have you told them what you've noticed in terms of your mood? If so, how have those conversations gone?

[Jay27]

We had an appointment a few weeks ago but I was only able to talk to her for a few minutes. I have a follow up appointment in May. We just talked about the breakthrough bleeding and my iron levels. I’m bleeding a lot less and I started iron pills so she wants me to get my levels checked again. I also asked her to write an accommodations letter for my college so that took a bit of time. It would be really really hard for me to justify going off this pill just because I’m depressed because if my bleeding keeps getting more regular, I’ll have zero physical side effects.

[Sam W]

Got it. It does sound like you and she are trying to manage multiple elements of your health all at once, which for sure makes it harder to address everything at one appointment. Do you have any ability to do a telehealth appointment or a phone call with her? Those might allow you to get input on this much sooner.

Are there any other things going on in your life that you think might be contributing to this depression? Or does it really seem like starting the pill is when the depression started as well, and there aren't other factors that could be adding to or causing those feelings?

I do want to say that if you did decide that needed to go off this particular form of birth control because of mood side effects, that would be totally justified. Depression can be a really, really rough thing to deal with, and impact our lives as much, or even more than, some physical side effects can. And it really is frustrating to be stuck making the calculation of "is this side effect bad enough that I want to stop this medication or try a different one."

[Jay27]

There are definitely other things causing stress in my life. I also increased the dose of my antidepressant on this pill which didn’t do anything. I increased my anti anxiety med dose right before getting on the pill and it actually helped but as soon as I got on the pill, it basically stopped working. My psychiatrist said there’s no drug interaction that would affect how my body processes the meds. I have PMDD and I used to be really sad and moody but also able to experience joy. I feel less vibrant and less like myself. My mood is stable now, it’s just stabilized at mild depression all the time.

I’m just too anxious to change anything because the adjustment period sucks, and idk if any other pill will control the pain this well. Also mine is the only mini pill that’s anti androgenic. I have PCOS so I already have to shave my face and I used to get a lot of acne because of hyperandrogenism. I don’t want my doctor to tell me to stop taking it. What if I do and then I’m still depressed but also in a lot of pain?

[Sam W]

I totally get where that anxiety is coming from, and my hope would be that if you told your healthcare provider about your worries, their first reaction would be to try and come up with ways you could address the mood issues without losing the positive effects of being on the pill. But it's also 100% up to you to decide if and how to raise this concern with her.

With your psychiatrist, if they don't think the change in how you anxiety medication works is due to an interaction between it and your birth control pill, did they offer any alternative explanations for what might be happening, or things you could to try and boost the effectiveness of the anxiety medication?

[Jay27]

He thinks it’s a combination of stressful situations and the possibility that the hormones in the pill may be increasing my anxiety and depression on their own. I’ve maxed out the doses on all my psych meds. Idk if I should switch.

[Latha]

Hi Jay27,

When you mention switching, are you referring to your psych meds? If other medications could meet your needs, it might be a good idea. Do you think you could talk to your doctor about this?

Of course, the process of finding new medications isn't simple, and there is the adjustment period to consider... I'm sorry, it seems like all your options are difficult. You deserve to feel better, and you should be able to feel like yourself and experience joy. It might take a while to figure this out, but don't lose hope.

If you want, you could talk to us about those stressful situations.

[Jay27]

Yes, switching psych meds. It would be hard because I’ve already tried so many and got horrible side effects. My current meds are the ones I’ve been on for 3 years. I don’t have any side effects from them but I feel like they stopped working. Idk if there are options left.

[Amanda B]

Hey Jay27,

I'll echo Sam and Latha and say just how much it can suck to go through a medication-perfecting journey. At this point, I am not qualified to further recommend medication adjustments, and recommend continuing these conversations with your providers.

What would be most helpful at this point? Would you like tips for communicating with providers? Would you like to talk through the stressful situations you mentioned, to perhaps start to work through those? We're here to support in any way you see most helpful <3

[Jay27]

Yeah I think I’d like support in talking to providers. I also want support for my anxiety about the future. I wonder if I’ll always have to put up with a level of unhappiness to fix my pain

[Sam W]

Okay! With talking with providers, is there a specific conversation you feel like you struggle to have with them? Or is it more general things like figuring out how to advocate for yourself, ask questions, or even just be able to say "hey, I don't think this is working for me?"

As far as that anxiety about the future goes, I wish I could tell you that it will all sort itself out and you'll find the perfect combination of treatments. But that would be claiming to predict something that I just can't know. Too, for folks with overlapping health issues, especially ones that require ongoing management, it often is the reality that you end up with a solution that's imperfect. But an imperfect solution can still be an optimal one under the circumstances, one where you go through life with side effects or symptoms that feel manageable in a way they didn't before.

Another thing that may help ease your anxiety around all this is that people dealing with recurring or ongoing pain, or folks dealing with depression, still can have lives that are happy and fulfilling. That doesn't mean they're without complication or frustration from the things medication is managing, but sometimes I find reminding myself of this helps when I'm having moments of "oh my god it's going to be this bad FOREVER."

I will also say that with depression, medication is only one means people have of managing it. There are behavioral interventions, whether they're done in therapy, on our own, or in another space, that you might have the option to explore as well if medication continues not to be effective for you. Too, if your psychiatrist offered the theory that some of this is due to external, stressful situations, it might help to hold onto the idea that those situations will likely change or go away, and your mood might change as a result.

[Jay27]

I feel like there’s always a stressful situation. This past fall was just a combination of bad things: new job, long distance relationship, losing a 2 year long friendship, family problems (including being harassed by relatives over my politics and needing to block them),questioning multiple aspects of my identity, getting an iron deficiency. Besides my relationship not being long distance anymore and getting adjusted to my job, the other situations are ongoing. Especially my family problems. A bunch of my relationships (distant, but still) are over. I don’t think I’ll be severely depressed forever, but I’m worried there’s just gonna be a level of permanent sadness due to all my health issues. Even if I didn’t have depression, common side effects like acne and nausea would wreck my mental health.

I’m kind of sad that I have to do this, but I’m taking everything off my plate except for 3 college classes, my part time job, and the required events for my sorority. I wanted to do a leadership position but I decided not to apply. I’m trying to get back into therapy because I haven’t seen her in a while due to scheduling conflicts. My mom (who’s very toxic and also needs therapy but won’t accept it) doesn’t think I need therapy anymore but she’s clueless.

I don’t know how to talk to my providers because I feel like nothing works and I don’t want them to get tired of me and frustrated. My psychiatrist has been seeing me for almost 4 years and I’m just constantly going through something:

[Amanda B]

Hey Jay27,

I'll just say that from what I'm hearing, you are so capable of challenging things, including getting through this time. You without a doubt have a lot going on, including many changes. What I'm hearing is though, that you're noticing what's going on, you're paying attention to what is making you feel certain things, and you're taking action to find solutions. This is incredible! One of my favorite mantras is "trust yourself". While I'm sure it feels like you're really in the thick of it right now, you're also actively working towards bettering all of these conditions. And when life inevitably comes at you hard again, have trust in yourself that you'll act in ways that support your growth, as you're doing now.

As far as your providers go, it's their job to help you. Your psychiatrist likely knows you well at this point, and it sounds like the two of you can continue figuring out the best thing you need at this moment. How does all of this sound?

[Jay27]

I can do that. I’m seeing my psychiatrist in a few days. Hopefully he’ll find something but I’ve just kind of given up. I recently read about someone whose friends stopped inviting her on trips because her periods were irregular and they’d cause such bad pain that she couldn’t do anything. It reminded me how bad my pain used to be, and how I need to be grateful that I found a solution, even if that solution makes me sad all the time.

[Andy]

Fingers crossed the appointment is helpful!

I hear you on both the happiness that you found something that help as well as on the frustration that it’s likely contributing to other problems. Unfortunately, there often isn’t one perfect solution when it comes to chronic health issues and that means that sometimes there is still some level of discomfort left even when everything is done medically "right". But that said, there can be many shades of that compromise and I’d say that generally as we try different treatments and get to know our minds and bodies better, things get easier for a lot of people over time. There are many different approaches, both medical and non-medical, for treating pain and mental health issues, and I hope that your psychiatrist and other providers will help you explore them to find what works the best for you.