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Going on birth control felt more like a rite of passage than a serious health decision. As a 15 year-old with cystic acne and a collection of padded bras, my motivations were chiefly superficial—I hoped it would clear up my skin and make me gain weight (and by extension, a figure). Aside from, “Will this make me grow a cup size?” I didn’t ask any questions.
Fourteen years later, I’m birth control-free for the first time since my sophomore year in high school. And in a way, I feel like I’m 15 again—my breakouts are teenage-level, my cramps are worse, and to my surprise, my anxiety is better. While I’m not rushing to wean off Lexapro anytime soon, that steady undercurrent of low-grade anxiety has dulled, and I can’t explain my relief.
As I reflect on my 14 mostly anxious years spent taking Sprintec, I wonder how much of my anxiety and slow plunge into depression was caused (or at least exacerbated) by this tiny pill. My 20s in particular marked my first panic attacks, therapy appointments, and antidepressant prescriptions.
While anxiety runs in my family and will likely always affect my life in some capacity, birth control or not, I find myself wondering if the pill worsened my mental health issues. My mind turns to the widely-circulated study from 2016 that found women on the pill were more likely to be diagnosed with depression and prescribed antidepressants. Was I a part of that group? And if the pill can worsen anxiety and depression, why wasn’t this mentioned to me in high school?
How The Pill Can Affect Anxiety and Depression
For some much-needed insight, I deferred to Dr. Jacques Moritz, MD, a New York City-based obstetrician-gynecologist and the medical director at Tia. “This is not in your head,” he said during our phone conversation. “Sex hormones affect your entire body, including your brain. There’s science behind the idea that the pill can affect your mental health; It’s not voodoo medicine.”
He explained the pill can actually blunt the effectiveness of certain neurotransmitters in the brain, including mood-boosting serotonin and relaxing GABA, a natural sedative that plays an important role in your body’s stress response. In turn, stress and anxiety may be heightened while reward processing is dampened, which can lead to depression over time.
While he does think that this important BC side effect will continue to garner attention in the field, that hasn’t always been the case. “I used to teach at Columbia and Cornell, and we never talked about the link between birth control and depression,” he notes. “Doctors need to take family history of mental health issues into account when prescribing the pill, and patients need to understand how the pill works before they put one of those tablets into their mouths." Simply telling a patient they won’t get pregnant is dangerously simplified.
The Many Benefits of Birth Control
Of course, the many positives of the birth control pill are not to be discounted. Not only did it spark the sexual revolution in the 1960s and afford anyone with a uterus so much of the autonomy and independence they enjoy today, it helps countless people deal with mind-numbing cramps and debilitating PMS symptoms. “If a patient has to leave school or work because of cramps or wants to delay their period for a special event, I have no other option for them than birth control,” adds Dr. Moritz.
It’s also worth mentioning many doctors aren’t convinced birth control is bad for your mental health. “Some studies show those on the pill have an increase in mood symptoms such as anxiety and depression, while others have an improvement in mood,” says Sara Twogood, MD, an obstetrician-gynecologist at Cedars Sinai hospital in Los Angeles. “Data does not universally support the idea that combined oral contraceptives affect mood, and it's hard to study these types of correlations since the research is not robust.”
Making Birth Control Work For You
Of course, the fact that there isn’t more research on such a ubiquitous medication used by millions of people around the world underscores a larger problem in our approach to sexual health for anyone with a uterus. But, you can take matters into your own hands when configuring your approach to birth control.
“If a patient is worried about side effects of the pill because of their own personal medical history or family history, there are alternatives to birth control pills that do not have hormones they may consider instead,” says Twogood. Low-dose birth control pills, copper IUDs, and vaginal rings are popular alternative options. Moritz adds that “you have to listen to your body, consider all the risks, and decide if the pill is right for you. If you’re prone to depression and sensitive to hormones, it may not be the best choice."