Yes, The Pill Can Mess With Your Mood. Here's Exactly What To Do About It
"The first time it hit me was a few months after I started the pill," my 29-year-old patient Brittney told me during our initial consultation. "I woke up one morning and felt like a very dark cloud hovered over my head. I thought going off the pill would help, but that mood still lingers and hijacks my otherwise happy days."
Brittney isn't alone. According to the Centers for Disease Control and Prevention (CDC), about 30 percent of women go off the pill because they feel dissatisfied, foremost because of side effects like depression. And while Brittney’s doctor never addressed them when he prescribed the pill, once she noticed changes in her mood, she promptly found it listed as a side effect in the fine print.
Yes, there is a connection between the pill and depression.
As a doctor who helps women balance their hormones, I’ve had numerous patients confirm what studies show: Chief among the pill’s side effects is depression. One massive epidemiological study1 followed a total of 1,061,997 women between the ages of 15 and 34 for 13 years. Researchers found those who used the pill were more likely to be diagnosed with depression. In fact, women prescribed combination pills were 23 percent more likely to be prescribed antidepressants, and teens who used the combined pill were 80 percent more likely to develop depression. The progestin-only pill wasn’t much better, increasing teens’ risk for depression twofold. For the first time, this groundbreaking study showed a strong connection between birth control and depression in over a million women.
The results of depression and other birth control side effects can be devastating. One study2—this one followed nearly half a million women for about eight years—found that compared to those who never used hormonal contraceptives, current and recent users had a threefold increased risk for suicide. Sadly, adolescents had the highest relative risk here.
How to know if you're at risk for depression from the pill.
You have a higher risk for depression if you have a personal or family history of it, but it's important to remember that everyone who uses hormonal birth control becomes susceptible because the pill can increase inflammation3, which studies4 show contributes to depression. Brittney had no history of depression, but her lab work showed elevated inflammatory markers like C-reactive protein (CRP). That made sense to me, since the pill can deplete your body5 of certain nutrients that are important for your brain, thyroid, adrenal, and gut health—all of which can affect your mood.
Natural approaches to depression from the pill.
In naturopathic and functional medicine, we believe symptoms like depression are manifestations of underlying imbalances. We dig for the root cause of those symptoms and naturally restore balance, most of the time without drugs or other invasive procedures. More and more experts are advocating what I’ve recommended for years: Doctors should thoroughly screen patients and personalize counseling before they recommend hormonal contraceptives. Not all of us respond the same to hormones, and having individualized recommendations can dramatically reduce side effects like depression. Please note: Depression is often a multifaceted issue that often requires support from several health care professionals, including a functional medicine doctor (who can uncover the root cause of your issue) along with a mental health therapist.
Frustrated that her depression still lingered—even though she had been off the pill for three months—Brittney arrived in my office asking for an alternative to the antidepressants her doctor had prescribed. She didn't want to try another pill; she wanted to fix the root cause of her symptoms. For me, Brittney’s inflammation provided a huge clue as to why she often felt depressed, but that wasn’t the whole story, and during subsequent consultations, her labs revealed that other potential imbalances contributed to Brittney’s depression. During that initial consultation, though, Brittney needed fast relief. We used these nine strategies to alleviate her symptoms and improve her mood:
1. Ditch sugar (even from "healthy" sources).
Research shows that6 high sugar intake contributes to mood disorders like depression. Among other havoc, sugar spikes and then crashes your blood sugar—leaving you moody, lethargic, yet oddly craving more. Brittney’s sugar came from sneaky sources like agave-sweetened crackers and sugar-sweetened almond milk. We identified those problem foods and found smart replacements like no-sugar-added seed crackers and unsweetened almond milk.
2. Reduce inflammation.
Researchers found7 that the massive amounts of inflammatory omega-6 fatty acids, like soybeans and corn in our diets over the last 150 years can create or exacerbate many inflammatory-related diseases, including depressive disorders. To dial down inflammation, Brittney decreased her intake of omega-6s and increased her omega-3 healthy-fat sources, like wild-caught fish and freshly ground flaxseed. She also added tons of leafy greens and cruciferous veggies. For even more anti-inflammatory support, she added fresh ginger to her morning protein smoothie and sprinkled turmeric onto her veggies.
3. Address food sensitivities.
On the list of so-called healthy foods Brittney regularly ate were Greek yogurt and whole grain tortillas. Dairy and gluten are two food sensitivities that frequently contribute to gut problems, revving up inflammation and keeping your immune system in overdrive. I had Brittney do a three-week elimination diet that nixed these common offenders and helped heal her gut.
4. Support digestion.
Most of your immune system, which regulates inflammation and so much more, resides in your gut. Your gut also manufactures many mood-modulating neurotransmitters, including serotonin8. (In fact, up to 95 percent of serotonin gets made here.) Fixing your gut and providing the right nutrients can greatly help reduce symptoms like depression. For Brittney, that meant stepping up fermented foods like sauerkraut and kimchi as well as fiber-rich freshly ground flaxseed, which she put in her protein smoothie.
5. Supplement smartly.
Even the healthiest diet might not provide the optimal amount of nutrients. Along with a quality multivitamin, Brittney started taking a B-complex supplement to restore her B6 levels and anti-inflammatory nutrients like fish oil and curcumin. She also took a high-dose probiotic to repopulate her healthy gut bugs and a digestive enzyme to help her break down food so her body could absorb and use the nutrients.
6. Get moving.
Brittney already knew the invigorating feeling after a great workout, but she found going to the gym regularly a chore. I switched her over to high-intensity interval training (which she could do in 15 minutes) and twice-weekly yoga classes because exercise is that important. One meta-analysis that looked at exercise for depression strongly supported the idea that exercise can be an evidence-based treatment for depression.
7. Dial down stress.
Studies show that chronic stress can rev up inflammation9, and this contributes to mood disorders like depression. Yoga helped lower Brittney’s stress levels—so did walking her terrier, scheduling regular tea dates with her friends, and taking five minutes throughout the day to practice deep breathing.
8. Get better sleep.
Brittney found that just one night of bad sleep left her feeling more depressed the next day, and it wasn't all in her head. Researchers have found10 that about three-quarters of depressed patients have insomnia symptoms, and sleep disorders adversely affect mood disorders, creating a vicious cycle. While fitting in eight hours of high-quality, uninterrupted sleep initially felt like a challenge, once she understood how important sleep becomes for hormonal balance and so much more, Brittney did everything she could—including turning off electronics an hour before bed—to make it happen.
9. Heal your liver.
While I use a professionally designed detoxification plan with patients several times every year, I find doing this becomes especially crucial after women go off the pill. Nutrients like B vitamins and minerals support liver detoxification pathways, helping to rebalance hormones and steady your mood.
Brittney visited me several months later feeling far less depressed. She had been working with her counselor to deal with emotional issues, and subsequent consultations helped us pinpoint and eliminate other imbalances that contributed to her depression. Whether or not you’re on the pill, you never need to settle for depression. Speak with a naturopathic or functional medicine doctor to discuss non-hormonal alternatives for birth control and other medications. I even created a free post-birth-control syndrome detox diet to get you started!
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Jolene Brighten, N.D., is a women’s health expert currently working as the President and Chief Medical Officer at Rubus Health in Portland, Oregon. She received her Doctorate of Naturopathic Medicine at the National University of Natural Medicine and a bachelor’s in Nutrition Science from Cal Poly, San Luis Obispo. She is the best-selling author of Beyond the Pill, in which she shares her clinical protocols aimed at supporting women struggling with symptoms of hormone imbalance, including Post-Birth Control Pill Syndrome and birth control related side effects. Dr. Brighten has been featured in the New York Post, Cosmopolitan, Forbes, ABC News, and The Guardian.