Wednesday, April 27, 2005

Thoughts on Medicated Depression

The problem with being somebody like me, who is very clear about what works regarding dealing with my "low" days or holiday freakouts, is that when I'm confronted with a serious depression that's actually caused by my reaction to a new birth control pill, I try to "treat" the medicated depression the same way I deal with my low days.... you know, eat right, exercise, try to figure out what it is that's really bothering you. Depression is a message, right?


Which is, of course, the big problem with depression. If you can't physically get up and get out of bed for anything but bare survival (and keep hitting your alarm every morning, when you've never, ever, not in the entire year you've had this 5:15am job, ever hit the alarm in the morning and skipped your weight routine), then it's very difficult to deal with "low" days the way you're used to. About all you can do is crawl into bed when you get home and maybe get some reading done.

Now that I'm back to myself again, I'm starting to realize just how bad it was getting. I figured out what the problem was when I started to burst into tears at weird moments, like on the bus, at work. Hysterical tears for no real reason.

The rest of the stuff - the low energy, the lack of willpower - I could tack up to sheer laziness, or the stress from traveling a month or so ago, or the stress of figuring out what I was doing next, or the stress from being so sick dealing with the *other* consequences of the bc pill. But the weepiness I remembered from when I was a teenager first getting hopped up on hormones.

The great thing about being older - and getting off the pill for six years and then on it again - is that it was pretty obvious to me what was wrong, and instead of trying to continue to pawn it off as just me being "hysterical" or freaked-out, I can call it for what it is: my body's reaction to synthetic hormones.

And my body reacted with a really freaky, really nasty depression.

It's a funny thing, because it's not like I lacked the will to do things, it's just that it felt like there was this gray gauze between my will to do things and the part of me that was actually consciously doing (or not-doing) things, and every day I'd get home and my will would tap-tap me about going jogging, about not eating those fries, about going to MA class, and it's like the conscious part of me just wasn't picking it up. Just wasn't reacting. Like there's something that kept those parts of my brain from actually talking to each other properly. I got pretty disconnected from everything else around me. It's like stuff was going on, and I was aware that time was passing, but I was having trouble really connecting with everything around me.

On Monday, I was taking my usual walk at the nature preserve, and I was like, "Wow! It's spring! When did that happen!" and I actually went around, like, touching trees and stuff. Everything was so bright and shiny.

It was fucking weird, to realize just how out of it I'd been.

Getting up in the morning this week, doing my regular weights routine, hasn't been like pulling teeth, even though I've been staying up talking to B until past 10pm, my usual oh-shit-I'm-going-feel-like-crap-tomorrow-if-I-don't-go-to-bed time.

I decided Monday that I'd start turning my nature preserve walk into a 40-minute power walk, and I'd bring an extra set of clothes into work (I'd jog it, but we still don't have a shower here in the office, so I compromised), and start on Tuesday.

And, suddenly, unlike all the other shit I've been trying to do the last couple months that's been so fucking hard, like ripping something out of myself so I don't feel even worse about myself, I went home, packed my clothes, and did the power walk yesterday, and will continue today, and wow, hey, all the sudden I can really *do* stuff again, without feeling like I'm pushing through a gray curtain!

What bugs me the most about this is that I'm such a stubborn bitch. If I hadn't experienced pretty much *all* of the side-effects related to this birth control pill (depression, nausea, breakthrough bleeding, yeast infection [FROM HELL], weight gain/increased appetite), I would have probably just let the depression thing go. I might have done the adoloscent thing and just been like, "Well, you know, I'm just feeling really low. I did a lot of traveling, I'm not happy with my job, I'm starting a new relationship, I'm not sure where I'll be living in a year, I don't know what to do, I haven't been writing anything, things are just really shitty right now."

And I might have just let it go, because, hey, it was "just" depression! I'd just deal with it the way I always had, and everything would be great! Right!?

Problem was, I could track it. I could say, "It's been about two months, actually, that I've felt this way."

And the connection was just so blaringly in-my-face obvious that I had to make the connection: I started the pill two months ago. I couldn't shrug that off.

And, to be honest, a low period lasting that long was really, really scary, cause there's always that fear that maybe it's *not* the pill, and you'll be stuck that way forever.

In any case, it was a great learning experience, not only for the future, but for the way I view my past. I remember starting the pill when I was 16 and bursting into tears at work one day (in front of my boss, no less), and thinking, "What the fuck is wrong with me?" and moving through a crappy relationship like some sort of zombie.

The pill has always worked for me: no pregnancy! Yay! But it's exacerbated my own occastional tendency to have low days, and it's turned low days into one long sweeping period of gray fog interspersed with that 7-day-no-pill breather period that's just long enough for you to think, "I'm being silly! There's nothing wrong with me!"

Problem was, being the stubborn bitch I am, I never connected the dots when I was younger. Three years of freakouts. Wow. And I didn't even question it. I just told myself I was a hysterical idiot freakshow, and that's just the way things were.


It's so great to be back in the world again.

Full of fucktards as it may be.....

16 comments so far. What are your thoughts?

Anonymous said...

Oh wow, I can't tell you how much I identify with that...

I just sent the whole thing to my boyfriend to try and help him understand what I was going through, I just came off the Depo-Provera injection a month ago, because I had this CRIPPLING feeling of worthlessness.

I don't know if it was depression but I'm pretty damn sure that's what it feels like, if it isn't, I don't wanna know.

Anyway, I came off it a month ago, and have been feeling better and better every day! I think the worst thing about the Depo shot is that if you don't like it, you can't take it out, you just have to wait. 3 months. And you don't get a break from it either!

I will never EVER go on synthetic hormones again, not if I can help it! 

Posted by Brooke Tohiariki

Anonymous said...

Oh, shit. Depo.

Yea. Yea. Eighty times yea. I've heard that's one of the ones with the strongest side-effects - one of the reasons I never tried it.

Many, many sympathies! Glad you're working with something else. A lot of it just comes down to individual reactions. We all respond differently, though in the case of Depo, I haven't heard of many women who it worked really well for. It's definately the one I heard the most complaints about, as far as side-effects (especially of the mood variety) go. 

Posted by Kameron Hurley

Anonymous said...

I hear you. I quit the pill after 2 months. Month 1, I was great, my skin was great, I was energetic. Month 2, I was constantly sleeping, my skin WENT TO HELL, and I was sleeping all the time. To the point that I gave up karate for a month (we met at 7:30 pm) because I was too tired by that time. I'm thinking about that Nuva Ring thing, but I just don't know. Maybe I should look into IUDs.


Don't want to be knocked up or in tears all the time 

Posted by Ismone

Anonymous said...

My sympaties. I tried the pill first when I was 18 (actually, I was 'strongly persuaded' - "here is a prescription for the Pill. You must take it." - after getting a Plan B when the condom ruptured, but that's another story) and was told that the only side-effect was a risk for weight gain.

Took it for a year, gained 10 kg, was constantly _very_ depressed and _very_ stupid. Finally, the relationship crashed due to my being depressed and I went off the Pill. And found that I wasn't stupid after all. Tried it again a year later, with the same effect, and dropped it after 2 months. I was later told by a friend that "my" brand was not prescribed any more, due to to many girls becoming suicidally depressed. Oh, joy.

Am now trying to convince my sister - who's been more-or-less depressed and eating anti-depressants since she went on the Pill three years ago.

Posted by Darjeeling

Anonymous said...

I think depression is one of the least talked-about side effects of hormonal birth control-along with sexual dysfunction. This piece just brought it home to me how much better able I am to handle my periodic depressive episodes than when I was on the pill all those years, and was low-level depressed all the time. Hurrah for the IUD! And hurrah for you, Kameron-thanks for telling your story. 

Posted by Equinox

Anonymous said...

Hey all.

A couple of things - Darjeeling, the idea did occur to me (and it's oh-so-frightening to me, actually) that a lot of women going in to get anti-depressents may not be being asked not just "when did your depression start?" but "are you on a form of hormonal birth control? When did you start using that?"

The amount of women who are taking a pill to feel better because they're taking a pill might be really, really startling. It's also made me think about asking at least one friend about her depression and pill use, and asking her if she's considered other options.

I think the depression isn't often talked about because it's one of those things that you can't actually get someone else to see or measure. Unlike the yeast infection, the breakthrough bleeding, there was nothing I could point to (ha), and say, "See, here, this isn't right."

It was all relative to me and how I felt before, vs. how I felt on the pill. And lord knows the medical establishment is really poor at figuring out the "feelings" issue. They have enough trouble gauging pain in order to prescribe pain medication. Trying to make a decision based on what a patient says they're "feeling" must be triply hard.

We're more likely to chalk it up as some sort of women's hysteria on our part, and not report it. It's also often difficult to differentiate between "normal" depression or "low days" and pill-induced depression: like I said, I kept trying to justify my inability to get my shit together.

And the way I phrase that is telling, also: there's a conception that depression is something that you can/should be able to "fight" through - even when it's caused by other drugs! Again: me eating right and exercising just wasn't going to "cure" me this time around. The only "cure" was to stop taking the pill that caused it.

What worries me is that I was taking a pill that's apparently pretty new to the market - Ortho Tricyclen Lo, and the reason the clinician started me out on that one was because it was the most popular pill of late: women kept coming in to ask for it. Why were they asking for it? Because they'd *seen the ads on TV.* It wasn't by hearing from other women about how great it was (which is when I first started to consider the IUD, when one of my friends praised it).

I've got my IUD appointment tomorrow, and I'll definately tell my clinician about the depression issue regarding that pill - if only to try and help spread the word that this may not be the best option for everyone, and also, hopefully, so they mention the potential side-effect to women as being a little more important than "Well, you might feel a little low." It's something you need to watch out for, not just shrug off as you being "overly emotional" or "hysterical" or whatever.

One of the reasons I really hesitated about talking about how I was feeling to my close friends was because I did feel so embarrassed about it. It was such typically "weak" behavior: I mean, bursting into tears at weird moments? Having no energy and sleeping a lot?

And, like I said, I'm just glad I'd been on the pill before, so I knew what to look for, and felt more freedom to stick my thumb on the problem, instead of just shrugging it off as "normal" freak-out "feminine" behavior.

And Equinox - whoa boy. Yea. I forgot to mention the sex drive thing! I'd expected to lose my usual desire spike around ovulation time, since I wouldn't be ovulating, but whoa boy, shit, do you have any idea how much more beautiful everybody is *every day*, once again?

I was starting to think there was something seriously wrong with me, trying to warm up in bed with a guy who I'm totally nuts about and who I was leaping on all the time because he's so damn sexy... and it turns out, once again, the problem wasn't me... it was the goddamn pill.

Oh, the boys are oh-so-beautiful again.

I swear, I saw somebody yesterday who looked just like Orlando Bloom in that new movie he's in (Kingdom of Heaven? You know, he has a beard now). Now that I'm dating B (who's either got a goatee or a beard, depending), guys with beards are way sexier.

Ahem. Anyway. Yea. It's nice to have my old sex drive back... 

Posted by Kameron Hurley

Anonymous said...

Ortho Tricyclen Lo? aw, hell. i just went off of that, due to breakthrough bleeding. i just started ortho tricyclen (regular), and it's been less than a week. but i will now watch it. the injury that this is adding insult to is that i'm getting divorced and am well and truly depressed about that, so it's hard to tell if i'm bursting into tears at random moments because of that or because of the hormones. 

Posted by betsy

Anonymous said...

Yes, Kameron, the idea that many girls/women may be on anti-depressants because they are on the pill has occurred to me, too.

Numbers may differ from country to country, but here in Sweden a lot of teen-aged girls seem to get on the Pill somewhere between 13 and 16 years of age (I've no statistics on this, regrettably, only found a small study 10 yrs old that said 20%, if one extrapolates it should be around 26% now).

Granted, not all of them may become depressed, but it seems to be a common enough side-effect, judging from some careful questioning of people I know well enough. (And loosing one's sex drive can be scary as hell and enough cause for depression on its own.)

But I think it is scarier that I became stupid, if that would be a common side-effect (if nothing else, one becomes more unintelligent/lazy from depression). People generally start going on the Pill at roughly the same time as they start higher education. You don't need girls to become much more 'stupid', just enough to shift the mean in the IQ distribution, and you still will have a very noticeable effect on the number of women in elite education - based on the assumption that elite education recruits people from the right tail end of the normal distribution of IQ. But that would be hard to quantify, it might just be my cynism speaking.

On another tangent, hormonally induced depression might not be due to the exact same mechanisms as 'usual' depression - after all, hormones have a profound effect on most of the brain - and then anti-depressants may not work in the same way. Now that is an even scarier thought: women eating anti-depressants due to the Pill, in vain, and spending years trying out one kind after another since they are not working...  

Posted by Darjeeling

Anonymous said...

Yeah, no wonder women don't get pregnant while they're on the pill, we become raving loony-bitches with no sex drive and dry vaginas! No one could even get close enough to impregnate us! I'm convinced the pill is an evil plot to keep women down. I mean really, do you think men would ever subject themselves to anything this sadistic so that we wouldn't have to "inconvenience" ourselves with something like condoms? 

Posted by Suzie

Anonymous said...

Real good discussion here folks. Kameron, you're right to report back to your PA the problems you've been experiencing, the FDA has a reporting mechanism here that is severely under utilized. If we want the drugs to get better everyone needs better feedback on the issues & concerns with the side effects. I'm glad you knew and suspected what was going wrong. You're right, most will be inclined to just chase the problem with more pills.

The reason why the pill is popular today is due mainly to it's 'safety', in that it's very unlikely to kill you. This distinguishes itself from most of the drugs out there [perhaps better than 70%], that may have severe life threatening side effects. The pills on the market today are some of the safest prescription medications we have. This said, ALL drugs have unpleasant and sometimes nasty side effects that should be more widely known and acknowledged. This is why it's always good to ask for and read that tiny print in the FDA required package insert.

The history of BC is a truly fascinating, (see, but suffice it to say that modern life would be all but impossible for women without it. Condoms, while certainly safe, are often not effective enough outside of a 'clinical context', with common failure rates around 10-15%. The IUD's of earlier times were monstrous and also unreliable and likely to injure. Diaphragms, plugs and pessaries all came without modern effective contraceptive jells or foams. It was a hit or miss proposition for earlier generations of women and 'traditional' forms of heavily stigmatized, almost never advertised 'heritage' BC.

The pill was the first real BC in thousands of years that was generally safe, very reliable, and almost 100% effective. It was and remains a small miracle of modern chemistry, despite the continuing problems of formulation, (which have been there from the start).

The ability to control one's reproduction to such a degree was impossible for women prior to 1963. It took nearly a century of court cases leading up to Griswold v. Conn, and some 60 years of path breaking medical research to achieve this victory for women. It's an accomplishment many would want to deny us still, but it's nothing to sneeze at.

Economists now tell us that higher education and full time careers would have been all but impossible to achieve for perhaps a majority of women without the easy availability of the pill to 2 generations of women. The fact that some 40 years on we still have a paucity of alternatives for BC other than the pill is one of the most damning failures of the present medical market place, other than all those who do w/o any care at all.

Of course the Docs are helpless in the face of advertising, everyone else is. It works too, they see an immediate spike in requests for the exact brand being advertised on the TV. (Hey it works on kids too around X-Mas, right?) This of course means that you should buy that SUV too, have the generic 2 blonde kids in the back with the frisky lab, and use that expensive national brand of toothpaste/detergent/lawncare/ 'cause, like everyone else is doing it.

If your BC or even BP meds do not fit you or your body chemistry, get something else. There might even be a pill that works for you, but that may take some time to find. And damnit, no one should have to suffer that much for sex. Not nowadays & Least of all not someone under the age of 50!

Again I'll note the great & useful search engine for drug interactions here from Public Citizen:
[] Good Luck! 

Posted by VJ

Anonymous said...

Hey, VJ, I think you're preaching to the choir :)

Well, at least in my case. Sex-education in the schools I've been to seemed to center on contraceptives history and not on the more useful things like current contraceptives. Or, you know, mutual respect and the other psychological parts. Ah, well.

And please do not take this the wrong way, but in my experience the "The Pill revolutionized the world for women!" pep-talk seems to be used quite a lot to imply that women complaining about the side effects of estrogens and other hormonal treatment are, in effect, ungrateful whiners. (Please note that I am not saying that _you_ are trying to imply that.Yours was a good post that I largely agree with.) To me, it says something about the world back then that women were willing to put up with all the side effects of the first generation of oral contraceptives. Just to not become pregnant.

Experience of me and my friends: young girls use the Pill beacause they do not have to have a big Discussion with their (often older, more self-assured and insistent) partner about using a condom ("But, honey, it feels so much better without it"). Not exactly my view of equality and empowerment. I think this was one of the big factors behind the popularity of the Pill. But, yes, also its relative safety was important.

On another note, you must be using some lousy condoms? Figure for failure rate that I've encountered are around 1%, compared to 0.1% for hormonal contraceptives. (Sorry, I cannot find the statistics on the web, it was in one of my biology books).

By the way, I was not that impressed by, in this case. They did not seem to have much, and what they had required a subscription to read. But there seems to be some other good information here (reprinted article from Journal of Gender Specific Medicine):

Most interesting:

"[...] found that oral contraceptives - particularly pills with a high progestin content - may induce depression. In fact, atypical depressive features are one of the most common reasons women stop taking birth control pills; up to 50% of women who discontinue oral contraceptives do so because of these side effects."

Ouch, 50%! And judging from my friends, and from this discussion, many who become depressed do _not_ quit. And a little about the probable mechanism:

"[...] Oral contraceptives enhance the kynurenine pathway in the liver and deter the serotonin pathway in the brain. A lower level of serotonin available in the brain is associated with depressive mood, suicidal symptoms, and impulsive behaviors. Oral contraceptives given with pyridoxine, or vitamin B6 (a competitive inhibitor of estrogen), can help mitigate some of the milder depressive symptoms."


Posted by Darjeeling

Anonymous said...

Thanks DJ, All good points. I've been recently disappointed in the site, and I've told them so. I've belonged to the consortium for well over 10 years now, and they used to have much better service, and for free. The stats. that I'm using are from Planned Parenthoold and the Alan Gutmacher Institute, the research arm of PP. Yes, Clinically the failure rate (the 'balloon break' test) is around 1-2% or under. In realistic situations where it is actually used, the best that they can consistently manage is about 5-10%. In short term partnerships or partners under 20, this begins to approach 15% however. It really depends on your experience and comfort level. Teens rarely manage that well, let alone long term partners. But as far as disease prevention is oncerned, they are consistently very relaible, again according to the CDC.

But yeah, the most frequent cause for going off the pill are the myriad and sometimes serious side effects. The fact that most women of reproductive age will eventually use the pill in some form makes the common experience of these problems fairly significant. Still this can be said to be true of most commonly used drugs. Mix your BP meds poorly and you don't wake up the next morn.

But really and truly, it WAS a damn revolution, and I only wish we had better options presently to compliment their use, or to use instead due to the many women who can not tolerate the side effects.  

Posted by VJ

Anonymous said...

I just started taking the Ortho Tricyclen Lo and can definitely feel the difference. I'm a lot snappier, pissier for no particular reason, inclined to wildly depressive mood swings. I was using the NuvaRing, which was great until the last three months, when my body decided it didn't want a hard plastic ring shoved up around my cervix and started cramping mid-cycle. Like, IUD-insertion pain level of cramping.

My fiance got a vasectomy a few weeks ago, as neither of us want children, so in another few weeks - by the time this round of pills is done - I'll never have to take one of the damned things again. Almost 20 years on BC pills, with very few breaks. I wonder what my body will feel like without regulated hormone doses screwing me up. Nobody ever told me that depression was a side effect. I just thought I'd been hating life since adolescence, but have refused to take anti-depression meds. I'm really pissed off about this, and that's not the pills talking. 

Posted by inkgrrl

Anonymous said...

Hey ink - yea. I was pretty pissed that nobody talked more about the depression. Again, I think we're encouraged to shrug it off as having to do with other shit, and don't bring it up.

When I told my clinician about my reaction to OTL, she wasn't surprised. Apparently, the depression is especially bad in the 3-hormone-cycling pills. I'm pissed that more women don't speak up. But, again, what's the alternative - rings and IUDs, which can have their own incredibly nasty sideeffects, especially if you're at a higher risk for STD infection. I'm holding out hope that this IUD works for me. I have no idea what I'll do if it doesn't: if the bleeding doesn't abate, if the pain twinges continue, etc. I just don't know.

That's awesome that you've got a partner who went the vasectomy route. Not a lot of guys will do it, but it sure as hell saves everybody a world of pain, agony, depression, and worry, if you don't want to have kids in the future.  

Posted by Kameron Hurley

Anonymous said...

Am I glad to have found your blog tonight, sitting here feeling the crippling guilt and loneliness after another hormone-filled bout of hurting myself and my husband followed by breaking down in floods of tears...why do so many women have to go through this pain month after month after month!! what hurts the most is the fact that we try and dismiss these desperate feelings as 'mood swings' as if it was so easy!! Just reading your writing makes me feel a little less alone so thank you 

Posted by Fiona

meghan said...

The only only only reason my doctor told me that my BC was likely causing my mood swings and depression was because I have a history of depression and mental illness in my family. The patch was really bad for moods swings, like clock work friday night would be spent in tears, the day after I had changed the patch. I switched to a lower dose pill but there was no relief, I started experiancing suicidal thoughts, so I quit all together. I HATE the way condoms chafe but better then pregnant and better then depressed and irritable.