Psychiatric reactions to oral contraceptives
Kane, F.J.
American Journal of Obstetrics and Gynecology 102(7): 1053-1063
1968
ISSN/ISBN: 0002-9378 PMID: 5724394 DOI: 10.1016/0002-9378(68)90471-7Document Number: 471351
There are grounds to expect behavioral and emotional changes during use of oral contraceptives, in the known frequency of premenstrual, postpartum and menopausal psychoses. A review of 11 studies on the effect of the pill on psychiatric symptoms yielded a low but definite incidence of adverse reactions, notably depression and other mood and behavior changes, but generally an improvement, particularly for patients with premenstrual exacerbation of their psychosis. In case reports, 4 women have suffered psychotic episodes on withdrawal from the pill and 3 have become psychotic on starting oral contraception. The author interviewed and tested 50 women in one study: 28 reported adverse effects, usually depression, decreased libido, and decreased ability to cope with stress. Another interview study of 101 pill users and 90 pregnant controls produced 34% with depression, 29% with irritability, 23% with lethargy, 15% with decreased libido, 64% with adverse effects and 25% discontinued. 11% reported increased well-being in addition to reporting adverse symptoms, which the author interpreted as increased emotional lability. Other systems through which oral contraceptives may exert these effects include catecholamine metabolism, tryptophan metabolism, corticoid hormones, drug interactions, susceptibility of EEG to progesterones depressant effects, and unconsious and conscious attitudes of the patient.