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Birth Control and Depression

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Over the last couple of years birth control and it’s affect on mood, most commonly depression, has been in the news. Many are left wondering if birth control is safe for women. I’ve assessed a couple of studies, looking at various groups of women to get a better idea of what the research is saying. 

What is depression?

Like most conditions, a person must experience a certain number of symptoms to be diagnosed with a major depressive episode. 

 Five or more of the following symptoms must be present on most days for at least 2 weeks

  • Depressed mood*

  • Diminished interest or pleasure*

  • Significant weight loss or weight gain

  • Insomnia or hypersomnia

  • Psychomotor agitation or impairment

  • Fatigue or loss of energy

  • Feelings of worthlessness or excessive guilt

  • Decreased ability to think, concentrate, or ability to be decisive

  • Recurrent thoughts of death/suicide, or a suicide attempt

*One of these symptoms MUST be present

Select Populations & Birth Control

Adult Women 

A study conducted in Sweden (Zethraeus, 2017), looked at the effects of a combined pill (150 mg of levonorgestrel and 30 mg of ethinylestradiol) on general well being and depression in women aged 18-35. Compared to the placebo group, there was no difference in anxiety, depressed mood, general health. However, there WAS a significant reduction in in general well-being in women who used a levonorgestrel-containing OC, compared to women taking the placebo. 

Postpartum Women

A study by Horibe analyzed the connection between postpartum depression, drugs, and reported adverse events. They found that levonorgestrel was the top drug reported in connection with postpartum depression. This was followed by other progestins: etonogrestrol and drospirenone (further down in the list). The authors concluded that contraceptives or intrauterine devices with progestin might convey risk for postpartum depression.

With this in mind, I believe that postpartum women should be aware of the risk of depression with many of the pharmaceuticals they may taking during that first postpartum year. Moreover, it’s important to have these conversations with their doctors of what may happen, and what the next steps would be. Currently progestin-only contraception is considered first-line therapy for breastfeeding women. Estrogen-containing contraceptives are not started until breastfeeding is stopped as it may decrease milk supply. 

Adolescents

A groundbreaking study (looking at over a million women!) in 2016 by Skovlund, looked to investigate if hormonal contraception is associated with antidepressant use and a depression diagnosis. They ended up finding that adolescents (15 to 19 years) using hormonal contraception are more sensitive than older women (20 to 34 years old). when it came to getting a diagnosis of depression or using antidepressants. This effect was seen in both the combination pill as well as progestin-only pills (which was more predominant). The study also indicated that the incidence of depression and use of antidepressants decreased with age. 

For teens considering taking birth control, I would ask yourself why this might be. What is the outcome you are hoping to achieve? There are two conditions in which girls are given birth control as a treatment: endometriosis and acne (usually resulting from PCOS).

If you are experiencing heavy and painful periods (where you are unable on some days to go to school), talk to your medical doctor about endometriosis and if it’s a possibility. If you are experiencing acne, hair growth in places usually seen in males, and even irregular periods, talk to your doctor about PCOS as a possible explanation.  

Women with Bipolar Disorder and Depression

The study by Pagano aimed to look at the safety of contraception in women with depression and/or bipolar disorder. This was a meta analysis which looked at 6 studies that met their specific inclusion criteria. They found that oral contraception, levonorgestrel-releasing IUD and the depo shot, were not associated with worse clinical outcomes of depression or bipolar disorder in women who already had this condition. 

A couple things to note about this review: there was no 
standard definition or assessment of depressive and bipolar disorders or symptoms across studies, and the use of depression medication was unknown in three of the six studies. 

Final Thoughts on Birth Control and Depression

Overall, while there’s no clear cut answer on whether birth control causes depression – these studies still give you an idea of what the risk might be. Here are a couple of questions to think about if you’re considering taking birth control:

  • Why do you want to take birth control?

  • Are you considering birth control because of painful periods or ‘regulating’ your cycle?

  • Are you considering birth control because you want to prevent a pregnancy?

  • Are you willing to live with side effects (ie. a decreased quality of life)?

  • Are you an adolescent?

  • Have you given birth within the past year? 

While there isn’t a naturopathic alternative to birth control (I’m talking about supplements, not the fertility awareness method), it’s necessary to dive deeper into why you may be considering this option. This may also have you wondering what’s going on in your body and if you can help support it in other ways – perhaps with the assistance of Naturopathic Doctor as well!

References

Zethraeus N, Dreber A, Ranehill E et al. A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 2017;107(5):1238-1245. doi:10.1016/j.fertnstert.2017.02.120.

Horibe M, Hane Y, Abe J et al. Contraceptives as possible risk factors for postpartum depression: A retrospective study of the food and drug administration adverse event reporting system, 2004-2015. Nurs Open. 2018;5(2):131-138. doi:10.1002/nop2.121.

Pagano H, Zapata L, Berry-Bibee E, Nanda K, Curtis K. Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: a systematic review. Contraception. 2016;94(6):641-649. doi:10.1016/j.contraception.2016.06.012.

Worly B, Gur T, Schaffir J. The relationship between progestin hormonal contraception and depression: a systematic review. Contraception. 2018. doi:10.1016/j.contraception.2018.01.010.

Skovlund C, Mørch L, Kessing L, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154. doi:10.1001/jamapsychiatry.2016.2387.

Mom Squad with Lindsay Forsey (Tenth Moon Mothercare)

September 5, 2017
mom squad, tenth moon mothercare, naturopath toronto, toronto naturopath

A few months ago, I stumbled across Tenth Moon Mothercare on Instagram and fell down the rabbit hole. It’s a company that promotes self care for mom in the postpartum period and covers all aspects of discomforts after childbirth! While I don’t have a baby registry (nor a baby), when that time comes this package is going to be first on my list! Blend up a bulletproof coffee and learn why Lindsay of Tenth Moon Mothercare cares so much about your postpartum experience, and why you should too!

What inspired you to start this company?

Let’s face it: in most of Western culture, nearly all attention falls to preparing for and caring for our babies. A new mom’s wellbeing is so often overlooked, but the reality is that it’s absolutely essential to the wellbeing of her family, and her newborn. (That’s not just my opinion; there are studies that prove it.)  

Tenth Moon Mothercare is Canada’s first postnatal care package company. In different cultures around the world, there are beautiful traditions of mothering the mother and making sure that women are taken care of so that they’re best able to thrive and care for their newborn. I find this hugely inspiring and want to create a new tradition of care for moms in Canada.

My postpartum experience with my first baby was nothing like what I had imagined. I’d ended up having an emergency caesarean and found myself physical and emotionally depleted in a way I didn’t know was possible. Even though I was a doula, I was prepared for how challenging new motherhood would be. I had tons of support from my husband and my mum, and I remember thinking, “How would I possibly be surviving right now without this encouragement and care?” A few months later, the idea for Tenth Moon started to blossom. I started making small care packages for friends, and getting requests from friends of friends. Eventually I began connecting with suppliers and fine-tuning the details and I was seven months pregnant with my second baby with I officially launched Tenth Moon Mothercare.

The business is and always has been about maternal health and wellness, with a vision to change the way we think about postpartum care in Canada. The heart-warming feedback I get from women who receive Tenth Moon packages is an amazing source of inspiration for me now.

What was your favourite product to create?

I love all of the products in our packages, but when it comes to “creation” I’d say my favourite is our Yummy Mama granola. It’s addictively delicious. It’s packed with nutrient-dense organic oats, pumpkin and sunflower seeds, coconut and pecans, and toasted in maple syrup. Oats and pecans are considered galactagogues, or foods that help to promote a healthy breastmilk supply, so it’s perfect for nursing moms. But even if someone isn’t breastfeeding, for whatever reason, it’s a super nutritious, easy snack that’s yummy any time of the day or night. Our mamas love it.   

Which of your packages is the most popular?

Tenth Moon Essentials is our most popular. It includes our Herbal Sitz Bath, Lavender Mineral Soak, Organic Raspberry Leaf Tea, Yummy Mama Organic Granola, Organic Coconut Oil and Shoosha Rescue Nipple Balm. The Essentials are included in all of our bigger packages as well.

What’s the first thing you do every morning to start your day off right?

My day pretty much always starts with my youngest daughter crawling into our bed for snuggles around 6.30 a.m. Her big sis isn’t an early riser, but she and I have a morning cuddle, too, when she wakes up. We talk about our dreams, if we can remember them. Aside from that, I start the week with sunrise yoga at 6.30 a.m. every Monday.   

What’s your favourite self-care practice?

I try to keep it simple with self-care. For the past few months I’ve been listening to a yoga nidra mediation at bedtime. I love it, because it requires me to do nothing and helps me to fall asleep with a calm mind, rather than rethinking the zillion items on my to-do list.   

What’s the best advice you’ve ever received?

I’ve done a lot of travelling and spent a few years living abroad in different places. In my early twenties, when I was getting ready to leave on my first epic backpacking adventure, my mum gave me a card with this quote by Henry David Thoreau on it:

“Go confidently in the direction of your dreams. Live the life you’ve imagined.”

It meant so much to me to receive that from her at the time, and I’m still living my life that way. (Thanks, Mum!!)  

What’s your personal or professional motto?

No official motto, but I do love listening to the super quirky 80s one-hit-wonder Break My Stride by Matthew Wilder when I’m working, whether it’s a personal project or Tenth Moon Mothercare.  

Nobody’s gonna break my stride/

Nobody’s gonna slow me down/

Oh, no. I’ve got to keep on moving/

The video features dancers in sparkly green leotards, for extra inspiration. If you’ve ever heard this song before it’ll likely be stuck in your head for the rest of the day. I hope that’s a good thing! 

How can moms connect with you?

Website:  tenthmoonmothercare.com
Facebook:  tenthmoonmothercare
Instagram:  @tenthmoonmothercare

On your way out

Join Mom Squad’s Facebook Group AND sign up here to receive the official monthly Mom Squad newsletter!

Other #MomSquad members: Angelique Montano-Bresolin, Olivia Scobie, Beth Yarzab, Stephanie Kishimoto, Rhondda Smiley

Mom Squad with Rhondda Smiley (Doula and Yoga Instructor)

August 1, 2017
mom squad, rhondda smiley, smiley birth services, doula, yoga, breastfeeding, naturopath toronto, toronto naturopath

Meeting Rhondda blew my mind! I peppered her with question after question, because she’s just so knowledgeable about birth and catered her practice to truly helping mom in all aspects of her pregnancy. From prenatal yoga to supporting breastfeeding after birth, this woman does it all! Grab yourself a cup of tea and dig in – there are so many great pearls in this interview!

When can a woman begin prenatal yoga?

Whenever she feels like it. During the first trimester, she may choose to be conservative in her practice, watch her energy levels, and avoid twists, inversions, or jumps. Listen to what your body has to tell you. Yoga during pregnancy is a wonderful path to cultivate your own deep inner knowing of what’s right for you, your body, your baby and your pregnancy.

Does every yoga class have the same sequence, or do you modify it based on the yogis?

I don’t teach a set sequence. I like to change things up from class to class.

We do usually begin with some attention to the breath and a short mindfulness practice, to release tension and arrive to our practice. Then there’s a few minutes to check in with each other. Each person has an opportunity to share any news from the pregnancy or how they are feeling, whether they are working with any particular issues in their body and so on. Then I can tailor our practice to accommodate those individual needs.

Every class includes poses to bring the pelvis into healthy balance, movements that flow with the breath, standing postures that build the strength to power you through labour, and of course a yummy svasana or restorative pose to end on a relaxing note.

Is there one universal yoga pose that is beneficial for each trimester?

While there is never one-size-fits-all, a wide kneed child’s pose can be helpful to many during all stages of pregnancy. It helps to keep the pelvis open and relieves low back tension. It allows for a deep breath that moves through the belly, back and pelvic floor. It may encourage baby to move into an optimal position for labour. If it feels too crowded to bring your forehead down to the ground, you can support your upper body by resting on your forearms, a firm cushion or birth ball.

Why is a doula a great support to have during a birth?

There are soooo many reasons! But here are three that are key.

A hallmark of doula care is continuous support. As your doula I’m with you from early labour, through active labour and delivery, straight through until an hour or two after the birth, with no shift changes or extended breaks. I’m usually the only person on your care team who’s with you for the whole journey once labour starts, and that continuity can be just the reassurance you need.

My number one job is to do all that I can to ensure that the birthing person feels safe, nurtured and heard. The rest of your care team – your doctors and nurses or midwives –  have the physical health and safety of you and your baby as their primary role. Good clinical caregivers may also provide emotional support – but it’s not their first priority. When they are called to attend to your clinical needs, I will always be there to support your very real emotional needs. How you feel during your birth experience matters. The mind-body connection means that when you feel safe and at ease, you unleash a physiological response that allows your body to labour efficiently.

And then there’s this. A doula and a birth partner – whether it’s a spouse, parent or friend – make a match made in heaven. Your partner knows you, and I know birth! Partners – I’ll share with you my best tried and true comfort measures to keep her at ease, making you look like a rock star in her eyes! I could never replace you, and in fact do all I can to encourage connection between you. I also know you may be feeling overwhelmed and support you with information, experience, and breaks!

So many of my clients – and especially their partners – tell me after their birth, “I knew it would be great to have you there, but I had no idea how much you would offer me”.

What is a postpartum doula, and what does she do?

Think about a postpartum doula like having your BFF over – but one who knows ALL about babies! As a postpartum doula, I share experience, hands-on help, information and encouragement with parents of new babies. When I arrive to a postpartum visit, I look and listen to find out what is most needed in the household so that everyone can feel as nourished as possible in body, mind and spirit. I follow your lead and support your choices for what works best for your family without judgement.

What does that look like? An old hand who can tell you about normal newborn behaviour and development. Experienced support as you learn the ropes with breastfeeding. Warm arms to soothe your baby while you take a nap or shower. A friendly reminder to keep yourself fed and hydrated while bringing you a drink and nutritious snack. An extra pair of hands while you balance the needs of your new baby and your toddler. A companion who accompanies you to the pediatrician or midwife’s office, or runs a neighbourhood errand for you. An insider who knows all the best local resources. A compassionate ear who will help you process the tremendous changes you and your family are moving through.

Most expectant parents are so focused on the birth that they haven’t given much thought to how they are going to manage once baby is here. Parents who don’t have the support of near-by friends and family can benefit from booking a postpartum doula before the birth, as will any family that is feeling overwhelmed once baby has arrived. As a postpartum doula, I don’t take over the care of your baby. Rather, I share tools and impart confidence as you learn how to satisfy the unique needs of your baby.

Some doulas – yours truly included – even provide overnight support. This can be a lifesaver if you’ve got twins, your partner is away or sick, or just to help you get caught up on some much needed sleep!

What’s the first thing you do every morning to start your day off right?

Before I get out of bed, when I’m still lying there and thinking about what the day may hold, I try to consider how what I’m going to do may be of service to others. It’s so easy to wake up, map out the day, and think, “what do I have to look forward to today, what am I going to get out of it?” Instead I try to start the day by breaking that self-centred impulse and begin with the most positive motivation I can fire up.

What’s your favourite self-care practice?

Breathing. No, really!

The moments when I pause to take even just a few rounds of full, conscious breath make SUCH a difference. Even just ONE good breath can totally change how I’m feeling in my body, my feelings, my energy level, my state of mind, and how I am in my present situation.

Making time to spend a little longer exploring my breath is like a trip to the spa for my mind and body – delicious! And it’s always available! You don’t need to go anywhere, change your clothes, buy anything, get a partner, be in any particular position… It’s always available to us – right here, right now.

What is your favourite yoga pose?

I’d like to think that I’m like the mother of many children who is when asked, “which one is your favourite?”, replies “which ever one I’m with right now”. But I do really love to spend time in child’s pose.

How can moms connect with you?

Website: www.smileybirthservices.com
Facebook: www.facebook.com/smileybirthservices/
Instagram: smileybirth

Because I believe that the best way to get to know someone is face-to-face, I offer a complimentary in-person consultation for moms who’d like to find out more about how doula care can add value to their birth experience. I take the time to listen to what’s important to them, answer any questions about doula care and see if we’re a good fit, because in the end Mom’s comfort level is the first priority. Moms can connect with me at www.smileybirthservices.com to book a session.

On your way out

Join Mom Squad’s Facebook Group AND sign up here to receive the official monthly Mom Squad newsletter!

Other #MomSquad members: Angelique Montano-Bresolin, Olivia Scobie, Beth Yarzab, Stephanie Kishimoto