Oral contraceptives i.e. the birth control pill, cause low vitamin B6 and zinc, thereby reducing serotonin levels and can increase anxiety and depression in susceptible women.
Dr. Daniel Amen sees the association between the birth control pill and anxiety/depression in his practice and shared this when I interviewed him during season 3 of the Anxiety Summit.
Unfortunately, they drop serotonin levels. You’ve got to ask yourself why are 23 percent of women between the ages of 20 and 60 taking antidepressants? In large part, it’s the birth-control pills that are changing the hormones in their brain, the neurotransmitters in their brain. All of a sudden they’re more anxious and they’re more depressed.
Oral contraceptives lower serotonin due to various nutrient depletions and can also impact mood due effects on the progesterone/estrogen ratio.
Drug-induced nutrient depletions, especially vitamin B6
Many medications cause drug-induced nutrient depletions and oral contraceptives do this too. In this 2013 paper, Oral contraceptives and changes in nutritional requirements, the authors report:
It has been shown that the key nutrient depletions concern folic acid, vitamins B2, B6, B12, vitamin C and E and the minerals magnesium, selenium and zinc.
Zinc, magnesium, folate, vitamin C and vitamin B6 are all needed for the conversion of tryptophan to serotonin and can therefore impact both anxiety and depression, accentuating or precipitating the development of depression (and presumably anxiety too) in susceptible women.
The World Health Organization (WHO) report, Advances in Fertility Regulation, states that:
It has been shown that about 80% of women taking oral contraceptives have abnormal tryptophan metabolism suggestive of relative B6 deficiency.
Many of these same nutrients have a major impact on how women handle stress:
Magnesium and vitamin B6 may be effective in combination in reducing premenstrual stress, and vitamin B6 alone may reduce anxiety effectively in older women. High-dose sustained-release vitamin C may reduce anxiety and mitigate increased blood pressure in response to stress.
Zinc and copper imbalances occur very quickly
In this paper published in 1980, Serum copper and zinc in hormonal contraceptive users, it is reported that
Use of combined estrogen-progestogen contraceptives resulted in a significant decrease in serum zinc levels within 3 days and an increase in serum copper levels within 10 days.
In users of combined estrogen-progestogen contraceptives the magnitude and time of occurrence of the decrease in zinc levels and the increase in copper levels was unaltered by chemical composition, dosage, route of administration, and duration of use beyond 3 months.
We know zinc plays a role in the serotonergic system, reducing depression and anxiety.
Zinc and vitamin B6 are also key nutrients for alleviating symptoms of the social anxiety condition called pyroluria.
Lowered levels of endogenous estradiol and progesterone
Other mechanisms on how oral contraceptives lower serotonin relate to lowered levels of endogenous estradiol and progesterone (i.e. the estradiol and progesterone our bodies make), as well as out of balance progesterone/estrogen ratios leading to negative moods and emotional changes. The decreased prolactin response mentioned in this paper suggests reduced serotonergic activity.
High clinical relevance
The WHO report mentioned in the 2013 paper (mentioned above), states that this topic of nutrient depletions with oral contraceptives has high clinical relevance and should be receiving the attention it deserves.
Unfortunately, the nutrient-depletion with oral contraceptives conversation is not something many of my clients have ever had with their doctors, despite this being old news. The WHO report was published over 40 years ago, in 1975!
I’m particularly concerned about teens starting on birth control at such a young age and starting down this very slippery slope with no awareness of what they are getting into.
My recommendation is to NOT use oral contraceptives because of this increased risk in depression and anxiety. I write about this and FAM as an alternative here.
However, if you (or your daughter or grand-daughter or sister or friend) chooses to use oral contraceptives we need this awareness and you/they will very likely need to address these nutrient deficiencies.
This awareness is also needed if you are using oral contraceptives (or have used them in the recent past) and have found you’ve needed to continuing using tryptophan or 5-HTP long-term.
And finally, this awareness is needed if you know you have pyroluria and the pyroluria protocol doesn’t seem to be working for you.
Trudy,
HELP! This is me. I went on the pill Lo Ovral 28 as a young woman 20 and was on it for almost 10 years to avoid having 2 periods a month, or rather about 20 a year. And such PMS and cramps with it all. Now, I am a 56 year old woman with the foggiest thinking and so much anxiety and depression, I feel hardly functionable. I am seeing a ND, but just recently plunged into some kind of eating anxiety and I desperately need your help. I learned about you a couple of years ago from Sean’s Depression Session or one of those and have kept up on you and wish you were somewhere near me. I desperately need your help. I have been on Bio identicals and we thot they may be too high of ratios and so my ND is trying to cut me down, but it is horrid on me and my family. And, this may not even be the problem. Can you please help me? They say I have antibodies to making anti anxiety neurotransmitters and so what does that mean, even. Could you at least contact me back with some encouragement. I am so down and people need me. Thank you for all your help and research.
Meliss
I’m sorry to hear what you’ve been through. Unfortunately many young women are put on the pill because of period issues, PMS, cramps (and often to address acne too) instead of addressing the root cause.
I’d recommend discussing the amino acids GABA and tryptophan with you ND and considering a trial to help with the anxiety, depression and eating issues while you’re figuring all this out. You’ll find plenty of good information on this here on the blog and in my book “The Antianxiety Food Solution”. These actually start to balance the hormones. Of course, addressing low zinc and low vitamin B6 would be key too, assuming they are low.
I’d need to know more about this “antibodies to making anti anxiety neurotransmitters” before I can comment
Trudy,
This is what he wrote me exactly. but we know that your body has antibodies to the GDA (I
think this was a typo GAD )enzyme which inhibits your body from making GABA (anti-anxiety neurotransmitter).
Write now I’m on 300 then mg up 400 this week nightly of 5HTP and if that doesn’t work he was going to take me to tryptophan. I am also trying to come down off lorazepam on which I was way overscripted with a stretch out my hours in between and a homeopathic drop to help my brian and body deal with coming off it. He says something else needs to be producing GABA for me, not me just taking a GABA supplement. I would appreciate hearing from you again on this. I am really struggling, and of course coming down off hormones plus lorazepam is a double whammy to my older and frailer body. ALso, do you know of a way I can get out of this “fight or flight” that I am in? It is why I went on the LORazepam, but am on too much of that. I thank you for any and all help!
Is this true for HRT used in menopause? I use bio identical estradiol and progesterone, but wonder if the same info holds true as contraceptives,
Is this true for progesterone only pills as well
?
Hope
If it’s synthetic progesterone yes
I’ve been following you for a while. I love your blog.
I have a question. I came across Morley Robbins. Are you familiar with him? He says not to supplement with zinc and to take bioavailable copper. You say the opposite. What is your take on this?
Thank you!
Christine
I’m pretty new to bioavailable copper and it’s on my list to dig into as it appears to have some applications for certain individuals. As of now, I’m sticking with the zinc recommendation based on the benefits 1000s and 1000s of clients have experienced.
Can you please advise I went on the poisen that is Depo Provera for 2.5 years at my doctors advice saying there was no side effects to this injection. A yr after taking it I starting getting bad anxiety and depression and gastro problems ive turned into a wreck of who I used to be. My injection was due May 30th and I never got it ..it’s now three weeks past and I’ve never felt nausea like it it’s like my body has gone into a pregnancy mode…im fatigued, nauseas, struggling to eat anything, will this be a withdrawal from it?..do you know if there’s anything I can do to get my body into a normal routine again and help the nausea?. I really hope to hear from you.
Sarah
I don’t have much experience with Depo Provera but respect the work of Leslie Carol Botha – here is an article on her site https://holyhormones.com/recovering-from-depo-provera-withdrawal-symptoms-explained/ I’d recommend finding a functional medicine practitioner to work with in order to help with hormone balancing
I asked my trusted, open-minded woman OB/GYN about this and she was so confused and concerned about the misinformation. She said our bodies make these vitamins naturally and there is no need to supplement because it is impossible for them to be depleted and then went on to example how vitamins work in our body. She asked me where on Earth I heard this and I sited this article. And FYI, she doesn’t push pills or o.c. birth control.
Mollie
I would suggest sharing the article and have her read the references I’ve listed. An open-minded practitioner always has a curious mind and is willing to learn rather than say she is confused and concerned – the research will open her eyes. I would also share this book with her “Beyond the Pill” by Jolene Brighton. More here https://www.everywomanover29.com/blog/beyond-the-pill-by-dr-jolene-brighten-my-book-review/
Trudy,
Thank you so much for writing this. It has given me much clarity into my situation. I recently started taking oral contraceptives about two and a half months ago, and a few weeks into my first pack, I began to experience extreme anxiety and panic, followed by waves of depression and mental fog. This is a very strange and overwhelming change for my as I have struggled with some anxiety and depression in the past, but since adopting a healthier lifestyle have been free of those intense feelings for close to three years (until, again, now, with starting oral contraceptives). I am midway through my third pack and my symptoms have gotten drastically worse, to the point where I am stopping the pill now.
Do you have any insight on how/when my body will regulate itself back to its normal hormone levels? When I may begin feeling more like myself again?
Thank you,
Em
Emily
Good for you for making the connections. It can take awhile and the best is to be addressing any nutritional deficiencies that have been caused. I start my clients on tryptophan and GABA, vitamin B6 and zinc for quick relief. This is a great book for more insights “Beyond the Pill” https://www.everywomanover29.com/blog/beyond-the-pill-by-dr-jolene-brighten-my-book-review/