TMS THERAPY
FDA-cleared, non-medication depression treatment
Theodora Blanchfield
Medically reviewed on 12/4/2020 by
Dr. Kimberly Cress
Texas Regional Medical Director
Sadness, irritability, tearfulness, anxiety—up to 80 percent of people experiencing menstrual periods are all too familiar with these common premenstrual syndrome (PMS) symptoms. While some people find that birth control pills provide relief from these symptoms, others feel worse—notably, experiencing increased depressive symptoms. Here's a look at what we know about the relationship between birth control and depression, and how to seek treatment if you're concerned that birth control is harming your emotional health.
In the luteal phase of a menstrual cycle—the time between ovulation and an individual's period—the hormone progesterone quickly rises. Progesterone is responsible for preparing the body for pregnancy. If no egg fertilizes, progesterone production decreases sharply in the days leading up to the period. This hormone affects the chemical balance of the systems that control serotonin levels in the body, leading to mood changes. Allopregnanolone (also known as ALLO) is a steroid that helps metabolize and regulate progesterone, and studies show that when it decreases dramatically, it can have the same depressive effects on the body as alcohol or benzodiazepines (anti-anxiety medications). A small subset of people—somewhere from two to six percent—may experience a condition called premenstrual dysphoric syndrome (PMDD), a severe form of PMS recognized by the DSM-V, a manual used by clinicians to diagnose and classify mental illness. Those already experiencing a primary depressive disorder may encounter a premenstrual episode as an exacerbation of existing depressive symptoms.
While hormonal birth control, which includes everything from oral contraceptives to intrauterine devices, was originally developed to prevent pregnancy, many have found that it provides some relief from PMS symptoms associated with hormone fluctuations. The oral contraceptive Yaz (drospirenone and ethinyl estradiol) has specifically been studied for its role in reducing PMDD symptoms. Your OB- GYN may also prescribe your birth control pills so you only have one menstrual cycle every three months, therefore eliminating PMS or PMDD to just four times a year.
Meanwhile, other studies show a link between birth control pills and depression leading to subsequent necessity of antidepressants. The research is currently inconclusive, as researchers haven't reached an across-the-board consensus on how hormonal birth control affects depression and manifestations can be unique for each individual. Whether depression is caused or exacerbated by birth control or something else, it is a real medical condition that requires treatment. Some symptoms associated with depression include sleep issues, weight changes, depressed mood, and fatigue. If your experience with these symptoms hinders your day-to-day life, you deserve to feel better, and there are myriad treatment options available for you. The most common first-line choices are usually talk therapy and/or a medication for depression. If you are using hormonal birth control, you will also want to talk to your health care provider about how it is impacting your mood. When starting or stopping birth control—or any medicine that may affect your mental health—it is important to keep a log of your moods.
There are also a variety of apps that can be used to help track your mood along with your cycles. That way, your doctor can help you find patterns in your symptoms that will help you collaborate to find the right treatment. The first medication you try might not work. That can be frustrating, but it is also common. One medication not working doesn't mean you will never find relief, though. It's possible you may benefit from switching to a different classification of antidepressant, such as from an SSRI (selective serotonin reuptake inhibitor) to an SNRI (serotonin-norepinephrine reuptake inhibitor) or exploring non-medication options. Keep in mind that one in three people don't see relief from their symptoms even after trying two medications.
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To find relief, you may want to look into Transcranial Magnetic Stimulation (TMS) treatments. TMS therapy involves magnetic pulses that gently stimulate the parts of the brain that regulate mood. Treatments are short, typically lasting about 20 minutes. Unlike with some other depression treatments, you will be able to drive home or back to work afterward. Further, TMS comes with minimal side effects. Antidepressant side effects are typically systemic (affecting your whole body), but any TMS side effects are mild, limited mainly to scalp discomfort, and typically dissipate within a few hours. You're far from alone if birth control is affecting your mood. Take steps now to find the treatment and relief you deserve.
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