Anti-Depressants with the birth control pill
Many women of reproductive age take a combined or progestogen-only oral contraceptive while also using a chronic medication such as Anti-Depressants (Anti-Depressants). The combination is generally fine at 10mg, 20mg, 40mg, 30mg, 60mg, but a small number of medications can reduce contraceptive efficacy meaningfully and need either a backup method or a switch.
How Anti-Depressants can affect contraceptive efficacy
Combined and progestogen-only contraceptives are metabolised through CYP3A4. Strong CYP3A4 inducers (some antiepileptics, rifampicin, St John's Wort) lower contraceptive plasma levels and reduce efficacy. Whether Amitriptyline, Bupropion, Citalopram, Duloxetine, Escitalopram, Fluoxetine, Mirtazapine, Paroxetine, Sertraline, Trazodone, Venlafaxine acts on CYP3A4 determines whether Anti-Depressants affects contraception. Most agents in Anti-Depressants have no clinically meaningful effect on the pill at 10mg, 20mg, 40mg, 30mg, 60mg.
Practical guidance
According to the prescribing information for Amitriptyline, Bupropion, Citalopram, Duloxetine, Escitalopram, Fluoxetine, Mirtazapine, Paroxetine, Sertraline, Trazodone, Venlafaxine, women on hormonal contraception should review Anti-Depressants with the prescribing pharmacist or doctor. Where an interaction is documented, additional barrier contraception or switching to a non-oral method (IUD, implant) for the duration of Anti-Depressants therapy is the standard mitigation.
Frequently asked questions
Will Anti-Depressants make my pill less effective? ▾
Most Anti-Depressants medications at 10mg, 20mg, 40mg, 30mg, 60mg do not affect oral contraceptive efficacy. The exceptions are CYP3A4-inducing drugs and a small number of others. The prescribing information for Amitriptyline, Bupropion, Citalopram, Duloxetine, Escitalopram, Fluoxetine, Mirtazapine, Paroxetine, Sertraline, Trazodone, Venlafaxine states whether the interaction is meaningful.
Do I need a backup contraceptive on Anti-Depressants? ▾
Backup contraception is needed only when there is a documented interaction between Anti-Depressants and the contraceptive method. For most users at 10mg, 20mg, 40mg, 30mg, 60mg, no backup is required. The pharmacist confirms whether Amitriptyline, Bupropion, Citalopram, Duloxetine, Escitalopram, Fluoxetine, Mirtazapine, Paroxetine, Sertraline, Trazodone, Venlafaxine interacts with hormonal contraception.
Medications in Anti-Depressants
More on Anti-Depressants
- With alcoholAnti-Depressants and alcohol — is it safe to drink?
- With foodShould Anti-Depressants be taken with food?
- Side effectsAnti-Depressants side effects: common, rare and warning signs
- For older adultsAnti-Depressants after 60: doses and safety in older adults
- For womenAnti-Depressants for women: indications and considerations
- For menAnti-Depressants for men: indications and considerations
The information on this website is provided for reference and educational purposes only. It does not replace consultation with a qualified healthcare professional.