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Case of a Girl on Psychotropic Medications Seeking Birth Control

  • Jean Someshwar
  • Rollyn M. Ornstein

Abstract

For patients with mental health disorders treated with psychotropic medications, contraceptive management can be challenging for the primary care provider. Effectiveness of the combined oral contraceptive may decrease with concomitant use of certain psychotropic medications, although notably SSRIs do not have this interaction. Certain psychotropic medications may convey sexual side effects or hormonal effects such as elevated prolactin levels, elevated androgen levels, and decreased sex hormone-binding globulin, which may lead to clinical symptoms. The lack of effective contraception in patients on psychotropic medications may lead to teratogenic effects in the event of an unplanned pregnancy. Long-acting reversible contraceptives may be a preferred contraceptive method in these patients for improved rate of pregnancy prevention and the avoidance of pharmacologic interactions.

Keywords

Hormonal contraception Mental health disorders Psychopharmacology 

References

  1. 1.
    Murray CJ, et al. Disability-adjusted life years (DALYS) for 291 diseases and injuries in 21 regions, 1991-2010: a systematic analysis for the Global Burden of Disease study 2010. Lancet. 2012;380(9859):2197–223.CrossRefGoogle Scholar
  2. 2.
    Merikangas KR, et al. Epidemiology of mental disorders in children and adolescents. Dialogues Clin Neurosci. 2009;11(1):7–20.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Burcu M, et al. Atypical antipsychotic use among medicaid-insured children and adolescents: duration, safety, and monitoring implications. J Child Adolesc Psychopharmacol. 2014;24(3):112–9.CrossRefGoogle Scholar
  4. 4.
    Hall KS, et al. The risk of unintended pregnancy among young women with mental health symptoms. Soc Sci Med. 2014;90:62–71.CrossRefGoogle Scholar
  5. 5.
    Hall KS, et al. Role of young women’s depression and stress symptoms in their weekly use and nonuse of contraceptive methods. J Adolesc Health. 2013;53(2):241–8.CrossRefGoogle Scholar
  6. 6.
    Young EA, et al. Influences of hormone-based contraception on depressive symptoms in premenopausal women with major depression. Psychoneuroendocrinology. 2007;32:843–53.CrossRefGoogle Scholar
  7. 7.
    Keyes KM, et al. Association of hormonal contraceptive use with reduced levels of depressive symptoms: a national study of sexually active women in the United States. Am J Epidemiol. 2013;178(9):1378–88.CrossRefGoogle Scholar
  8. 8.
    Pagano HP, et al. Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: a systematic review. Contraception. 2016;94:641–9. doi:https://doi.org/10.1016/jcontraception.2016.06.012.
  9. 9.
    Curtis KM, et al. U.S. Medical Eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep. 2016;65(RR-3):1–104. doi:https://doi.org/10.15585/mmwr.rr6503a1.CrossRefPubMedGoogle Scholar
  10. 10.
    Herzog A, et al. Valproate and lamotrigine level variation with menstrual cycle phase and oral contraceptive use. Neurology. 2009;72(10):911–4.CrossRefGoogle Scholar
  11. 11.
    LaTorre D, Falorni A. Pharmalogical causes of hyperprolactinemia. Ther Clin Risk Manag. 2007;3(5):929–51.Google Scholar
  12. 12.
    Correll CU, Carlson HE. Endocrine and metabolic adverse effects of psychotropic medications in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2006;45:771–91.CrossRefGoogle Scholar
  13. 13.
    Rasgon NL, Altshuler LL, Fairbanks I, et al. Reproductive function and risk for PCOS in women treated for bipolar disorder. Bipolar Disord. 2005;7:246–59.CrossRefGoogle Scholar
  14. 14.
    Bishop JR, et al. The association of serotonin transporter genotypes and selective serotonin reuptake inhibitor (SSRI) associated sexual side effects: possible relationship to oral contraceptives. Hum Psychopharmacol. 2009;24(3). https://doi.org/https://doi.org/10.1002/hup 1006.CrossRefGoogle Scholar
  15. 15.
    Parker C, Coupland C, Hippisley-Cox J. Antipsychotic drugs and risk of venous thromboembolism: nested case-control study. BMJ. 2010;341:c4245.CrossRefGoogle Scholar
  16. 16.
    Zornberg GL, Jick H. Antipsychotic drug use and risk of first-time idiopathic venous thromboembolism: a case-control study. Lancet. 2000;356(9237):1219.CrossRefGoogle Scholar
  17. 17.
    Bergemann N, et al. Estrogen and comprehension of metaphoric speech in women suffering from schizophrenia: results of a double-blind, placebo-controlled trial. Schizophr Bull. 2008;34(6):1172–81.CrossRefGoogle Scholar
  18. 18.
    Hall KS, et al. Contraception and mental health: a commentary on the evidence and principles for practice. Am J Obstet Gynecol. 2015;212(6):740–6.CrossRefGoogle Scholar
  19. 19.
    Gotlib D, et al. Guideline adherence for mentally ill reproductive aged women with valproic acid: a retrospective chart review. J Clin Psychiatry. 2016;77(4):527–34.CrossRefGoogle Scholar
  20. 20.
    ACOG Practice Bulletin: clinical management guidelines for Obstetrician-Gynecologists. 2008;111(4):1001–20.Google Scholar
  21. 21.
    Finer LB, et al. Changes in use of contraceptive methods in the US, 2007-2009. Fertil Steril. 2012;98(4):893–7.CrossRefGoogle Scholar

Suggested Reading

  1. AACAP Practice Parameter for the use of psychotropic medication in children and adolescents. J Am Acad Child Adolesc Psychiatry 2006Google Scholar
  2. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists. 2008;111(4):1001–20.Google Scholar
  3. World Health Organization. Medical eligibility criteria for contraceptive use. 5th ed. Available at: http://www.who.int/reproductive-health/publications/mec. Accessed 8 June 2016.

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Adolescent and Young Adult MedicineChildren’s National Health System, George Washington UniversityWashington, DCUSA
  2. 2.Division of Adolescent Medicine and Eating DisordersPenn State Hershey Children’s HospitalHersheyUSA

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